HOME NURSING INTERVENTION FOR DRUG EXPOSED INFANTS

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Approximately 375,000 U.S. newborns are born to mothers who used illicit drugs during pregnancy. In utero drug exposed infants are at "double jeopardy" for developmental problems due to the biological effects of intrauterine exposure to drugs, as well as the postnatal environmental challenges which may interfere with stimulating and effective parenting. Few studies have addressed the specific use of home-based nurse interventions for in utero drug exposed infants. The objective of this clinical trial was to test the effectiveness of a home based nurse intervention compared to usual care (control group) for in utero drug exposed infants. The intervention group was provided with counseling sessions prior to nursery discharge, 16 home visits to monitor infant health status and provide informational and emotional support to the caregiver and 24 hour availability of the nurse by phone. Primary infant outcomes include (1) morbidity defined as feeding problems, failure to thrive (weight for length below - 1. 5 Z scores from the National Center for Health Statistics (NCHS) median), impaired growth and development and neurological deficits, (2) health care utilization defined as number of hospitalizations and well child care visits, incomplete immunization status and (3) psychosocial status defined as protective service (PS referrals and foster care placement (FCP). Follow-up measures wilI be collected at 3,6,9,12,18 and 24 months of age at study clinic visits. Statistical analysis will focus on mean differences in morbidity, developmental and neurological test scores, number of hospitalizations, PS and FCP referrals between groups (Intervention and Control). The final multiple regression analyses will allow for interaction effects and joint analyses of multiple data points for the growth, developmental and neurological scores. Preliminary results to date indicate that birth weight and length were significantly different by type of drug exposure with the opiate only infants the largest in weight (p=.000I) and the longest (p=.008). Differences in head circumference size were not statistically significant (p=.58). Mean Z-scores were 1 S.D. lower for birth weight and length and 1.5 S.D. lower for head circumference versus NCHS growth standards. There were no statistically significant differences in the neurological exam between the three groups (p=.34).