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Chapter 5: Summary and conclusions
The aims of this study were:
- to develop and deliver a community-based health visitor intervention that will be used to:
- determine the prevalence of continuing and delayed onset NAS in infants of substance misusing mothers;
- produce recommendations for service developments;
- to measure the prevalence of delayed visual maturation in this group of infants;
- to evaluate the community-based structured health visitor assessment by comparing it to data from the existing service, and by canvassing the views of the professionals involved.
Summary
Grampian 2000-2001
- In Grampian in 2000 and 2001 35 of 61 and 34 of 58 infants born to substance misusing mothers developed NAS. Continuing and/or delayed onset withdrawal was identified in 7 and 17 of these infants in 2000 and 2001 respectively;
- Signs of infant withdrawal were not always identified (and therefore untreated) due to a high rate of non-attendance at out patient appointments. Reasons for this included distance from the hospital, lack of money for transport, child protection problems and continuing parental problem use of drugs.
The study period
- During the study period (Jun 2002-Dec 2003) 110 infants were born to substance misusing mothers; 75 of these were admitted to the neonatal unit with NAS symptoms;
- 72 of the 110 eligible infants were recruited to the study;
- For the study period, attendance rates at hospital appointments for infants identified as being born to substance misusing mothers was 57%; completion of health visitor community assessments was 96%;
- The new community assessment identified (and therefore offered appropriate treatment to):
i. 42 infants with continuing NAS
ii. 12 infants with delayed onset NAS.
The vision test
- The health visitor aimed to complete the vision screen test on the 72 infants recruited to the study at 2, 4, 8, 12 and 24 weeks following expected date of delivery (a small number were not assessed);
- 19 of the 72 infants were referred to the hospital outpatient clinic because they failed the test, and 8 of these were diagnosed with eye problems (nystagmus, squint or coloboma).
Views of the community assessment
- Of the 31 health visitors who offered their opinions on the community assessment, most felt if provided them with an increased awareness of NAS which they valued.
Conclusion
- The study has provided information on the prevalence and incidence of infants born to substance misusing mothers and the rate of initial NAS in a defined population area.
- The study identified children with Continuing or Delayed Onset NAS. This facilitated support to parents and prompt hospital follow up, where appropriate.
- The new assessment identified infants with continuing and delayed onset NAS who might otherwise not have been identified.
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