Neurodevelopmental outcome after prenatal exposure to opiates Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Neonatal neurobehavior effects following buprenorphine versus methadone exposure. Peripartum pain management in opioid dependent women. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18months in preterm infants Development after prenatal exposure to cocaine, heroin and methadone Characteristics of Opioid-Using Pregnant Women Who Accept or Refuse Participation in a Clinical Trial: Screening Results from the MOTHER Study Neurodevelopmental outcome following exposure to sedative and analgesic drugs for complex cardiac surgery in infancy. Lessons learned from a comparison of evidence-based research in pregnant opioid-dependent women. Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenophine substitution. Comparison of methadone and slow-release morphine maintenance in pregnant addicts. The Effect of Integrating Substance Abuse Treatment With Prenatal Care on Birth Outcome Buprenorphine in pregnant opioid-dependent women: first results of a prospective study. Ongoing Maternal Drug Use, Parenting Attitudes, and a Home Intervention: Effects on Mother-Child Interaction at 18 Months Risk factors for disruption in primary caregiving among infants of substance abusing women. Early Intervention with Portuguese Mothers: A 2‐Year Follow‐up
Abstract To study the developmental effects of prenatal exposure to opiates , a prospect i ve follow up study of 34 drug-exposed ( opiates and nicotine ) and 42 reference infants ( nicotine exposure only ) was conducted from January 1992 to September 1995 . At the time of delivery , 12 of 34 mothers used opiates without medical control . Twenty-two mothers participated in a methadone maintenance programme .  At 1 year , the average Griffiths Developmental Quotient ( DQ ) was lower in the drug-exposed group ( mean : 100.5 vs. references 107.9 ; P < 0.001 ) . This difference was mainly due to lower subscales “ locomotor ” ( mean 100.8 vs. 111.4 ; P < 0.05 ) and “ intellectual performance ” ( mean 100.8 vs. 108.5 ; P < 0.05 ) in the drug-exposed group . Severe developmental retardation mean DQ ( −2 SD ) was diagnosed in 2 drug-exposed infants . Mild developmental retardation ( mean DQ : 1 SD– > 2 SD ) was found in 7 drug-exposed and in 3 reference infants ( P < 0.05 ) . Neurological abnormalities were found more frequently in the drug-exposed group ( 11 vs. 3 infants ; P < 0.01 ) . Among the opiate-exposed infants , the subscales “ hearing and speech ” and “ intellectual performance ” were lower in the uncontrolled drug-using than in the methadone group . The 17 fostered infants showed no difference in developmental outcome compared with the 10 infants living with their biological parents ( mean DQ : 100.0 versus 101.3 ) . Conclusions At 1 year infants prenatally exposed to opiates are at risk for mild psychomotor developmental impairment Background Methamphetamine ( MA ) use during pregnancy is associated with many pregnancy complications , including preterm birth , small for gestational age , preeclampsia , and abruption . Hawaii has lead the nation in MA use for many years , yet prior to 2007 , did not have a comprehensive plan to care for pregnant substance-using women . In 2006 , the Hawaii State Legislature funded a pilot perinatal addiction clinic . The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model , encompassing perinatal care , transportation , child-care , social services , family planning , motivational incentives , and addiction medicine . We present the implementation model and results from our first one hundred three infants ( 103 ) seen over 3 years of operation of the program . Methods Referrals came from community health centers , hospitals , addiction treatment facilities , private physician offices ,  homeless outreach services and self-referral through word-of-mouth and bus ads . Data to describe sample characteristics and outcome was obtained prospect ively and retrospectively from chart abstract ion and delivery data . Drug use data was obtained from the women 's self-report and r and om urine toxicology during the pregnancy , as well as urine toxicology at the time of birth on mothers , and urine and meconium toxicology on the infants . Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale . Data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame , who were enrolled in another study of pregnancy outcomes . Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies . Results Between April 2007 and August 2010 , 213 women with a past or present history of addiction were seen , 132 were pregnant and 97 delivered during that time . 