Related Experiment Video
Updated: May 20, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Association between out-of-home care and mortality in children with prenatal drug exposure: a retrospective
Kate Lawler1, Mithilesh Dronavalli1,2, Hannah Uebel1,3
1Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Out-of-home care (OOHC) significantly reduces mortality risk for children exposed to drugs during pregnancy (PDE). This protective effect was observed across various maternal drug exposures, including opioids, stimulants, and cannabis.
Area of Science:
- Public Health
- Pediatrics
- Neonatal Care
Background:
- Prenatal drug exposure (PDE) is associated with increased childhood mortality.
- Understanding protective factors for children with PDE is crucial for public health interventions.
- Out-of-home care (OOHC) is a potential intervention for vulnerable children.
Purpose of the Study:
- To investigate whether out-of-home care (OOHC) mitigates the risk of death in children with prenatal drug exposure (PDE).
- To quantify the protective effect of OOHC across different categories of PDE.
Main Methods:
- Population-based cohort study utilizing linked administrative data from New South Wales, Australia (2001-2020).
- Identified children with PDE, categorized into neonatal abstinence syndrome (NAS), PDE without NAS, and exclusive tobacco exposure.
- Employed multivariate regression and causal mediation analyses to assess the impact of OOHC on mortality.
Main Results:
- Children with PDE exhibited a higher risk of death compared to unexposed children, with the highest risk observed in infants with NAS (HR=4.20).
- Out-of-home care (OOHC) demonstrated a significant protective effect, reducing the risk of death for children with PDE (NAS: OR=0.5; PDE without NAS: OR=0.8).
- Subanalyses confirmed OOHC's protective effect across maternal opioid (OR=0.7), stimulant (OR=0.8), and cannabis (OR=0.9) use.
Conclusions:
- Any form of out-of-home care (OOHC) is associated with a reduced risk of death for children experiencing prenatal drug exposure (PDE).
- These findings underscore the critical role of OOHC interventions in safeguarding vulnerable children with PDE.
- Emphasizes the need for strengths-based, culturally sensitive OOHC services for children with PDE.
Objective:
To determine if out-of-home care (OOHC) reduces the risk of death in children with prenatal drug exposure (PDE).
Design:
Population-based cohort study.
Setting:
New South Wales, Australia.
Patients:
Children with PDE, born between 2001 and 2020 and discharged alive after birth.
Exposure:
PDE was defined as intrauterine exposure to maternal use of drugs of addiction, categorised into (1) neonatal abstinence syndrome (NAS) (n=5978); (2) exposure to maternal drugs of addiction, but not meeting diagnostic criteria for NAS (n=12 162); and (3) exposure to maternal exclusive tobacco smoking (n=187 827). Subanalyses by type of maternal drug use (opioids, stimulants and cannabis) were conducted.
Main Outcome Measures:
Multivariate regression analyses of linked administrative data were used to determine the primary outcome of death after birth hospital discharge. Causal mediation analyses assessed the mediating effect of OOHC between PDE and mortality.
Results:
Compared with no exposure, PDE was associated with a higher risk of childhood death. Risks were highest for infants with NAS (HR=4.20, 95% CI=3.23 to 5.44), followed by infants with PDE but no NAS diagnosis (HR=2.53, 95% CI=2.01 to 3.18). Mediation analyses demonstrated a natural indirect protective effect of OOHC in reducing risk of death (NAS: OR=0.5, 95% CI=0.5 to 0.5; PDE but no NAS diagnosis: OR=0.8, 95% CI=0.8 to 0.8). Subanalyses demonstrated a protective effect of OOHC for three types of maternal drug use (opioids: OR=0.7; stimulants: OR=0.8; cannabis: OR=0.9).
Conclusions:
Any OOHC intervention was associated with reduced risk of death for children with PDE, emphasising the importance of strengths-based, culturally-sensitive support for this vulnerable population.
More Related Videos
Related Concept Videos
01:21Factors Affecting Drug Response: Overview
01:07Teratogenicity
01:19Pharmacovigilance
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
01:20Comparing the Survival Analysis of Two or More Groups
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
01:25Mutagenicity and Carcinogenicity