The authors are commended for attempting to elucidate the poorly understood consequences of neona... more The authors are commended for attempting to elucidate the poorly understood consequences of neonatal abstinence syndrome (NAS), a current global public health concern. 1 Contrasting school test results from children diagnosed with NAS with matched controls and other children, the authors conclude that NAS is "strongly associated with poor and deteriorating school performance." Determining academic risk for substance-exposed children could inform the need for early intervention services; therefore, the information could be important. We are concerned that this conclusion is not supported by the methodological approach, potentially leading to inaccurate perceptions by the public and policymakers.
The Journal of Clinical Endocrinology & Metabolism, 2008
Context/Objective: Hyperinsulinism with islet cell hyperplasia is a frequent complication, of unk... more Context/Objective: Hyperinsulinism with islet cell hyperplasia is a frequent complication, of unknown cause, in hemolytic disease of the newborn, occurring in Rh(D)-positive infants of Rh-isoimmunized Rh(D)-negative mothers, but not in infants with other hemolytic disorders. We investigated the possibility that trans-placentally acquired anti-D Ig is the cause of both conditions.Design: Monolayer cultures of human islet cells were exposed to sera from Rh-isoimmunized mothers and newborns, where jaundice, hyperinsulinism, and hypoglycemia in the infant had ensued. Parallel cultures with anti-D, specific anti-D monoclonal antibodies, normal human Ig (15 μg/ml), and serum controls were also undertaken. Islet cell proliferation was determined by [3H]thymidine incorporation. Insulin storage and chronic and acute insulin secretion to glucose were analyzed by RIA. Rh(D) surface antigen expression was determined on islet cells by flow cytometric analysis.Results: Islet cell proliferation an...
We determined the safety, feasibility and sustainability of an outpatient model of care for infan... more We determined the safety, feasibility and sustainability of an outpatient model of care for infants exposed to intra-uterine drugs. Methods: This was a retrospective chart review of 774 drug-exposed infants born between
Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal ... more Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. Mean test scores (range 0-1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with...
Paediatric and perinatal epidemiology, Jan 5, 2016
This study analyses the incidence of Neonatal Abstinence Syndrome (NAS) in a large geographically... more This study analyses the incidence of Neonatal Abstinence Syndrome (NAS) in a large geographically defined population in Australia. Database linkage analysis of all births between 2000 and 2011 in New South Wales (NSW), Australia. The diagnosis of NAS was derived from hospital coding P96.1, 'Neonatal withdrawal symptoms from maternal use of drugs of addiction'. Temporal trends were studied by comparing epoch 1 (2000-05) with epoch 2 (2006-11). The relationship with changes in maternal factors was further analysed. The NAS was coded in 3842 of 1 022 263 live born infants (0.38%). NAS incidence peaked at 5.07 per 1000 live births in 2002, decreasing to 3.18 in 2011 and was negatively correlated with maternal age (r = -0.7). The rate of NAS in epoch 2 (3.4 per 1000 births, 95% CI 3.28, 3.58) was significantly lower than in epoch 1 (4.1 per 1000 births, 95% CI 3.96, 4.33). Epoch 2 mothers were significantly older (mean 29.8 years vs. 28.3 years), less likely to be multiparous (OR...
Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after ... more Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS. Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1 018 421 live born infants without an NAS diagnosis. Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poiso...
