Authors (including presenting author) :
Lee TST, Lau KYH, Li CH
Affiliation :
Department of Paediatrics & Adolescent Medicine, Tuen Mun Hospital
Introduction :
Infants with maternal exposure to illicit drugs are at risk of developing physical, mental and psychological complications. Collective literature on developmental neuroscience have revealed how early childhood biological and psychosocial experiences are important in shaping brain structure and function, and neurodevelopment. Parental drug abuse has been linked to ongoing behavioral problems, for example inattentiveness, impulsivity, problems with peers, attention deficit, or low school performance, when compared with non-exposed children. Children with drug abuse mothers are at higher risk of child abuse and neglect as well. Emerging data suggested that optimization of caregiving environmental factors could be protective to the neurodevelopment in children with substance abuse mothers. With appropriate intervention it could help to cater for future risk of neurodevelopmental or neuropsychiatric issues. In Hong Kong, the Comprehensive Child Development Service (CCDS) program was started in 2005, which has been providing early identification and intervention to at-risk children and families, namely mothers with psychiatric illness, mothers with drug or substance abuse or teenage mothers.
Objectives :
This is a retrospective review which looks at the neuropsychiatric outcome and environmental risk factors of infants with substance abuse mothers during pregnancy, so as to provide a better understanding on the severity of this issue in Hong Kong, in hope to exhibit more insight in how we could improve the existing services.
Methodology :
This retrospective single-centre cohort study recruited infants born in the New Territories West Cluster between January 2014 and June 2018 with maternal substance abuse and positive urine toxicology for illicit drug(s). Exclusion criteria were infants lost to follow-up before 36 months old, and preterm births (< 37 weeks of gestation). Case data were retrieved from the CCDS database within the Department of Paediatrics and the Chemical Pathology laboratory of Tuen Mun Hospital. Neurodevelopmental outcome was based on the assessment by a child psychiatrist or a physician from the Child Assessment Centre (CAC). We hope to identify predictive factors predisposing poor neuropsychiatric outcomes in these subjects. We analyzed the association of neurodevelopmental outcome with concurrent maternal mental illness and early out-of-home placement. We looked at the caregiving environment at first follow up before 1 year of age, and at the last follow up (3-years follow up), as well as the degree of social support received by mothers. Data was analyzed using the Microsoft Excel 2016 and IBM® SPSS® version 26. We correlated the neurological outcomes of the infants with the associated protective and risk factors that could incur in children and mothers with drug abuse. Pearson’s chi-square test or Fisher’s exact test (when one or more expected values are less than 5) was performed to identify the significant factors that could be associated with poorer neurodevelopmental outcome.
Result & Outcome :
A total of 63 infants were recruited. The commonest illicit drug detected in newborns with positive urine toxicology was methamphetamine (63.5%), followed by opioids (25.4%), ketamine (22.2%), cough mixture (12.7%) and cocaine (4.8%). They had low birth weights with the mean at 2.95kg. Twenty-four children (38.1%) were assessed to have abnormal neurodevelopmental conditions. Twenty-two cases (34.9%) have developmental delay. Nine (14.3%) were diagnosed with attention deficit hyperactivity disorder (ADHD). Risk factors associated with poorer neurological outcome included child placement outside of the biological home after 3-years follow up (odds ratio (OR)=12.667; 95% confidence level (CI)=3.684-43.555, P< 0.001) and before 1 year of age (OR=6.458; 95% CI=2.077-20.082, P< 0.001), and concurrent maternal mental illness (OR=3.875; 95% CI=1.270-11.823, P=0.015). Most of the children with abnormal neurodevelopmental outcome (95.8%) received training services.
