An evaluation of rooming-in among substance-exposed newborns in British Columbia.

OBJECTIVE: Rooming-in, the practice of caring for mother and newborn together in the same room immediately from birth, is preferred for the general postpartum population but is not yet standard practice of care for newborns of substance-using women. Such newborns are usually separated from their mothers and admitted to a neonatal intensive care unit and treated for substance withdrawal if necessary. We compared clinical and psychosocial outcomes associated with traditional standard care models versus an interdisciplinary rooming-in model of care for substance-exposed newborns. METHODS: We conducted a retrospective comparative review of a cohort of substance-exposed newborns. Data were extracted from the British Columbia Perinatal Health Program database to populate the standard care and rooming-in groups. The main study outcomes were neonatal admission to NICU, breastfeeding, presence of neonatal withdrawal, length of stay, and custody status at discharge. RESULTS: Rooming-in was associated with a significant decrease in admissions to NICU and a shorter NICU length of stay for term infants, increased likelihood of breastfeeding (either exclusively or in combination with formula) during the hospital stay, and increased odds of the baby being discharged home with the mother. There were no significant differences between groups with respect to the presence of neonatal substance withdrawal or breastfeeding status at discharge. CONCLUSION: Rooming-in may facilitate a smooth transition to extrauterine life for substance-exposed newborns by decreasing NICU admissions and NICU length of stay for term infants, encouraging breastfeeding, and increasing maternal custody of infants at discharge. This review supports the finding that rooming-in is both safe and beneficial for substance-exposed babies.

A review of physician anaesthesia prescribing practices in an abortion clinic in British Columbia.

OBJECTIVE: The primary purpose of this study was to review the standard prescribing practices of physicians providing local anaesthesia in a major abortion clinic in British Columbia. METHODS: We conducted a retrospective review of patients who underwent a first trimester surgical abortion at the Comprehensive Abortion and Reproductive Education (CARE) Program at BC Women's Hospital and Health Centre during 2004 (n = 1546). Patients' demographics and reproductive history including age, weight, gestational age, and gravidity were recorded. Main outcomes recorded were dosage of lidocaine administered and amount of conscious sedation (midazolam and fentanyl) administered for pain management. Incidence of toxicity was also recorded. RESULTS: Almost one half (49.9%) of the patients received 20 mL of 0.5% lidocaine, and the remainder received 20 mL of 1.0% lidocaine. The volume of conscious sedation did not differ between groups. There was a positive correlation computed between midazolam and fentanyl dosages (r = 0.583, P < 0.01). Neither was significantly associated with gravidity. Gestational age was associated with both midazolam and fentanyl dose (r = 0.05, P = 0.047; r = 0.06, P = 0.024). There was no reported incidence of toxicity. CONCLUSION: Similar doses of midazolam and fentanyl were administered to patients regardless of the amount of lidocaine given (20 mL of either 0.5% or 1.0%). Further investigation is required to assess whether fentanyl and midazolam doses used during procedures can be used as surrogate measurements of pain. Our findings suggest it would be reasonable to consider using a lower dose of local anaesthetic for first trimester abortions to further reduce the risk of toxicity.