103 live-born infants were delivered . There were 3 first-trimester Spontaneous Abortions , two 28-week intrauterine fetal deaths , and two sets of twins and 4 repeat pregnancies . Over 50 % of the women had lost custody of previous children due to substance use . The majority of women who delivered used methamphetamine  ( 86 % ) , either in the year before pregnancy or during pregnancy . Other drugs include marijuana ( 59.8 % ) , cocaine ( 33 % ) , opiates ( 9.6 % ) , and alcohol ( 15.2 % ) . Of the women served , 85 % smoked cigarettes upon enrollment . Of the 97 women delivered during this period , all but 4 ( 96 % ) had negative urine toxicology at the time of delivery . Of the 103 infants , 13 ( 12.6 % ) were born preterm , equal to the state and national average , despite having many risk factors for prematurity , including poverty , poor diet , smoking and polysubstance use . Overwhelmingly , the women are parenting their children , > 90 % retained custody at 8 weeks . Long-term follow-up showed that women who maintained custody chose  long-acting contraceptive methods ;  while those who lost custody had a very high ( > 50 % ) repeat pregnancy rate at 9 months post delivery . Conclusion Methamphetamine use during pregnancy does n't exist is isolation . It is often combined with a multitude of other adverse circumstances , including poverty , interpersonal violence , psychiatric comorbidity , polysubstance use , nutritional deficiencies , inadequate health care and stressful life experiences . A comprehensive harm reduction model of perinatal care , which aims to ameliorate some of these difficulties for substance-using women without m and ating abstinence , provides exceptional birth outcomes and can be implemented with limited re sources Neonates born to opioid-maintained mothers are at risk of developing  neonatal abstinence syndrome ( NAS ) , which often requires pharmacological treatment . This study examined the effect of opioid maintenance treatment on the incidence and timing of NAS , and compared two different NAS treatments ( phenobarbital versus morphine hydrochloride ) . Fifty-three neonates born to opioid-maintained mothers were included in this study . The mothers received methadone ( n=22 ) , slow-release oral morphine ( n=17 ) or buprenorphine ( n=14 ) throughout pregnancy . Irrespective of maintenance treatment , all neonates showed APGAR scores comparable to infants of non-opioid dependent mothers . No difference was found between the three maintenance groups regarding neonatal weight , length or head circumference . Sixty percent ( n=32 ) of neonates required treatment for NAS [ 68 % in the methadone-maintained group ( n=15 ) , 82 % in the morphine-maintained group ( n=14 ) , and 21 % in the buprenorphine-maintained group ( n=3 ) ] . The mean duration from birth to requirement of NAS treatment was 33 h for the morphine-maintained group , 34 h for the buprenorphine-maintained group and 58 h for the methadone-maintained group . In neonates requiring NAS treatment , those receiving morphine required a significantly shorter mean duration of treatment ( 9.9 days ) versus those treated with phenobarbital ( 17.7 days ) . Results suggest that morphine hydrochloride is preferable for neonates suffering NAS due to opioid withdrawal AIM To determine the effects of in utero exposure to methadone or buprenorphine on infant neurobehavior . DESIGN Three sites from the Maternal Opioid Treatment : Human Experimental Research ( MOTHER ) study , a double-blind , double-dummy , r and omized clinical trial participated in this sub study . SETTING Medical Centers that provided comprehensive maternal care to opioid-dependent pregnant women in Baltimore , MD , Providence , RI and Vienna , Austria . PARTICIPANTS Thirty-nine full-term infants . MEASUREMENTS The Neonatal Intensive Care Unit ( NICU ) Network Neurobehavioral Scale ( NNNS ) was administered to a subgroup of infants on postpartum days 3 , 5 , 7 , 10 , 14 - 15 and 28 - 30 . FINDINGS While neurobehavior improved for both medication conditions over time , infants exposed in utero to buprenorphine exhibited fewer stress-abstinence signs ( P < 0.001 ) , were less excitable ( P < 0.001 ) and less over-aroused ( P < 0.01 ) , exhibited less hypertonia ( P < 0.007 ) , had better self-regulation ( P < 0.04 ) and required less h and ling ( P < 0.001 ) to maintain a quiet alert state relative to in utero methadone-exposed infants . Infants who were older when they began morphine treatment for withdrawal had higher self-regulation scores ( P < 0.01 ) , and demonstrated the least amount of excitability ( P < 0.02 ) and hypertonia ( P < 0.02 ) on average . Quality of movement was correlated negatively with peak NAS score ( P < 0.01 ) , number of days treated with morphine for NAS ( P < 0.01 ) and total amount of morphine received ( P < 0.03 ) . Excitability scores were related positively to total morphine dose ( P < 0.03 ) . CONCLUSION While neurobehavior improves during the first month of postnatal life for in utero agonist medication-exposed neonates , buprenorphine exposure results in superior neurobehavioral scores and less severe withdrawal than does methadone exposure Increased pain sensitivity and the development of opioid tolerance complicate the treatment of pain experiencedby opioid maintained pregnantwomenduring delivery and the perinatal period . The aim of the present study was to investigate differences in pain management of opioid maintained compared to nondependent pregnant women during delivery and the postpartum period . 