Children of Chemically Involved Parents : Part 2

by Child Welfare Information Gateway

(Page 2 of 10)

Neonatal and Infant Complications

There are a number of pediatric medical complications associated with prenatal substance abuse. These include neurological disturbances, prematurity, infectious diseases, Fetal Alcohol Syndrome (FAS), Sudden Infant Death Syndrome (SIDS), failure to thrive (FTT), intrauterine growth retardation (IUGR), and central nervous system (CNS) disorders.

Neurological Symptoms

Various neurological disturbances have been noted in newborns who have been exposed prenatally to drugs and alcohol. The following symptoms are most commonly observed:

• irritability,
• tremors or jitteriness,
• prolonged or high-pitched crying,
• increased or decreased muscle tone,
• alternating periods of lethargy and irritability,
• frantic sucking of hands,
• uncoordinated sucking,
• seizures,
• fever,
• sweating,
• diarrhea,
• excessive vomiting,
• unusual or rapid (nystagmus) eye movements, and
• disturbances in sleep patterns.

Infants born to mothers who abuse stimulants such as cocaine and methamphetamine may appear lethargic and unresponsive during the first few days following birth. When such infants are alert, however, they are often easily overstimulated and may progress from being asleep to a state of loud crying within seconds. As they become older, infants who were lethargic during the immediate postnatal period often become more irritable and difficult to console. However, these behaviors often are self-limiting and may subside by age 2.

The majority of infants born to mothers who have used narcotics such as heroin or methadone during pregnancy become symptomatic within 72 hours after birth. Although irritability and tremulousness often decline over the first month of life, some narcotic-exposed infants remain symptomatic for many months. Initially, infants may have red, dry skin on their knees, elbows, and cheeks as a result of their excessive body movements. Frequently, these infants have diarrhea and episodes of vomiting that interfere with weight gain. These newborns may require medication in order to calm them, help them suck and swallow more successfully, and also limit their bouts of diarrhea.

Medication for symptomatic infants is warranted when the infant's vomiting or diarrhea causes weight loss or dehydration. The Neonatal Narcotic Abstinence Scale is used to determine which infants require medication. Commonly used medications include paregoric and phenobarbital. Infants who have seizure activity require immediate treatment with anticonvulsants.

Ideally, all infants receiving drug therapy for symptoms of prenatal substance exposure should be weaned from these medications before hospital discharge. Those children who are on medications at time of discharge need to be carefully monitored. Overdoses can occur, and it is important to be certain that parents or other caregivers are administering medications properly. If an infant is on phenobarbital, the amount of medication circulating in the blood stream (the blood level) needs to be checked at regular intervals.

Infants with seizure disorders may require ongoing medication and followup with a pediatric neurologist.

Prematurity

Prematurity is defined as birth at less than 37 weeks of gestational age. Usually, premature infants weigh less than 2,500 grams. However, low birth weight also may occur in full-term infants of substance-abusing women. Prematurity in and of itself poses a distinct set of biological risks that can result in chronic illness for the infant and interfere with normal growth and development. In general, preterm delivery occurs in less than 10 percent of the newborn population. However, the risk of prematurity among substance-exposed infants is higher.

The problems commonly observed in preterm infants, including those who were prenatally exposed to drugs, are intracranial hemorrhages, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), respiratory distress syndrome (RDS), and disorders that interfere with normal feeding ability. Infants who display these conditions are often termed "medically fragile."

Intracranial Hemorrhages

Intracranial hemorrhages refer to bleeding into the brain tissue. Such an occurrence is known to be a risk factor for later physical and/or intellectual problems. Cerebral palsy, or impaired motor movements, for instance, can occur when there has been an intracranial bleed or an interference with the blood flow to specific areas of the brain.

Because a hemorrhage can obstruct the normal flow of cerebral spinal fluid that circulates around the nervous system, some preterm infants who experience intracranial bleeding require treatment for hydrocephalus, an accumulation of serous fluid within the cranium that can interfere with physical and/or intellectual development. Treatment for hydrocephalus involves the surgical insertion of a ventricular peritoneal (VP) shunt, or tube, that provides drainage of the fluid from the brain into the abdominal cavity.

Infants with hydrocephalus require followup by a neurosurgical team to ensure that the shunt does not obstruct or become infected. In addition, parents need to know how to identify signs of infection and obstruction.

For infants with developmental delays or motor problems, evaluations by developmental disabilities specialists are needed to ensure that appropriate early intervention is made available.

Bronchopulmonary Dysplasia (BPD)

One of the most well-recognized complications of prematurity is BPD, a condition that affects lung tissue and interferes with normal breathing functions. Following their discharge from the neonatal intensive care unit (NICU), children with this condition may continue to require oxygen, have complex medication regimens, and need special home-monitoring of their heart and respiratory rates. Children with BPD are at increased risk for poor weight gain, serious respiratory tract infections, multiple hospitalizations, and delayed development.

The health care team needs to ensure that parents/caregivers are able to use equipment and administer medications properly, as well as detect signs of respiratory infection.

Caregivers for children who have periods of apnea (prolonged cessation of breathing) and who require apnea monitors also must be able to perform cardiopulmonary resuscitation.

About the Author

www.childwelfare.gov
Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.