Miles J, Sugumar K, Macrory F, Sims D G, D'Souza S W
University of Manchester, Division of Human Development and Reproductive Health Clinical Academic Group, St Mary's Hospital, Manchester, UK.
Child Care Health Dev. 2007 Mar;33(2):206-12. doi: 10.1111/j.1365-2214.2006.00635.x.
To evaluate the impact of a shared care approach in clinical management with a drug liaison midwife (DLM) service for mothers and infants established in 1995-1996 in an inner city area and to address the problem of congenital abnormality and microcephaly with fetal drug exposure.
Descriptive analysis of data in live births of women enrolled in a methadone maintenance programme in 1991-1994 (n = 78) and 1997-2001 (n = 98), including time spent in hospital, treatment for neonatal abstinence syndrome (NAS), admission to the neonatal medical unit (NMU) and follow-up for child health checks.
In 1997-2001 compared with 1991-1994, the mothers used more methadone in the last week of pregnancy (median 40.0 mg/day vs. 21.5 mg/day, P = 0.0006) and there were more preterm deliveries (36% vs. 21%, P = 0.03). The infants spent less time in hospital (median 5 days vs. 28 days, P < 0.0001), a smaller proportion had treatment for NAS (14% vs. 79%, P < 0.0001), and NMU admission was reduced (median 14 days vs. 26 days, P < 0.0003). Neonatal convulsions (P = 0.0001) and jaundice (P < 0.001) occurred less frequently, and more infants were breastfed (P = 0.001). One infant in each study group had a cleft palate and none had microcephaly. Child health checks for 18-24 months showed a favourable outcome in 1997-2001.
We altered antenatal care and modified neonatal management, subsequently infants spent less time in hospital and NMU admissions were reduced with less NAS treatment. Congenital abnormalities and microcephaly were not common and as regular child health checks were possible, the impact of the DLM service in shared management merits further investigation, for mother-infant bonding and developmental outcome.
评估1995 - 1996年在市中心城区设立的由药物联络助产士（DLM）服务进行母婴临床管理的共享护理方法的影响，并解决胎儿药物暴露导致的先天性异常和小头畸形问题。
对1991 - 1994年（n = 78）和1997 - 2001年（n = 98）参加美沙酮维持治疗项目的妇女的活产数据进行描述性分析，包括住院时间、新生儿戒断综合征（NAS）治疗、新生儿医疗单元（NMU）入院情况以及儿童健康检查随访。
与1991 - 1994年相比，1997 - 2001年的母亲在妊娠最后一周使用的美沙酮更多（中位数40.0毫克/天对21.5毫克/天，P = 0.0006），早产更多（36%对21%，P = 0.03）。婴儿住院时间更短（中位数5天对28天，P < 0.0001），接受NAS治疗的比例更小（14%对79%，P < 0.0001），NMU入院人数减少（中位数14天对26天，P < 0.0003）。新生儿惊厥（P = 0.0001）和黄疸（P < 0.001）发生频率更低，更多婴儿进行母乳喂养（P = 0.001）。每个研究组各有1名婴儿腭裂，无小头畸形。18 - 24个月的儿童健康检查显示1997 - 2001年结果良好。
我们改变了产前护理并调整了新生儿管理，随后婴儿住院时间缩短，NMU入院人数减少且NAS治疗减少。先天性异常和小头畸形并不常见，由于可以进行定期儿童健康检查，DLM服务在共享管理中的影响值得进一步研究，以探讨母婴联结和发育结局。
