Coordinated outpatient care of the narcotic-dependent infant

Objective: Concern regarding parental capacity to manage their infant's drug withdrawal traditionally leads to prolonged hospitalization for both mother and infant. This study examines the impact of a multidisciplinary follow-up clinic for infants discharged home on morphine. Methodology: Records of full-term infants born to mothers with narcotic dependency were reviewed retrospectively. Two periods were compared: 1995-1997 (period A) and 1998 to September 1999 with clinic established (period B). Results: Twenty-five and 26 mothers were identified in periods A and B, respectively. Almost half had fewer than four antenatal clinic visits and most were on methadone with other substance usage. Despite higher maternal methadone doses (mean 48.5 vs 89.5 mg/day, P = 0.009) and withdrawal rates, the mean length of stay was significantly shorter for period B mothers (7.8 +/- 4.8 vs 5.4 +/- 3.3 days, P = 0.01) and babies (14.8 +/- 9.7 vs 8.7 +/- 7.2, P = 0.01). Median duration of morphine treatment was significantly shorter in period A (17 vs 60 days, P = 0.0001) when only four babies were discharged on morphine. In contrast, 18 treated period B babies were discharged on morphine. No families were lost to follow up. Compliance with clinic attendance was 92%. Conclusions: Hospital stay was reduced with establishment of the clinic. The shorter treatment duration before establishment of the clinic could have been related to a lesser abstinence severity or a perceived need of a more rapid weaning prior to discharge. Further studies are needed to assess the impact of this model of care on the health outcome of the narcotic-dependent mother and infant unit.