Increasing Prevalence of Neonatal Withdrawal Syndrome: Population Study of Maternal Factors and Child Protection Involvement

Author:

O'Donnell Melissa1,Nassar Natasha2,Leonard Helen2,Hagan Ronnie3,Mathews Richard4,Patterson Yvonne5,Stanley Fiona2

Affiliation:

1. Telethon Institute for Child Health Research

2. Centre for Child Health Research

3. Department of Neonatology, School of Women's and Infants’ Health, University of Western Australia, Subiaco, Western Australia, Australia

4. Department for Child Protection

5. Department of Education and Training, Western Australian Government, Perth, Western Australia, Australia

Abstract

OBJECTIVES. Illicit drug use during pregnancy is an important public health issue, with adverse effects on the newborn and implications for subsequent parenting. The aim of this study was to measure the birth prevalence of neonatal withdrawal syndrome over time, associated maternal characteristics and child protection involvement. METHODS. This is a retrospective cohort study that used linked health and child protection databases for all live births in Western Australia from 1980 to 2005. Maternal characteristics and mental health–and assault-related medical history were assessed by using logistic regression models. RESULTS. The birth prevalence of neonatal withdrawal syndrome increased from 0.97 to a high of 42.2 per 10 000 live births, plateauing after 2002. Mothers with a previous mental health admission, low skill level, Aboriginal status or who smoked during pregnancy were significantly more likely to have an infant with neonatal withdrawal syndrome. These infants were at greater risk for having a substantiated child maltreatment allegation and entering foster care. Increased risk for maltreatment was associated with mothers who were aged <30 years, were from socially disadvantaged backgrounds, Aboriginal status, and had a mental health–or assault-related admission. CONCLUSIONS. There has been a marked increase in neonatal withdrawal syndrome in the past 25 years. Specific maternal characteristics identified should facilitate planning for early identification and intervention for these women. Findings demonstrate an important pathway into child maltreatment and highlight the need for well-supported programs for women who use illicit drugs during pregnancy as well as the need for sustained long-term support after birth.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Reference27 articles.

1. Australian Institute of Health and Welfare. Statistics on Drug Use in Australia 2004. Canberra, Australia: Australian Institute of Health and Welfare; 2005

2. Australian Institute of Health and Welfare. 2001 National Drug Strategy Household Survey: Detailed findings. Canberra, Australia: Australian Institute of Health and Welfare; 2002

3. Substance Abuse and Mental Health Services Administration. Results From the 2006 National Survey on Drug Use and Health: National Findings. Rockville, MD: Office of Applied Studies; 2007

4. Sherwood RA, Keating J, Kavvadia V, Greenough A, Peters TJ. Substance misuse in early pregnancy and relationship to fetal outcome. Eur J Pediatr. 1999;158(6):488–492

5. Abdel-Latif ME, Bajuk B, Lui K, Oei J. Short-term outcomes of infants of substance-using mothers admitted to neonatal intensive care units in New South Wales and the Australian Capital Territory. J Paediatr Child Health. 2007;43(3):127–133

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