[Developmental outcome of 5-year-old children born to opiate-dependent mothers: effects of a multidisciplinary intervention during pregnancy]. / Devenir à 5 ans des enfants de mères dépendantes aux opiacés : effets d'un suivi multidisciplinaire pendant la grossesse.

BACKGROUND: Studies on infant outcomes of opiate-dependent pregnant women find a high rate of premature mother-child separation and to a lesser extent developmental delay. The specific role of in utero heroin exposure in the determination of the developmental outcome seems to be less important than the home environment. OBJECTIVE: Describe the health and development of 5-year-old children whose drug-addict mothers allowed an early multidisciplinary intervention (medical and psychological) in the maternity hospital and neonatology. PATIENTS AND METHODS: Thirty-seven children (62% of the initial cohort) were seen in consultation with their parents. Growth and development was compared with a control group of 374 children of the same age. Comparisons were made between the children's and parents' state (social, medical, drug addiction, etc.) upon discharge from the maternity hospital and 5 years later. A study was conducted on those lost to follow-up. RESULTS: The rate of placement in 5 years was very low (13%). Seven children showed a developmental delay, 21 no disorder, and nine some problems. Anxiety (37%) and overweight (48%) were the only disorders differentiating them from the control group. Compliance with the care provided in the maternity hospital was the only item significantly related to the development of the 5-year-old children (P=0.05). DISCUSSION: The hypothesis of an attachment disorder in those with the greatest need is raised. The likely relations between the quality of the care in the maternity hospital, mother-child relations, and the attrition of the cohort are also discussed. CONCLUSION: Management of the symptoms as well as social and psychological care during pregnancy and neonatal hospitalization for opiate-dependent pregnant women facilitates a long-lasting relation with childhood professionals, avoids court-ordered placements, and reduces the appearance of developmental disorders in these children.

Comparison of chlorpromazine versus morphine hydrochloride for treatment of neonatal abstinence syndrome.

AIM: To compare the duration of treatment for neonatal abstinence syndrome (NAS) using chlorpromazine versus morphine hydrochloride. METHODS: We compared two case series of term infants with NAS treated with either morphine hydrochloride (MH) or chlorpromazine (CP). Seventeen infants were treated with MH from 1998 to 1999, and 20 infants were managed with CP from 2000 to 2001. The duration of treatment was compared, and multivariate analysis was used to identify independent risk factors related to the duration of treatment. RESULTS: Characteristics of the mothers (duration of drug addiction, abuse of other substances) and infants (birth weight, proportion breastfed) were similar in the two groups. The mean duration of CP treatment was 6 days (range 3.5-9 days), significantly fewer days than with MH treatment, which was 16 days (range 10-21 days; p < 0.001). There were fewer hospitalization days (11 days; range 9-14 days) for CP treatment compared with MH-treated infants (18 days; range 16-25 days). Treatment with CP was independently associated with shorter hospitalization time. CONCLUSION: CP appears to shorten the duration of NAS compared with MH. Larger prospective randomized trials are needed to confirm our findings.

[Development of widely available reference frames of pediatrics in maternity in the Languedoc-Roussillon region]. / Elaboration et mise à disposition de référentiels de pédiatrie en maternité: expérience de la région Languedoc-Roussillon.

UNLABELLED: In France the organization of the care in perinatality is governed by the decrees of October 1998 and was specified by the "plan périnatalité" 2005-2007. This organization allowed an operation in network, declined in a variable way according to areas. In this context, the group of the paediatricians in Languedoc-Roussillon took concrete action of harmonization of the reference frames of care of paediatrics in maternity. METHODS: The methodology installation since 2001 lies on the active participation of many paediatricians of the Languedoc-Roussillon region, pledge of an appropriation of these reference frames by the professionals. It relies upon a rigorous process of drafting and validation, and on the use of the data processing tool for the drafting and the diffusion via Internet of these reference frames. RESULTS: In June 2006, 60 reference frames were placed at the disposal of the professionals who intervened with the children in maternity (paediatricians, midwifes, nursery nurses). The paediatricians taking part in the drafting of these regional reference frames accounted for 43% of the paediatricians exerting in maternity of Languedoc-Roussillon. The majority (77%) of the establishments of birth of the area were represented, whatever the level (1, 2 or 3). CONCLUSION: We showed that paediatricians could organize themselves to write a great number of reference frames contributing to the improvement of the quality of the care, and harmonization of the practices within the perinatal network.