by Susan S. Mattingly
page 5-13
Increasing knowledge on infants of mothers, behaviours during pregnancy raises important ethical issues for health professionals regarding their moral obligations and appropriate responses. This paper reviews the flaws in applying the two-patient (mother and fetus) model of medical care to the ethical dilemmas involved in efforts to prevent or reduce morbidity in offspring. A more appropriate ethical response combines clinical efforts to alter maternal behavior with attention to maternal support systems and public policy advocacy to create an environment more conducive to health and parental responsibility.
by Shelly J. Lane
page 15-29
The dramatic rise in cocaine use in the 1980s has increased concern on the part of clinicians for both the user and, if the user is a woman of child-bearing age increased concern on the part of clinicians for both the user and , if the user is a woman of child-bearing age, for the developing fetus. The impact of prenatal cocaine exposure on the new borns and their care givers which may be of some help in getting through initial crises.The long-term impact is presently poorly articulated. Although anecdotal reports of developmental concerns on prenatally exposed children at preschool and school age are available, and expectations for developmental expectations exist, reports are not available to support these contentions. Understanding the action of cocaine, and the implications of cocaine use may assist parents and professionalism being realistic in both predictions and expectations. This article provides a summary of these issues.
by Marcia W. Swanson
page 35-47
The effect of prenatal cocaine exposure on the neuromotor outcome of infants has been investigated through animal research, neurophysiological studies of neonates, and longitudinal follow-up of exposed infants. The inconsistency in reported findings may reflect methological problems as well as variations among study populations and individual infants. Several studies using the Movement Assessment of Infants (MAI) have reported significant differences in motor performance at four months of age in infants who were cocaine-exposed prenatally, but specific clinical findings vary. A review of relevant work is presented here with a discussion of issues and variables which must be considered in an evaluation of the neuromotor consequences of intrauterine cocaine exposure for the developing infant.
by Katherine B. Stewart, Pamela K. Richardson, Heather Carmichael Olson
page 51-68
Focusing on families affected by parental substance abuse, this article discusses literature relevant to pediatric physical therapists and occupational therapists, describes examples of research assessment protocols, and offers a number of clinical considerations for in-depth assessment of this population. Based on what we currently know as a result of empirical studies, and what we have learned clinically from infants and families affected by substance abuse, recommendations are made for pediatric physical therapy and occupational therapy assessments of this infant population. Pediatric may wish to consider a transactional developmental model that includes examination over time of the biological, environmental, and interactional risk and protective factors in infants and young children.
by Ruth Rose-Jacobs, Deborah A. Frank, Elizabeth R. Brown
page 73-84
Health care providers in clinical and research settings assess the developmental status of increasing numbers of infants and children who were prenatally exposed to drugs. Although assessment of these is similar to that of other at-risk infants, limitations and other issues of assessment may be overlooked given societal concerns about drug exposure. In order to meet the evaluation needs of children who were prenatally exposed to drugs, providers must know the limitations associated with the process and instrumentation of assessment, and address the short comings of evaluation itself. We review the issue and provide recommendations for change related to measurement; source of bias; specificity and sensitivity of assessment tools; longitudinal assessment; and multidimensional approaches to assessment.
by Mary P. Grattan, Sydney L. Hans
page 89-106
The motor behavior of 35 children with a documented history of prenatal exposure to opoid drugs and 41 comparison children with no history of prenatal substance exposure was assessed from birth to approximately 10 years of age using a clinical neurological examination and electronically quantified test motor steadiness. There were no opiod exposure effects on the skills assessed by the clinical neurological examination. An interaction was found between prenatal opoid-exposure and age of child on the motor steadiness tasks with deficits related to opoid exposure only observable before the tenth birthday. In discussion emphasis is placed on the range of motor skills in opoid-exposed children and on implications for clinical practice.
by Marie D. Cornelius
page 111-123
Pregnancy in a teenager presents increased risks for both mother and offspring. When a pregnant teenager also uses drugs, tobacco, alcohol or a combination of these substances, results are especially problematic. This paper reviews the complications of adolescent pregnancy, rates of teenage use of commonly abused substances, and data on effects of prenatal substance abuse in adolescents on gestational length and on growth and development of offspring.
by Robert E. Arendt, Sonnia Minnes, Lynn T. Singer
page 129-140
Research on animal models demonstrates that fetal cocaine exposure results in neurologic deficits in memory and learning. Although drug effects on human infants are difficult to separate from other environmental influences of a drug-using lifestyle, studies suggest that infants exposed to cocaine in utero have reduced growth, delays in sensory-motor development, attentional deficits,and depressed responsitivity to social stimulation. Standard interventions to promote behavioral state regulation in affected infants may be helpful when parents are capable of participating.
by Dewey J. Bayer, Bruce Bleichfeld, Shelly J. Lane, Martin A. Volker, Barbara Alif, Brian Floss
page 145-152
In the present study both the Fagan Test of infant intelligence (FTII) and the motor assessment of infants (MAI) were administrated to 36 full term infants previously exposed to cocaine in utero. The infants were participating in a program at the PACT (Parents And Children Together) clinic operated by Childrens' Hospital of Buffalo, New York. The FTII was administered at 69 weeks post-conceptional age and the MAI was administered 8 months from birth. It was hypothesized that significant relationships between the mean novelty preference scores on the FTII at 69 weeks and the risk scores on the subsections of the 8 month MAI. Moderate, but statistically significant, negative correlations were found between the FTII and both the automatic reactions and the primitive reflexes subsections of the MAI. The implications of these results are discussed in the context of a homeostatic model of functioning, under which the infants are viewed as having difficulties with internal regulation and motor control, leading to higher risk scores on the MAI and to lower novelty preference scores on the FTII.
by Laura M. Giusti
page 155-171
Twenty-four foster children aged 12 to 28 months were assessed using the Bettelle Developmental Inventory Screening Test (BDI). A subset of the children (15) had been exposed to cocaine in utero. All of the children were of African-American descent; eight of the drug-exposed and five of the non-exposed children were female. Results of t-tests for total domain scores on the BDI suggested that there were no significant developmental differences between the drug-exposed and non-exposed groups. Overall, however, the sample of foster children scored lower than average on the norms for the BDI, and their age equivalents as measured by the BDI were significantly lower than their actual ages. Possible explanations are discussed, including the diminution of adverse affects of prenatal cocaine-exposure, as well as the overall poor developmental outcome of foster children.
by Cheryl Riegger-Krugh, Angela Blair, and Joyce W Sparling
page 173-186
Measurement of fetal joint angular velocity may be beneficial in assessing the effect on the fetus of maternal use of drugs. The effect of maternal cocaine and other drug use on the fetus is not well defined. The ability to measure the effect of maternal drug use on the fetus in a safe, accurate, and reliable way is challenging. A method of measuring fetal knee joint angular velocity is described. Clinical implications for use of the method are discussed.
Transcribed by Angus Nicolson, 11th October 1996