40 deliveries of 37 opioid dependent women enrolled in a double-blind , double-dummy r and omized controlled trial ( RCT ) examining the safety and efficacy of methadone ( mean dose at the time of delivery = 63.89 mg ) and buprenorphine ( mean dose at the time of delivery = 14.05 mg ) during pregnancy were analyzed and participants were matched to a non-dependent comparison group of 80 pregnant women . Differences in pain management ( opioid and non-opioid analgesic medication ) during delivery and perinatal period were analyzed . Following cesarean delivery opioid maintained women received significantly less  opioid analgesics  ( day of delivery p = 0.038 ; day 1 : p = 0.02 ) ,  NSAIDs  were administered more frequently to opioid dependent patients than to the comparison group during cesarean section and on the third day postpartum . Significantly higher nicotine consumption in the group of opioid dependentwomenhad a strong influence onthe retrieved results , and might be considered as an independent factor of altered pain experience . Differences in pain treatment became evident when comparing opioid maintained women to healthy controls . These differences might be based on psychosocial consequences of opioid addiction along with the lack of an interdisciplinary consensus on pain treatment protocol s for opioid dependent patients ABSTRACT Procedural pain in the neonatal intensive care unit triggers a cascade of physiological , behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm , who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development . The aim of this study was to examine relationships between cumulative procedural pain ( number of skin‐breaking procedures from birth to term , adjusted for early illness severity and overall intravenous morphine exposure ) , and later cognitive , motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age ( CCA ) , and further , to evaluate the extent to which parenting factors modulate these relationships over time . Participants were N = 211 infants ( n = 137 born preterm ⩽32 weeks gestational age [ GA ] and n = 74 full‐term controls ) followed prospect ively since birth . Infants with significant neonatal brain injury ( periventricular leucomalacia , grade 3 or 4 intraventricular hemorrhage ) and /or major sensori‐neural impairments , were excluded .  Poorer cognition and motor function were associated with higher number of skin‐breaking procedures , independent of early illness severity , overall intravenous morphine , and exposure to postnatal steroids . The number of skin‐breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation . In general , greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months , but not at 18 months CCA , however , specific protocol s for morphine administration were not evaluated . Lower parenting stress modulated effects of neonatal pain , only on cognitive outcome at 18 months In Amsterdam a longitudinal , prospect i ve and multidisciplinary study on the development of infants of drug‐dependent mothers ( IDDM ) was started in 1983 : 35 IDDM and 35 reference infants were originally enrolled . The drug‐dependent women had used combinations of methadone , heroin , cocaine and other drugs during pregnancy . Of the IDDM , 80 % had to be treated pharmaceutically for neonatal abstinence symptoms ( NAS ) . Physical , neurological , cognitive and the socio – emotional development of the children were studied regularly from birth until 5.5 years of age . Differences between the reference group and the IDDM were found most clearly in cognitive development . The IDDM also had more behavioural problems at some of the ages studied . No group differences were seen in motor development . So far the results of the study show that IDDM and their caregivers need extra support in order to improve early communication and the children 's cognitive development Background : Although concerns arise about the generalizability of results from R and omized Controlled Trials ( RCTs ) , few studies systematic ally examine this issue . Objectives : This study compared the characteristics of 427 opioid-using pregnant women who did ( n = 208 ) and did not consent ( n = 219 ) to enrollment in a multicenter clinical trial of agonist medications ( i.e. , the MOTHER study ) . Methods : Logistic regression models were used to compare consenters and non-consenters to examine the effect of screening variables on the likelihood of consenting . Results : Of nine characteristics examined , most differences did not reach statistical significance . Consenting participants were less likely than non-consenting women to be currently enrolled in a methadone maintenance program ( 74.5 % vs. 84.5 % , p = .01 ) . Conclusion and Scientific Significance : These data show that the recruited sample of drug-dependent pregnant women enrolled in an intensive RCT is representative of the larger population of treated opioid-dependent patients and supports the generalizability of r and omized controlled trials in this population OBJECTIVES / AIM To determine whether sedation/analgesia drugs used before , during , and after infant cardiac surgery are associated with neurodevelopmental outcome . BACKGROUND Animal models suggest detrimental effects of anesthetic drugs on the developing brain . Whether these results can be extrapolated to human neonates is unclear . METHODS / MATERIAL S This is a prospect i ve follow-up project conducted in Western Canada . In all infants ≤6 weeks of age having surgery for congenital heart disease between April 2003 and December 2006 , demographic and perioperative variables were collected prospect ively .  Sedation/analgesia variables were collected retrospectively . For each drug class ( inhalationals , opioids , benzodiazepines , ketamine , and chloral hydrate ) , we calculated the cumulative dose received during hospitalization , average dose received per day , and cumulative number of days the patient received the drug . The outcomes at 18 - 24 months were as follows : General Adaptive Composite and motor scaled scores of the Adaptive Behavior Assessment System , significant mental , motor , and vocabulary delay . Multivariable logistic and linear regression was used to analyze the data . RESULTS One hundred and thirty-five neonates underwent open heart surgery ; 19 died , 16 had chromosomal abnormality , and five were lost to follow up , leaving 95 survivors for analysis . Multiple linear regression analysis found no evidence of an association between sedation/analgesia variables and ABAS-GAC score or motor scale score . Multiple logistic regression analysis found no evidence of an association between sedation/analgesia variables and significant mental , motor , or vocabulary delay . CONCLUSION We found no evidence of an association between dose and duration of sedation/analgesia drugs during the operative and perioperative period and adverse neurodevelopmental outcomes OBJECTIVES Lessons learned in research and treatment of opioid dependence demonstrate the need to include pregnant women in clinical trials . METHODS Two double-blind , double-dummy , r and omized controlled trials ( Pilot study , European sample ( † ) of MOTHER-trial ) comparing buprenorphine and methadone in opioid-dependent pregnant women were conducted . In both studies , participants received voucher-based incentives for attendance and completion of study assessment s. In the MOTHER trial , participants additionally received escalating voucher incentives for drug-free urine sample s. Neonatal abstinence syndrome was treated with oral morphine solution based on st and ardized modified Finnegan scores . RESULTS After a mean treatment period of 13.79 weeks in the Pilot study ( PS , n = 18 ) and 20.78 weeks in the MOTHER-trial ( MT , n = 41 ) , respectively ( p < 0.001 ) , PS patients delivered at mean doses of 14.00 mg buprenorphine/52.50 mg methadone and MT participants at 13.44 mg buprenorphine/63.68 mg methadone . Nonsignificant differences regarding dropout rates were found ( 22 % in PS versus 10 % in MT ) , but dropout was significantly earlier in the MT ( p = 0.013 ) . Significantly higher rates of concomitant consumption of opioids and benzodiazepines occurred in the PS compared with the MT ( p < 0.001 ) , however , with no significant differences in neonatal data between both setting s. CONCLUSIONS Early treatment enrolment combined with contingency management contributes to reduced illicit drug use throughout pregnancy , surprisingly without influencing neonatal outcome parameters Specialized prenatal care and substitution programs improve the perinatal prognoses of pregnant drug-abusers and their infants . Although methadone is well documented , little is known about high-dose buprenorphine ( HDB ) . This prospect i ve , multicenter ( n = 35 ) observational study included 259 women on maintenance during pregnancy : 39 % on methadone and 61 % on HDB .  