P1 CLOSING THE LOOP: MULTIDISCIPLINARY ANTENATAL INTERVENTION TO REDUCE SEVERITY OF NEONATAL ABSTINENCE SYNDROME

J. Robertson, A. Hughes, D. Manning.Wirral Hospitals NHS Trust, Wirral, UK

Background: In 1993, with increasing concerns over the neonatal consequences of maternal drug misuse, our District Drug Service established a dedicated team to support pregnant drug misusers. This service offers intensive support largely through a community clinic with access to obstetric, midwifery, paediatric, drug liaison, and Social Work advice. Since 1993, the service has kept records which include numbers of registered mothers, declared drug misuse, and neonatal outcome. In 1993–94, we audited admissions to Special Care Baby Unit (SCBU) of babies with severe neonatal abstinence syndrome (NAS).

Change in Practice: Up to 1994, management of drug misusing mothers was directed at weaning all drugs simultaneously. In 1995, the emphasis changed to efforts to wean individual drugs whilst accepting the continued use of methadone. This was supported by education regarding the effects of different drugs antenatally, at the same time encouraging a more trusting working relationship with the team.

Repeat Audit: We reviewed the frequency of admission to SCBU for NAS of infants from the same district population, based on a perception that we were seeing far fewer such babies on the Neonatal Unit. Using the same drugs service records, and the SCBU admission register, we identified mothers attending the community clinic and infants admitted with severe NAS.

Results: See table

Conclusion: A change in antenatal practice in a group of drug misusing women attending a dedicated community clinic has been associated with a reduction in admissions of infants with severe NAS. There is no evidence for any other change in practice for the same patient group, and in particular no alteration in thresholds for admission to the Neonatal Unit. Intensive support in a dedicated clinic, alongside prioritising antenatal withdrawal of misused drugs, has significantly improved outcome …