Multidisciplinary antenatal care for opiate-using women: Child-care issues.

INTRODUCTION AND AIMS: The fact that particular parents suffer afflictions limiting their ability to care does not mean that they should automatically be deemed unsuitable parents. Prompted by neonatal team concerns about child-care issues, a local multidisciplinary group was set up to care for substance-abusing pregnant women in our region. DESIGN AND METHODS: This project was conducted in order to review the records of all the women who had been discussed at our management planning meetings over the past 5 years. Our assessment tool records were reviewed and analysed using spss. RESULTS: A total of 233 women were assessed. The majority of patients booked before 20 weeks (62%) and 96 women (41%) attended over 80% of their antenatal appointments. There was little change in substance use during the course of pregnancy. Overall, at delivery, 196 of the 233 women (84%) used methadone and 89(38%) used heroin. There was no correlation between usage and foster care of the baby (methadone: chi(2) = 0.5, P = 0.8 NS) (heroin: chi(2) = 3.1, P = 0.08 NS). There was an absolute correlation between social services involvement and foster care (chi(2) = 2.33, P < 0.0001). Adherence with planned antenatal appointments significantly increased the likelihood of a child being discharged with his mother (chi(2) = 6.7, P = 0.009). DISCUSSION AND CONCLUSIONS: The majority of newborns were discharged home with their mothers directly with the most significant factor in placing a child in foster care being prior involvement of social services. However, many of these families will continue to need support during the children's early years.

Heliox with inhaled nitric oxide: a novel strategy for severe localized interstitial pulmonary emphysema in preterm neonatal ventilation.

We describe the combined use of inhaled nitric oxide and heliox (79% helium and 21% oxygen) as a rescue therapy for a critically ill infant with localized interstitial pulmonary emphysema and pulmonary hypertension. Conventional interventions were ineffective, not feasible, or unlikely to take effect in time, during this infant's acute critical illness. We added heliox based on its known pulmonary effects, and inhaled nitric oxide to improve oxygenation, after echocardiographic evidence of high right-ventricular pressure. The infant made a full recovery. To our knowledge this is the first case report of heliox and inhaled nitric oxide used simultaneously in localized interstitial pulmonary emphysema.

Focal dermal hypoplasia with subependymal heterotopia and hypoplastic corpus callosum.

A case is reported with right-sided abnormalities involving the brain, eyelid, eye, face and chest. The features described are similar to those found in conditions including focal dermal hypoplasia, microphthalmia with linear skin defects, oculocerebrocutaneous syndrome and terminal osseous dysplasia and pigmentary defects. However, none of these conditions, fully explains the collection of abnormalities found in this patient.