Observational study using video recordings to explore the first hour after admission to a neonatal intensive care unit.

AIM: To explore the admission process to our neonatal intensive care unit. METHODS: A first phase quality improvement initiative was conducted. We utilised observational video recording of a convenience sample of inborn admissions. Two remote GoPro cameras were placed, one giving an overview of activity and the other focussed on the infant. Recordings captured the first hour after admission including transfer to the neonatal intensive care unit by the birthing team. The video footage of each case study was reviewed by a multidisciplinary panel using an agreed semi-quantitative analysis of events. RESULTS: Ten admissions to the neonatal intensive care unit were video recorded between June and October 2018. Gestational age 282 -401 . A focus on maintaining airway support was inconsistent as was the ability to provide continuous monitoring of vital signs. Overall leadership of the process was lacking and handover often appeared fragmented. Median temperature on admission was 362 (354 -373 ) °C. Vascular access and fluid management occurred at a median of 36 (13-67) minutes. CONCLUSIONS: Planning and approval for this study were protracted, particularly negotiating the use of video recording. Anecdotally, this delay is thought to have contributed to an improvement in managing admissions, particularly when maintaining airway support and monitoring. However, our baseline data have highlighted a lack of leadership, fragmented handover, low admission temperatures and broad time frames to achieve vascular access. A guideline to streamline handover and nursery transition is currently being implemented; a subsequent evaluation cycle is planned.

Methamphetamine use in pregnancy, child protection, and removal of infants: Tertiary centre experience from Western Australia.

The aim of this study is to explore factors that determine infant removal by Child Protective Services and placement in out of home care, for methamphetamine-using women receiving pregnancy care with Western Australia Women and Newborn Drug and Alcohol Service. METHOD: A prospective cohort study of 112 methamphetamine-using women attending Women and Newborn Drug and Alcohol Service for pregnancy care from 2015 to 2018 was undertaken. Maternal methamphetamine use was assessed during each trimester of pregnancy using a standardised assessment tool. Drug use was by maternal self-report. Involvement of Western Australia's Department for Child Protection and Family Support and removal from maternal care were recorded. Infant development was formally assessed at 12 months with Griffiths Mental Development Scales. The comparison was made between three groups: those women who had no involvement with Child Protection, those for whom Child Protection was involved but the child remained in maternal care and those women who had their infants removed from their care. A comparison between Aboriginal and non-Aboriginal women was also undertaken. RESULTS: Of the 110 infants born to 112 women, 33 (30.3%) of infants were removed from maternal custody after delivery. Overall 60 (53.5%) of women had Child Protection involvement. Aboriginal women were overrepresented in our population 59 (52.7%) and 24 out of the 33 infants were Aboriginal were removed and placed into out of home care. Infants were removed from women with a high level of risk factors associated with MA use including those who were homeless, in prison, unemployed or continued high use of MA, mental health issues. Aboriginal infants were at increased risk of removal. Children removed from maternal care had a trend towards poorer developmental attainment at around 12 months compared to those who remained with their mother. Infants who were removed by the Child protection had lower general quotients (p = 0.132) than infants who had no involvement or some involvement. CONCLUSION: Infants removed from maternal care were more likely to be from women with high use, adverse social factors and born to mothers who identified as being Aboriginal. Resources are required that work intensively with families to reduce the number of infants being removed from maternal care to overcome the risks and challenges of addiction. IMPLICATIONS FOR PRACTICE: Resources that provide long term support and community-based models that offer a comprehensive range of maternal-child services and in-home-support would be more effective in keeping families together.

Developmental outcomes following prenatal exposure to methamphetamine: A Western Australian perspective.

AIM: To describe neurodevelopmental outcomes among a cohort of Western Australian infants exposed to maternal methamphetamine use during pregnancy and to determine whether the Ages and Stages Questionnaire is a reliable screening tool for this population. METHODS: Methamphetamine-using women were approached for participation when referred to the state-wide perinatal specialist drug and alcohol service for pregnancy care. Drug use during pregnancy was self-reported in each trimester using a standardised questionnaire. Ages and Stages Questionnaires were completed by infant care givers at 4 and 12 months, and development was formally assessed at 12 months using the Griffiths Mental Development Scales. Griffiths results for term-born infants in our cohort were compared to a Western Australian historical cohort of 443 healthy 1-2-year-olds. RESULTS: A total of 112 methamphetamine-using pregnant women participated in the study, who gave birth to 110 live-born infants. Ages and Stages Questionnaires were completed for 89 (81%) and 78 (71%) of the infants at 4 and 12 months, respectively. The Ages and Stages assessment identified 30 infants (33.7%) as having a potential developmental delay at 4 months and 29 infants (38.7%) as having a potential developmental delay at 12 months. Griffiths assessments were performed on 64 (58%) of the infants, with a mean general quotient of 92.7. This was significantly lower in term-born babies compared to the historical cohort (who had a median general quotient of 113.0). There was a weak correlation between 12-month Ages and Stages scores and Griffiths general quotients (r = 0.322) and no correlation between 4-month Ages and Stages Questionnaire scores and later Griffiths results. CONCLUSIONS: Infants born to women reporting methamphetamine use during pregnancy are at increased risk of developmental delay and may warrant enhanced developmental follow-up. However, they are a challenging group to follow due to complex psychosocial factors. Ages and Stages Questionnaires at 4 and 12 months were not helpful in screening for infants who had a developmental delay at 12 months.