HOME NURSE INTERVENTION OF IUDE INFANTS: 3 YEAR FOLLOW UP

在美国，每年大约有22万婴儿的母亲在怀孕期间使用了非法药物。其他报告称，4-10%的孕妇使用过可卡因。越来越多的证据表明，子宫内可卡因的药物暴露（IUDE）构成了导致大脑功能长期改变的风险。对接触鸦片剂儿童的长期随访研究表明，尽管智力缺陷可能是轻微的或不存在，但行为异常可能持续到上学时期。研究接触鸦片剂儿童的一个主要困难是确定哪些因素（环境或直接影响或鸦片剂接触）导致不良后果。IUDE儿童的寄养安置率很高。在一项纵向研究中，几乎一半（43%）的阿片类药物暴露儿童与亲生父母分离。药物暴露婴儿的成本负担是早产、低出生体重和新生儿戒断症状高发的直接结果。42-68%的海洛因成瘾新生儿和63-85%的美沙酮成瘾新生儿出现新生儿戒断，导致住院时间延长。其他成本负担难以衡量，包括对个人一生的发展和表现的影响，包括家庭护理干预在内的早期干预项目被认为可以加强养育方式，以丰富生物和环境挑战婴儿的发展。本持续研究的目的是确定儿科护士专家（PNS）家庭干预是否与改善儿童健康的持续效果有关，并在204名入组的5岁以下子宫药物暴露婴儿中证明成本效益。此外，目标是将干预儿童与一组具有可比环境/社会经济地位的非药物暴露对照婴儿进行比较。这项正在进行的研究是一项随机、两组、重复测量对照临床试验，以测试以家庭为基础的PNS干预的有效性。将婴儿随机分为PNS干预组（N=100）和对照组（N=100）。所有204名宫内节育器婴儿均出生在约翰霍普金斯医院，并根据产妇用药史，通过产前记录和分娩时产妇尿液毒理学检查和/或出生后24小时内的婴儿尿液毒理学检查记录宫内节育器。从1996年12月1日开始，从约翰霍普金斯医院的儿科诊所招募了一个未暴露的对照组，以评估干预措施的全面影响。

Each year in the U.S. approximately 220,000 infants are born to mothers who used illicit drugs during pregnancy. Others report between 4-10% of all pregnant women have used cocaine. There is growing evidence that in utero drug exposure (IUDE) to cocaine constitutes a risk leading to long-term alterations of brain functioning. Long term follow-up studies of opiate exposed children indicate that although intellectual deficits may be mild or nonexistent, behavioral abnormalities may persists into the school years. One major difficulty in studying opiate exposed children is determining which factors (environmental or direct effects or opiate exposure) result in the poor outcomes. Foster care placement for IUDE children is high. Almost half (43%) of opiate exposed children were removed from the biological parent in one longitudinal study. Cost burden of drug exposed infants are a direct result of the high incidence of prematurity, low birthweight and neonatal drug withdrawal symptoms. Neonatal drug withdrawal occurs in 42-68% in heroin addicted and 63-85% of methadone addicted newborns contributing to an increased length of stay. Other cost burdens are difficult to measure including the effects on the development and performance of the individual over a lifetime Early intervention programs including home nurse interventions are thought to enhance parenting to enrich the development in biologically and environmentally challenged infants. The goal of this continuation study is to determine if a Pediatric Nurse Specialist (PNS) home intervention will be associated with sustained effects of improved child health and demonstrate cost effectiveness in the 204 enrolled in utero drug exposed infants up to age 5 years. Additionally, the goal is to compare the intervention children to a group of non-drug-exposed control infants of comparable environment/ socioeconomic status. This ongoing study is a randomized, two-group, repeated measures controlled clinical trial to test the effectiveness of a home-based PNS intervention. Infants were randomized into the PNS intervention (N=100) or control (N=100) groups. All 204 IUDE infants were born at the Johns Hopkins Hospital and had documented IUDE based on maternal drug history by review of prenatal records and maternal urine toxicology screens at delivery and/or infant urine toxicology screens obtained within 24 hours of birth. Starting in December 1, 1996, a non-exposed control group has been recruited from pediatric clinics at the Johns Hopkins Hospital to appreciate the full impact of the intervention.