Major findings were : 46 % of them received good prenatal care ; 62 % had  peridural analgesia ; 12.3 % delivered prematurely  ( < 37 weeks ) ; mean gestational age , 38.6 weeks ; mean birth weight , 2822 g . Three-quarters of the newborns developed neonatal abstinence syndrome ( NAS ) beginning at a mean age of 40h , with the mean maximum Lipsitz score of 9.1 at 72 h ; half of them were treated , mainly with morphine hydrochloride . No baby died . Newborns were discharged with their mothers ( 96 % ) or placed in foster care ( 4 % ) . Comparing methadone with HDB , respectively , mean age at the maximum Lipsitz score was 81 h versus 66 h ( P = 0.066 ) . The perinatal medical and social prognoses for these 259 drug addicts and their infants appeared to be improved by specialized prenatal care and was similar for methadone or BHD substitution during pregnancy AIMS To investigate whether the neonatal abstinence syndrome ( NAS ) is different in children born to women maintained on slow-release morphine  , compared with those maintained on methadone  , and to compare additional drug consumption in these groups of women . DESIGN , SETTING AND PARTICIPANTS An open , r and omized trial was conducted in an established clinic . Forty-eight pregnant women who presented to the clinic as opiate or polysubstance abusers were enrolled and maintained on either methadone ( 24 women ) or slow-release morphine ( 24 women ) up to and following delivery . The programme included psychosocial therapy and support for their opiate-addicted partners . MEASUREMENTS St and ard urinalysis methods were used to measure consumption of cocaine and benzodiazepines during pregnancy . Injection sites were monitored to indicate additional opiate use . NAS was measured according to Finnegan score and the amount of phenobarbiturates prescribed to alleviate the symptoms . FINDINGS No difference was found in the number of days that NAS was experienced by neonates born to methadone or morphine maintained mothers ( mean = 16 and 21 days , respectively ) . All children were born healthy and no serious complications arose . Fewer benzodiazepines ( p < 0.05 ) and fewer additional opiates ( p < 0.05 ) were consumed by the morphine-maintained women compared with those who took methadone , but no difference was seen in cocaine consumption . Nicotine consumption was reduced significantly in both groups during pregnancy ( p < 0.02 ) . CONCLUSIONS Both methadone and morphine are suitable maintenance agents for pregnant opiate addicts . Maintenance agents that result in a less prolonged NAS should be studied in further trials OBJECTIVE : To determine whether engaging pregnant substance abusers in an integrated program of prenatal care and substance abuse treatment would improve neonatal outcomes . STUDY DESIGN : The subjects were women who voluntarily enrolled in Project Link , an intensive outpatient substance abuse treatment program at Women and Infants Hospital , Providence , RI . A total of 87 women received substance abuse treatment in conjunction with their prenatal care ;  the comparison group of 87 women  received equivalent prenatal care but did not enroll in the substance abuse treatment program until after they delivered . The two groups of women were similar demographically and socioeconomically and had similar substance abuse histories . Univariate and multivariate analyses were performed . The key outcomes were gestational age at delivery , birth weight , preterm delivery , Apgar scores , and neonatal intensive care admission rate . Factors controlled in the multivariate models included demographics , socioeconomic status , parity , and prenatal care . RESULTS : Infants born to women who enrolled prenatally were 400 gm heavier ( p < 0.001 ) , and their gestational age was 2 weeks longer ( p < 0.001 ) than infants of mothers enrolled postpartum . In addition , they were approximately one-third as likely to be born with a low birth weight ( p < 0.01 ) and approximately one-half as likely to be admitted to the neonatal intensive care unit ( p < 0.05 ) . CONCLUSION : Neonatal outcome is significantly improved for infants born to substance abusers who receive substance abuse treatment concurrent with prenatal care compared with infants born to substance abusers who enter treatment postpartum AIM To report results on the prospect i ve follow-up of 34 pregnant women exposed to buprenorphine maintenance for opiate dependence . DESIGN AND SETTING Prospect i ve multicentre study : all pregnant women receiving buprenorphine as maintenance therapy were included as early as possible during their pregnancy . PARTICIPANTS The pregnant women were recruited from opiate maintenance therapy centres , general practitioner-networks involved in addiction , maternity hospitals and centres for drug information during pregnancy . MEASUREMENTS Women : drugs and medications consumed , medical and obstetrical events ; offspring : withdrawal syndrome , malformation , neonatal disease . FINDINGS The buprenorphine-exposed pregnancies result ed in 31 live births , one stillbirth , one spontaneous abortion and one voluntary termination . A neonatal withdrawal syndrome was observed in 13 cases ( 41.9 % ) and eight of these babies required opiate treatment . Two neonates had a malformation : a premature ductus arteriosus stricture and a tragus appendix . CONCLUSION Taken together with other prospect i ve studies , no alarming results were observed concerning pregnancy outcomes . However , further data from the comparative prospect i ve study are required to determine whether buprenorphine can be considered as a good alternative to methadone treatment in pregnant women ABSTRACT . This prospect i ve study examined the effects of ongoing maternal drug use , parenting attitudes , and a home-based intervention on mother-child interaction  among drug-using women and their children . At 2 weeks postpartum , mothers and infants were r and omly assigned to either an  Intervention ( n = 67 ) or  Control ( n = 64 ) Group . Intervention families received weekly visits until 6 months postpartum and biweekly visits from 6 to 18 months by trained lay visitors . The home intervention was design ed to increase maternal empowerment and promote child development .  