HOME NURSING INTERVENTION FOR DRUG EXPOSED INFANTS

大约375，000名美国新生儿出生于使用非法药物的母亲 怀孕期间的药物 在子宫内药物暴露的婴儿在“双 危险”的发展问题，由于生物效应的 宫内暴露于药物，以及产后环境 可能干扰激励和有效育儿的挑战。 很少有研究涉及家庭护士的具体使用 对宫内药物暴露婴儿的干预措施。 的目的 临床试验是为了测试家庭护士的有效性， 干预与常规护理（对照组）相比，子宫内药物 暴露的婴儿 干预组接受心理咨询 托儿所出院前的会议，16次家访，以监测婴儿 健康状况，并提供信息和情感支持， 护理人员和24小时电话护士的可用性。 初级 婴儿结果包括（1）定义为喂养问题的发病率， 不能茁壮成长（体重与长度之比低于-1。5个Z分数， 国家卫生统计中心（NCHS）中位数），受损生长 和发展和神经缺陷，（2）卫生保健利用 定义为住院和儿童保健就诊的次数， 不完全免疫状态和（3）心理社会状态，定义为 保护服务（PS转介和寄养安置）。 在3、6、9、12、18和24月龄时收集随访指标 在研究诊所访视时。 统计分析将侧重于平均值 发病率、发育和神经学测试分数的差异， 组间住院、PS和FCP转诊的数量 （干预与控制）。 最终的多元回归分析将 允许多个数据点的交互作用和联合分析 生长发育和神经系统评分 初步 迄今为止的结果表明，出生体重和身长 不同类型的药物暴露与阿片类药物只婴儿， 重量最大（p= 0.0001）和最长（p= 0.008）。差异 头围大小无统计学意义（p= 0.58）。是说 Z评分为1 S.D.。出生体重和身长较低，1.5 S.D.。 与NCHS生长标准相比，头围较低。 有 神经系统检查无统计学显著差异 三组之间（p= 0.34）。

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).