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Substance misuse in pregnant women – reduction in neonatal abstinence syndrome following introduction of a multidisciplinary management guideline
  1. L Elliott,
  2. C Mullan,
  3. J Davies
  1. Blackpool Victoria Hospital, Blackpool, UK

Abstract

Blackpool consistently tops a list of the highest drug mortality rates in the UK. A significant number of pregnancies in Blackpool are complicated by substance misuse, with major implications for the developing fetus and its neonatal outcome.

A specialist midwife and multidisciplinary guideline for the management of these women was established in 2009, providing one-to-one care with the specialist midwife and lead consultant. The key aims are reducing harm, by carrying out risk assessment, and stabilising drug use, via substitute prescribing or inpatient detoxification. An individualised plan of care is made for all women. This study compared the neonatal outcome for babies of substance misusing women before and after implementation of the multidisciplinary guideline.

In 2009, before the guideline was fully implemented, 41 substance misusers were cared for antenatally. 16 of these affected babies (39%) were admitted to the neonatal unit due to neonatal abstinence syndrome (NAS). In 2010, when the guideline was fully operational, 49 substance misusers were cared for antenatally. None of these babies were admitted due to NAS. It also means that the majority of women have shorter hospital stays, with resultant reduction in costs.

The results show a significant reduction in neonatal morbidity and are associated with improved quality and reduced cost. The figures show the true success story of providing multidisciplinary care. Perhaps the most important outcome is providing these vulnerable women with healthcare practitioners who they can trust and who can provide real results in terms of outcomes that matter to them.

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