Children of Chemically Involved Parents : Part 3

by Child Welfare Information Gateway

(Page 3 of 10)

Retinopathy of Prematurity (ROP)

Preterm infants are at risk for developing a disease involving the vessels in the eye called ROP. Multiple causes of this disorder have been suggested; however, no specific cause has been identified to date, and no fully adequate treatment modalities have been developed. All preterm infants should receive a thorough eye evaluation by an ophthalmologist before they are discharged from the nursery. In some cases, ROP improves over time, but in other cases, children may be left with varying degrees of a visual handicap.

Those babies who have symptoms of ROP, noted by changes in the vessels of the retina, must have followup eye examinations.

Those children who do develop a visual handicap need to be involved in early intervention programs specifically aimed at assisting them to learn about their environment through tactile and auditory channels as well as through their remaining visual abilities.

Diseases That Interfere With Normal Feeding Ability

There are several medical problems that may interfere with an infant's ability to take all of its daily nutrition by mouth. Infants with certain neurologic conditions may not be able to suck and swallow normally. Infants with BPD may expend too many calories working to breathe or may become short of breath while feeding. In such cases, supplemental gavage/forced feeding (formula given through a small tube that passes through the mouth or nose into the stomach) may be required. In more severe cases, a gastrostomy tube (feeding tube) is surgically placed into the stomach to augment caloric intake or to bypass oral feeding when an infant is unable to suck or swallow effectively.

Another, less common medical complication that may interfere with feeding is necrotizing enterocolitis (NEC). The cause of this disease is not known; however, it sometimes results in damage to the gastrointestinal tract making it impossible for the child's intestines to absorb food. In such cases, some type of total parenteral nutrition (TPN), for example, intravenous (IV) feeding, may be required.

Before hospital discharge, caregivers of infants requiring gavage feeding, gastrostomy tubes, or intravenous lines must be carefully trained and supervised in providing the specialized care their children need. Caregivers must receive detailed instruction regarding how to care for equipment and how to administer the feeding solutions through the catheters (tubes). In-home followup and close contact with the health care team are essential.

Because their feedings may be so disruptive and technical, infants who require gastrostomy tubes or TPN may not receive the social stimulation that usually accompanies feeding (i.e., holding, rocking, and talking). Therefore, it is important to help parents find alternative ways to provide these experiences in order to minimize adverse developmental effects.

Infectious Diseases

Infants with prenatal substance exposure are frequently exposed to infectious diseases of the mother, either prenatally or at the time of delivery. A mother who has multiple sexual partners, a history of prostitution, or a history of injection drug use is at increased risk of acquiring a variety of infectious diseases that can be passed to the child. Because many infectious agents cross the placenta, infants born to infected mothers are at increased risk of acquiring their mothers' infections during pregnancy. The infectious diseases most commonly seen in infants of substance abusers with multiple sexual partners are gonorrhea, syphilis, herpes, chlamydia, hepatitis B, and human immunodeficiency virus (HIV) and/or acquired immunodeficiency syndrome (AIDS). Multidrug esistant tuberculosis (TB) is yet another infectious disease experienced by some infants.

Gonorrhea

Gonorrhea may be transmitted from the mother to the infant during a vaginal delivery. The most common neonatal manifestation of gonorrhea is an infection of the eye (conjunctivitis) with a purulent discharge (pus) appearing 2 to 7 days after birth. As a preventive measure, it is standard medical practice to put silver nitrate or erythromycin in the eyes of all newborns at delivery. Untreated, gonorrhea of the eye can result in blindness. Conjunctivitis in any newborn must be evaluated.

Syphilis

Syphilis in newborns is acquired from an infected mother. Most often, newborns who have been exposed to syphilis prenatally are without physical symptoms. In such cases, a newborn's infection is discovered through a routine blood test at delivery. Congenital syphilis (syphilis that is acquired prenatally) must be treated with antibiotics or it can proceed to cause significant illness, affecting the CNS, bones, joints, and other organ systems. The long-term effects of congenital syphilis depend on the length of time the infant was infected before treatment.

Typically, antibiotic treatment for congenital syphilis is completed before the infant's discharge, with followup blood tests at 3, 6, and 12 months to ensure the adequacy of initial therapy.

If an infant's infection occurred shortly before birth, the blood test at delivery may be negative. Therefore, if maternal infection is suspected, many physicians currently recommend repeating the test for syphilis (VDRL) when the infant is 2 months of age.

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