Retrospektive Evaluation eines interdisziplinären Nachsorgeangebots für suchtmittelexponierte Neugeborene

Abstract

Zusammenfassung. Pränatale Suchtmittelexposition ist ein großer Risikofaktor für organische, neurologische und psychische Entwicklungsstörungen. In der Gesamtstichprobe ( N = 84) erfolgte auf Grund der Schwere der Störung bei fast der Hälfte der Kinder eine medikamentöse Behandlung des Neonatalen Entzugssyndroms. 56 Familien nahmen das Nachsorgeangebot im Rahmen einer Kooperation zwischen Geburtsmedizin, Neonatologie und Kinder- und Jugendpsychiatrie wahr (BK-Gruppe) und 28 erschienen nicht (N-Gruppe). In der N-Gruppe nahmen die Mütter präpartal häufiger Substitutionsmittel ein ( p=0,02). Kinder aus der BK-Gruppe erhielten häufiger Unterstützung durch Jugendhilfe (22 %) und wurden seltener (46 %) in den elterlichen Haushalt entlassen ( p<0,05). Bei über 80 % der Säuglinge wurde eine Regulationsstörung diagnostiziert. Nach unseren Erfahrungen besteht aufgrund der Vielzahl von Entwicklungsrisiken und psychosozialen Belastungen eine dringliche Indikation zur interdisziplinären Diagnostik und Behandlung aller dieser Neugeborenen.

Retrospective Evaluation of Interdisciplinary Follow-Up Care for Prenatally Drug-Exposed Infants

Abstract. Prenatal drug exposure is a risk factor for organic, neurological, mental, and developmental disorders. It is an important public health issue that comes with many negative short- and long-term consequences. The associated psychosocial burdens and often low adherence to care call for interdisciplinary and intensive follow-up care programs. Such an interdisciplinary monitoring program was implemented for the first time in Germany and exists as a close collaboration between the obstetrics, neonatology, and child and adolescent psychiatric departments of a university hospital. The aim of the current retrospective observation study is to give a descriptive evaluation of this newly established follow-up care program. A total of 84 women were monitored during pregnancy by the obstetrics department, gave birth in the collaborating neonatology unit, and were offered a follow-up appointment in the infant psychiatric unit. Almost two thirds of the families ( n = 56) showed up for the follow-up care appointment (BI sample) and 28 families did not (N sample). Of the overall sample, 98 % of the infants were diagnosed with neonatal abstinence syndrome at birth. Subsequently, almost half (49 %) were treated pharmaceutically for their withdrawal symptoms; 4 % of infants immediately received a diagnosis of fetal alcohol spectrum disorder. A retrospective comparison between the BI and N sample revealed that the mothers of the N sample significantly more often took pharmaceutical replacement therapy prepartum ( p = .016). Support by child services was needed significantly more often in the BI sample (22 %) and 45.5 % of cases were not discharged into parental care ( p < .50). Over 80 % of infants in the BI sample were diagnosed with a regulation disorder of sensory processing. On average the families in the BI sample participated in two follow-up appointments. Overall, these results show for the first time in Germany the value and practical feasibility of an interdisciplinary follow-up care program for prenatally drug-exposed infants. At the same time, clinical professionals have to adjust the care to the often reduced time management skills, limited insight, low concentration levels, and heightened psychosocial burdens of these families. Moreover, it is vital to include all the different parties during the follow-up process, for example, child services and/or pediatrician. Due to the high variety and cumulative nature of the associated developmental risks of prenatal drug exposure, a clear indication for interdisciplinary diagnostics, counseling, and treatment of these vulnerable infants is given. Further longitudinal studies are required to identify the effects of single as well as poly drug use on the different developmental stages in order to adjust follow-up care programs to the specific needs over the entire course of a child’s development well into adulthood.