1. A Clinical Outcome Study of Meth Exposed Infants Rizwan Z, Shah, M.D., FAAP Blank Children’s Hospital Des Moines, Iowa, USA

2. CAIRE Program (Children and Infant’s Recovery Efforts) CAIRE Program provides assessment and service coordination for drug exposed children. Started in 1989, CAIRE Program evaluated the first meth exposed child in 1993. Program serves children in a 100 mile radius area around Des Moines, Iowa. Consultation services are available to community agencies throughout the state of Iowa. Clinic is staffed by:Pediatrician, nurse practitioner, two nurses, two master level social workers, Program Manager, Psychological and Psychiatric Consultative Services.

3. Referring Agencies Department of Human Services Substance Abuse Treatment Programs School System Practicing Physicians Families - both biologic and adoptive Juvenile Court

4. Assessment Protocol Intake Clinic nurse gathers info regarding child and family. Determines how soon child should be examined and advises caregiver-social worker about what information to bring to clinic appointment.

5. First Visit Evaluation History History of drug exposure Prenatal and neonatal history Past medical history A. Feeding, sleep and social history B. Areas of concern C. What assessment/service are in place Psychosocial History

6. Assessment Complete Physical Exam Growth Assessment Dysmorphology Exam Neuromuscular Exam Neurobehavioral Assessment Developmental Screening

7. Conclusion and Recommendations Identify areas of concern Identify community resources for interventions Parent/caregiver education Follow up recommendations

8. Follow-up Assessment Ages newborn to 6 months - at one-two month intervals. Ages 6 months to 18 months - at three month intervals. Ages 18 months to 5 years - 6 months to 12 months intervals 5 years to 10 years - once a year.

9. PREGNANCY AND INFANT OUTCOME STUDY Population: Drug exposed infants evaluated at Blank Children’s Hospital. Population Characteristics: Meth exposed 61 Cocaine 36 Meth/cocaine exposed 12

10. MATERNAL DATA Substance Abuse Pattern Women who use meth/cocaine in the first trimester are more likely to use during the third trimester Nicotine use is universal among drug using pregnant women. Marijuana and alcohol are secondary drugs, used in 60% of the group.

11. PREGNANCY OUTCOME Meth group Cocaine group Meth/Cocaine No prenatal care 40% 22.2% 40% Acute illness 34.5% 44.4% 37.5% Nutritional Problems 16.7% 18.8% 71.4% Pre-term birth 25% 24% 30%

12. INFANT OUTCOME Growth: Meth exposed Cocaine exposed Meth/Cocaine Weight<10% 19% 30% 33% Head size<10% 10% 20% 40% Height value not effected in these groups.

13. INDICATORS OF CHILD WELL BEING Meth only Cocaine Meth/Cocaine Accidents 19.7% 8.3% 25% Feeding problems 34.4% 9.4% 33.3% Sleep problems 39.3% 44.4% 50% Neuro problems 21.3% 19.4% 16.7% Behavior Problems 57.4% 63.9% 75%

14. DEVELOPMENTAL OUTCOME Dev delays Meth exposedCocaine exposed Cocaine/Meth Gross Motor11.7% 5.6% 25.7% Fine Motor 9.6% 9.4% 16.7% Language 6.7% 14.3% 16.7% Social 4.9% 4.5% 11.1% Delay in any one domain 41% 41% 66%

15. Symptoms of Meth Exposed Infants and Children (I) NB to 4 weeks: (Dopamine Depletion Syndrome) Lethargic-Excessive Sleep Period Poor Suck and Swallow Coordination Sleep apnea Poor habituation

16. Symptoms of Meth Expose Infants and Children (II) Four Weeks to Four Month Age: Symptoms of CNS immaturity - Effects on motor development Sensory Integration Problems - Tactile, defensive, texture issues Neurobehavioral Symptoms - Interaction Social development

17. Symptoms of Meth Exposed Infants and Children (III) Six Months to Eighteen Months: The Honeymoon Phase Symptom Free Period

18. Symptoms of Meth Exposed Infants and Children (IV) Eighteen Months to Five Years: Sensory Integration Deficit (Same as 2) Less Focused Attention Easily Distracted Poor Anger Management Aggressive Outbursts