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Unanswered Question: What is the long term outcome for antenatally drug exposed children?

11 Jul, 07 | by BMJ

Whilst attending the adoption panels it has become clear that many of the prospective parents ask about the antenatal drug exposure of the babies and what that means for the future for these children. They are given fairly vague advice and told that we can’t be sure of the outcome and so are left with some uncertainty. Is it possible to give them better and clearer advice?

In babies exposed to in-utero illegal drugs [patients] and developing neonatal absitinence syndrome [risk factor] what are the long term developmental and behavioural outcomes [outcome].

Author

Anna Gregory (Paediatric SpR, Yorkshire deanery. anna@gregory.ms)

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  • Ian Wacogne

    I don’t have anything much to contribute by way of actual knowledge here, but I’ve never been one to let absence of knowledge get in the way of holding an opinion…
    I think this question is answerable – or more accurately unanswerable – on a number of different levels, all of which are fairly unsatisfactory. This isn’t to criticise the question – which is great. Bear with me.
    It’s probable that you could come up with an answer which said something like:
    “X% of babies whose mothers took drugs during pregnancy at such and such a level went on to develop a. Developmental delay. b. mild/moderate/tricky to characterise developmental difficulties. c. their own problems with substance dependence in later life. ”
    And of course, if someone hasn’t answered this, they should do…
    At another level, and one which I think adoptive families have a lot of insight into, the question is: “predict the future for me”. There is a lot of preparation for adoptive parents, and a lot of worries placed on them for their adopted children – and for good reason, since many children will be from highly complex backgrounds. But at some ways isn’t this exactly the same as a family saying “give me some reassurance that my child won’t get asthma/autism/knocked down by a car”. We all deal with odds or risks on a daily basis, but none of us can really quantify a risk which pertains to ourself, not unless it tends to certainty either way (almost certain to happen or almost certain to not happen) or the stakes are so high that lower risks seem to achieve certainty (profound disability or death). So, I don’t know what it would mean to a family if I gave them the information in my first level of answer. I certainly don’t know how I’d interpret it.
    (This has got a bit metaphysical, and I’m sure Bob is better at this stats and humans thing than me…)
    Last comment: More on quantifying the unquantifiable. There’s a phrase oft misused by social workers: “I think this child has a bit of fetal alcohol syndrome”. Used to cover a multitude of sins. But, we know what one extreme of EtOH does. We know what the other extreme does. But what about the doses in between? Can you, in fact if not in medical correctness, have a bit of FAS?
    Ian Wacogne

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