Control families received brief monthly tracking visits .  Mother-child interaction was evaluated at 18 months through observation of play . Mothers who continued to use cocaine and /or heroin had lower competence scores ( p < .05 ) ; poor parenting attitude was also associated with lower competence scores during mother-child interaction ( p < .05 ) . Although the intervention had no measured effect , ongoing maternal drug use and poor parenting attitudes were associated with less optimal maternal behavior during mother-child interaction OBJECTIVE To identify perinatal factors that are predictive of disruption in primary caregiving among infants of substance abusing women . METHOD A r and omized longitudinal cohort study . One hundred and fifty two mother/infant dyads were assessed for evidence of disruption of primary caregiving or neglect during the first 18 months of life , defined by mother 's inability to provide care . Data analyzed included neonatal characteristics , urine toxicology at delivery , maternal history of drug use , maternal depression , social support , and social and health history . RESULTS Sixty-six infants ( 43.4 % ) had disruption in their primary care during the first 18 months of their life , 86 infants ( 56.6 % ) remained in the care of their mothers . Women who were younger , were heroin users , had two or more children , had other children in foster care , and reported depressive symptoms were least likely to provide ongoing primary care for their infant . CONCLUSIONS Although all infants born to substance abusing women are at a high risk for disruption in the continuity of their primary caregiving , maternal demographic and psychosocial factors present at delivery can predict which infants are likely to experience an early disruption in their primary caregiving . Identifying these families can enable health care providers to monitor them more closely and , when appropriate , encourage support from the extended family ABSTRACT . Results of a 2-year follow-up after an early intervention with low-middle-class primiparous Portuguese mothers are presented . On the 3rd day of their infants ' lives , 40 mothers underwent a structured intervention using selected items of the Brazelton Neonatal Behavioral Assessment Scale .  An additional 20 mothers r and omized to the control group had a talk with a pediatrician about general problems of infant health care . On Day 28 , the “ sensory orientation ‘ ’ and “ cuddliness ‘ ’ competencies of the infants in the experimental group were significantly enhanced when compared with the same competencies among the infants in the control group . In addition , dyads in the experimental group had established a more favorable pattern of interaction , particularly after short stressful situations ( these situations included short separations from the mother in which a stranger was present , short separations in which no one was present , and a stillface situation ) . Short-term effects ( the first month of life ) were particularly noticeable , especially in terms of the babies ' neurobehavioral development and mother-infant interaction . Long-term effects ( 3 , 6 , 9 , 12 , 15 , 18 , and 24 months ) , though less clear , were evident in the form of better interactive patterns among the dyads in the experimental group . This was particularly evident after the stressful situations to which they were su bmi tted . These results are discussed in terms of both their scope and their clinical impact . J Dev Behav Pediatr 16:21–28 , 1995 . Index terms : early intervention , follow-up , neurobehavioral development , mother ,
This meta- analysis showed no significant impairments , at a non-conservative significance level of p < 0.05 , for cognitive , psychomotor or observed behavioural outcomes for chronic intra-uterine exposed infants and pre-school children compared to non-exposed infants and children .
However , all domains suggested a trend to poor outcomes in infants/children of opioid using mothers .
Conclusions Chronic intra-uterine opioid exposed infants and pre-school children experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers , although in all domains there was a trend to poorer outcomes .
Background It is assumed within the accumulated literature that children born of pregnant opioid dependent mothers have impaired neurobehavioral function as a consequence of chronic intrauterine opioid use .