Retrospective study found that outpatient care for infants exposed to drugs during pregnancy was sustainable and safe.

AIM: We determined the safety, feasibility and sustainability of an outpatient model of care for infants exposed to intra-uterine drugs. METHODS: This was a retrospective chart review of 774 drug-exposed infants born between 1998 and 2016 at the Royal Hospital for Women, Sydney, Australia. RESULTS: Most (86%) of the mothers used multiple drugs, including opioids (58%). More than three-quarters (78%) of the infants were born full term at a mean gestation of 38 weeks and hospitalised for a median of seven days. This rose to 14 days if they were medicated for neonatal abstinence syndrome (NAS). Most of the NAS patients (83%) were discharged on medication, namely morphine, and the median duration of NAS treatment was 76 (interquartile range 35-120). Three medication errors occurred: two extra doses of phenobarbitone and one infant weaned off morphine faster than prescribed. No infants were rehospitalised for NAS. Four died from sudden infant death syndrome at 2.2-5.8 months after discharge and one drowned at 15 months. None were medicated at the time of death. CONCLUSION: Outpatient care for drug-exposed infants was sustainable and had low complication rates, even for those with NAS. The optimum duration of follow-up and impact on hospital costs should be examined.

Cannabis, the pregnant woman and her child: weeding out the myths.

To review and summarise the literature reporting on cannabis use within western communities with specific reference to patterns of use, the pharmacology of its major psychoactive compounds, including placental and fetal transfer, and the impact of maternal cannabis use on pregnancy, the newborn infant and the developing child. Review of published articles, governmental guidelines and data and book chapters. Although cannabis is one of the most widely used illegal drugs, there is limited data about the prevalence of cannabis use in pregnant women, and it is likely that reported rates of exposure are significantly underestimated. With much of the available literature focusing on the impact of other illicit drugs such as opioids and stimulants, the effects of cannabis use in pregnancy on the developing fetus remain uncertain. Current evidence indicates that cannabis use both during pregnancy and lactation, may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation, with impacts on neuropsychiatric, behavioural and executive functioning. These reported effects may influence future adult productivity and lifetime outcomes. Despite the widespread use of cannabis by young women, there is limited information available about the impact perinatal cannabis use on the developing fetus and child, particularly the effects of cannabis use while breast feeding. Women who are using cannabis while pregnant and breast feeding should be advised of what is known about the potential adverse effects on fetal growth and development and encouraged to either stop using or decrease their use. Long-term follow-up of exposed children is crucial as neurocognitive and behavioural problems may benefit from early intervention aimed to reduce future problems such as delinquency, depression and substance use.

Amphetamines, the pregnant woman and her children: a review.

The objective of this study is to review and summarize available evidence regarding the impact of amphetamines on pregnancy, the newborn infant and the child. Amphetamines are neurostimulants and neurotoxins that are some of the most widely abused illicit drugs in the world. Users are at high risk of psychiatric co-morbidities, and evidence suggests that perinatal amphetamine exposure is associated with poor pregnancy outcomes, but data is confounded by other adverse factors associated with drug-dependency. Data sources are Government data, published articles, conference abstracts and book chapters. The global incidence of perinatal amphetamine exposure is most likely severely underestimated but acknowledged to be increasing rapidly, whereas exposure to other drugs, for example, heroin, is decreasing. Mothers known to be using amphetamines are at high risk of psychiatric co-morbidity and poorer obstetric outcomes, but their infants may escape detection, because the signs of withdrawal are usually less pronounced than opiate-exposed infants. There is little evidence of amphetamine-induced neurotoxicity and long-term neurodevelopmental impact, as data is scarce and difficult to extricate from the influence of other factors associated with children living in households where one or more parent uses drugs in terms of poverty and neglect. Perinatal amphetamine-exposure is an increasing worldwide concern, but robust research, especially for childhood outcomes, remains scarce. We suggest that exposed children may be at risk of ongoing developmental and behavioral impediment, and recommend that efforts be made to improve early detection of perinatal exposure and to increase provision of early-intervention services for affected children and their families.

How do readers know where to look next? Local information distributions influence eye fixations.

Skilled readers' eye movements were recorded as they inspected sentences in preparation for comprehension questions. The sentences were written around target words that had uneven distributions of information, in that the words were predictable, given either the first few letters or the last few letters. Some parts of these words can be described as being more important than others for successful word recognition, and the experiments asked whether inspection patterns reflect the uneven distributions. Four types of ten-letter word were used: words with highly redundant endings (e.g. engagement), with moderately redundant endings (e.g. repatriate), with moderately redundant beginnings (e.g. superstore), and words with informative beginnings and endings (e.g. amalgamate). Redundancy was defined operationally in terms of the number of possible completions of a word given the first few or last few letters. A highly redundant ending is therefore one that occurs frequently and cannot be used to identify the word. Words gaining just one fixation received this fixation nearer to the word's centre than in the case of the first fixation upon words gaining two fixations. The single fixation also had a longer duration, giving support to the notion of a convenient viewing location, which, when achieved, can lead to a net saving in inspection time. In the case of words with redundant endings gaining just one fixation, the fixation was nearer to the beginning of the word than in the case of words with informative endings, and this influence of word type upon the location of the first fixation was interpreted in favour of the parafoveal processing hypothesis of eye guidance during reading.

Eye fixations are influenced by the distribution of information within words.

Reader's eye movements were monitored while they inspected isolated words in preparation for a synonym judgement task. The 10-letter words appeared on a screen near the point of fixation, with the first fixation being imposed near the beginning, or the centre, or the ending of the word. The words themselves had uneven distributions of information, in that the beginnings or the endings contained common sequences of letters in English. Three types of words were used: those with very redundant endings (e.g., yearningly), with moderately redundant endings (e.g., varnishing), and with moderately redundant beginnings (e.g., contravene). Redundancy was defined in terms of the total number of words in English which possess that particular sequence of five letters as the beginning or the ending. The experiments asked whether the convenient viewing location within a word varied according to the distribution of information, and whether the extent of redundancy in a word ending is reflected in the distribution of visual attention given to the word. The results were analysed separately for those cases where the reader made just two fixations upon the word before moving to the synonym task, and for those cases where the reader made exactly three fixations. These were the dominant fixation patterns. Evidence for the notion of a convenient viewing position consisted of long first fixations (when there were just two fixations), when this fixation was near the centre of the word. The distribution of information within the words did not influence the duration of the first fixation, although the duration of the gaze within each half-word did increase when more informative letter sequences were being inspected. The extent of redundancy was also seen to influence the inspection patterns, when a comparison was made between the two types of words with redundant endings. Words with very redundant endings received fewer fixations when the first fixation was at the beginning, and for words gaining exactly two fixations, the second fixation was shorter if the word had a very redundant ending.

Information influences the pattern of eye fixations during sentence comprehension.

How does the pattern of eye fixation vary as an informative part of a word is encountered? If the processing of information lags behind the movement of the eyes, then we should expect no variation in the pattern; but if processing is immediate, then the movements of the reader's eyes should correspond to the distribution of information being inspected. An experiment is reported which examined the ways that the text ahead of the point of current fixation can be used to guide the eyes to future fixations, by monitoring fixations during a sentence comprehension task. The patterns of eye fixations upon words with uneven distributions of information (where, for example, words predictable from the sight of their first few letters but not from their last few letters are defined as containing informative beginnings) were observed, and it was found that more and longer fixations were produced when subjects looked at the informative parts of words, particularly at the informative endings of words. The results support the suggestion that eye movements are under the moment-to-moment control of cognitive mechanisms.