title: Methadone-exposed newborn infants: outcome after alterations to a service for mothers and infants.
abstract: OBJECTIVE
  To evaluate the impact of a shared care approach in clinical management with a drug liaison midwife (DLM) service for mothers and infants established in 1995-1996 in an inner city area and to address the problem of congenital abnormality and microcephaly with fetal drug exposure.
  
  
  METHODS
  Descriptive analysis of data in live births of women enrolled in a methadone maintenance programme in 1991-1994 (n = 78) and 1997-2001 (n = 98), including time spent in hospital, treatment for neonatal abstinence syndrome (NAS), admission to the neonatal medical unit (NMU) and follow-up for child health checks.
  
  
  RESULTS
  In 1997-2001 compared with 1991-1994, the mothers used more methadone in the last week of pregnancy (median 40.0 mg/day vs. 21.5 mg/day, P = 0.0006) and there were more preterm deliveries (36% vs. 21%, P = 0.03). The infants spent less time in hospital (median 5 days vs. 28 days, P < 0.0001), a smaller proportion had treatment for NAS (14% vs. 79%, P < 0.0001), and NMU admission was reduced (median 14 days vs. 26 days, P < 0.0003). Neonatal convulsions (P = 0.0001) and jaundice (P < 0.001) occurred less frequently, and more infants were breastfed (P = 0.001). One infant in each study group had a cleft palate and none had microcephaly. Child health checks for 18-24 months showed a favourable outcome in 1997-2001.
  
  
  CONCLUSIONS
  We altered antenatal care and modified neonatal management, subsequently infants spent less time in hospital and NMU admissions were reduced with less NAS treatment. Congenital abnormalities and microcephaly were not common and as regular child health checks were possible, the impact of the DLM service in shared management merits further investigation, for mother-infant bonding and developmental outcome.
authors.affiliation: University of Manchester, Division of Human Development and Reproductive Health Clinical Academic Group, St Mary's Hospital, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Miles
authors.forename: K
authors.initials: K
authors.lastname: Sugumar
authors.forename: F
authors.initials: F
authors.lastname: Macrory
authors.forename: D G
authors.initials: DG
authors.lastname: Sims
authors.forename: S W
authors.initials: SW
authors.lastname: D'Souza
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007224:Infant Care / Q000592:standards*; D007231:Infant, Newborn; D007400:Interprofessional Relations; D007902:Length of Stay; D008427:Maternal Health Services / Q000458:organization & administration*; D008691:Methadone / Q000009:adverse effects*; D008831:Microcephaly / Q000139:chemically induced / Q000453:epidemiology; D008880:Midwifery / Q000458:organization & administration*; D009294:Narcotics / Q000009:adverse effects*; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care / Q000458:organization & administration; D011247:Pregnancy; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced
chemical_list: D009294:Narcotics; D008691:Methadone