Published online March 30, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. e614-e621 (doi:10.1542/peds.2008-2888)
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ARTICLE

Increasing Prevalence of Neonatal Withdrawal Syndrome: Population Study of Maternal Factors and Child Protection Involvement

Melissa O'Donnell, MPsych, Grad Dip Ed, BPsych (Hons)a, Natasha Nassar, PhD, MPH, BEcb, Helen Leonard, MBChB, MPHb, Ronnie Hagan, MSc, MBA, MB, BChc, Richard Mathews, BPsych, MAd, Yvonne Patterson, RNPsy, MPsych, MBA, BSce and Fiona Stanley, MD, MBBS, MScb

a Telethon Institute for Child Health Research
b Centre for Child Health Research
c Department of Neonatology, School of Women's and Infants’ Health, University of Western Australia, Subiaco, Western Australia, Australia
d Department for Child Protection
e Department of Education and Training, Western Australian Government, Perth, Western Australia, Australia

OBJECTIVES. Illicit drug use during pregnancy is an important public health issue, with adverse effects on the newborn and implications for subsequent parenting. The aim of this study was to measure the birth prevalence of neonatal withdrawal syndrome over time, associated maternal characteristics and child protection involvement.

METHODS. This is a retrospective cohort study that used linked health and child protection databases for all live births in Western Australia from 1980 to 2005. Maternal characteristics and mental health–and assault-related medical history were assessed by using logistic regression models.

RESULTS. The birth prevalence of neonatal withdrawal syndrome increased from 0.97 to a high of 42.2 per 10 000 live births, plateauing after 2002. Mothers with a previous mental health admission, low skill level, Aboriginal status or who smoked during pregnancy were significantly more likely to have an infant with neonatal withdrawal syndrome. These infants were at greater risk for having a substantiated child maltreatment allegation and entering foster care. Increased risk for maltreatment was associated with mothers who were aged <30 years, were from socially disadvantaged backgrounds, Aboriginal status, and had a mental health–or assault-related admission.

CONCLUSIONS. There has been a marked increase in neonatal withdrawal syndrome in the past 25 years. Specific maternal characteristics identified should facilitate planning for early identification and intervention for these women. Findings demonstrate an important pathway into child maltreatment and highlight the need for well-supported programs for women who use illicit drugs during pregnancy as well as the need for sustained long-term support after birth.

Key Words: neonatal withdrawal abstinence syndrome

Abbreviations: NWS—neonatal withdrawal syndrome • ICD—International Classification of Diseases • OR—odds ratio • CI—confidence interval

Accepted Dec 16, 2008.


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eLetters:

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Prenatal care should include drug testing
Jacqueline A. Hobbs, et al.
Pediatrics Online, 4 May 2009 [Full text]