The effect of maternal drug use on the neonate. N. Ambalavanan MD, FAAP Neonatologist. Purpose of this presentation. To help you understand the prevalence and risks of drug use in pregnancy To help you identify the infants at higher risk of drug exposure in fetal and neonatal life
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N. Ambalavanan MD, FAAP
1970’s: 20% -->1990’s: 50%
At least one feature from each of three categories:
1. Prenatal and postnatal retardation - with small-for-age weight, length, and/or head circumference.
2. CNS disorders with signs of abnormal brain functioning, delays in behavioral development, and/or intellectual impairment.
3. At least two of the following:
abnormal craniofacial features - small head, small eyes or short eye openings, or a poorly developed philtrum (the grove above the upper lip), thin upper lip, short nose, or flattened mid facial area.
Fetal Alcohol Effects
Alcohol exposed babies that do not meet all these criteria for FAS.
(42% white, 33% black)
(4% white, 2.7% black)
This 90% reduction suggestive of awareness of danger
Use of multivitamins up to RDA is recommended. Mega-doses may cause problems and should be avoided.
(Am J Obstet Gynecol 1991; 165:924-7. n=5010, of which 2970 pregnant)
A) Mothers have a history of any one of:
1) H/o of drug abuse in present or past pregnancy
2) Limited prenatal care (<5 visits in term infants or onset of PNC at >18 wks GA in preterm infants)
3) H/o of Hepatitis B, HIV, Syphilis, Gonorrhea
4) H/o prostitution
5) Unexplained placental abruption / premature labor
B) Infants who exhibit any one of the following:
1) Unexplained neurological complications (e.g. intracranial hemorrhage/infarction, seizures)
2) Evidence of possible drug withdrawal ( e.g. hypertonia, irritability, trembling, muscle rigidity, constipation or diarrhea)
3) Unexplained IUGR
( modified from Wagner et al: The impact of prenatal drug exposure on the neonate: Obstet & Gynecol Clin North Am 25 (1):169-194, 1998)