Opiates are one of the most common drugs of dependence used by women of child-bearing age. Infant... more Opiates are one of the most common drugs of dependence used by women of child-bearing age. Infants may withdraw from maternal drugs for up to 6 months 1 and more than half of these babies 2 will need some form of medical treatment. Many of these infants are otherwise healthy 3 and have no other need to be in hospital. Discharge planning for the narcotic-dependent infant and mother, however, may be difficult because the socioeconomic milieu surrounding these families is frequently disadvantaged and parenting behaviours may be dysfunctional. Medical and nursing staff are commonly reluctant to discharge infants while they are still on pharmacological treatment because compliance with outpatient appointments is traditionally low. Such babies (and, often, their mothers) are thus commonly kept in hospital for lengthy periods, causing frustration for both staff and parents. We established a hospital-based weekly follow-up clinic in 1998 in an attempt to streamline the care of infants with the neonatal abstinence syndrome (NAS). Prior to this, the support team needed to maintain post-discharge care by frequent communications with a large number of individual paediatricians and family doctors, and community services and surveillance by home visits. The clinic's aim was to provide supportive, non-judgmental and coordinated care for these infants and their families after discharge from hospital, and this retrospective review examines the clinic's impact on the care of the term narcotic-dependent infant. METHODS We retrospectively reviewed the records of known narcoticdependent women and their term infants who were born at the Royal Hospital for Women from January 1995 to July 1999. These years were divided into two periods: (i) period A, from January 1995 to December 1997, was prior to the establishment of the clinic; and (ii) period B, from January 1998 to July 1999, was after. A specialized drug and alcohol support team, the Chemical Use in Pregnancy Service (CUPS) team, which comprises two drug and alcohol clinical nurse consultants, coordinates the perinatal care of substance-dependent women in the Southeastern Sydney Area Health Service. The CUPS team was first established at the Royal Hospital for Women during January 1995 and is responsible for the education and training of hospital staff in the recognition and management of substance-dependent women and infants. Pregnant women are interviewed by midwifery staff at the first antenatal point of contact, be it the antenatal clinic or delivery suite, and substance-dependent women are most commonly identified by detailed drug and alcohol-screening histories. Referrals to the CUPS team are also made from drug and alcohol services. Drug screens are not routinely performed on either the mother or the infant. All case records of narcotic-dependent mothers kept by the CUPS team were reviewed for the present study. These details were then cross-referenced with nursery
Aim: To determine the short-term outcomes of Australian buprenorphine-exposed mother/infant dyads... more Aim: To determine the short-term outcomes of Australian buprenorphine-exposed mother/infant dyads. Methods: Retrospective record review of drug-exposed mothers and infants in Australia. Groups were based on drug exposure: buprenorphine (55, 3.8%), non-buprenorphine opiates (O, 686, 48.6%) and non-opiates (NO, 671, 47.5%). Results: More than 30% of buprenorphine mothers continued to use heroin (21, 38%) and benzodiazepines (16, 29%). They were more likely to have child at risk concerns (29, 52.7%, P = 0.019) and have previous children placed in out-of-home care (9, 16.3%, P = 049). Buprenorphine babies were less likely to be preterm (16% vs. 25% (O), P = 0.001 and 23% (NO), P = 0.004) and had higher birthweights (median: 3165 g vs. 2842.5 g (O), P < 0.001 and 2900 g (NO), P = 0.004). Buprenorphine and non-buprenorphine opioid babies had similar maximum Finnegan scores (median 10 vs. 11(O), P = 0.144). The number of babies needing abstinence treatment (45% vs. 51% (O), P = 0.411) and length of hospital stay (median days 9 vs. 11(O), P = 0.067) were similar, but buprenorphine infants required lower maximum morphine doses (mg/kg/day) (median 0.4 mg vs. 0.5 mg (O), P = 0.009). Conclusions: Short-term medical outcomes of infants of buprenorphine-using mothers are similar to those of non-buprenorphine opiateusing mothers, but interpretation of these results is confounded by the high rates of polydrug exposure in the buprenorphine group. This and other social concerns noted in buprenorphine mothers and infants warrant further study.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2011
To determine the characteristics of dopamine D2 receptor gene (DRD2) polymorphisms in drug-expose... more To determine the characteristics of dopamine D2 receptor gene (DRD2) polymorphisms in drug-exposed and unexposed neonates and the relationship to neonatal abstinence syndrome (NAS). Retrospective case-control analysis between drug-exposed and unexposed infants between DRD2 polymorphisms, drug exposure and NAS treatment. Drug-exposed (n=48) and drug-free (n=49) infants born between March 1999 and December 2006. Analysis of DNA for the Taq1A, -141Ins/Del and Ser311Cys DRD2 polymorphisms. Drug exposure was determined by antenatal maternal drug and alcohol history. Frequency measures of DRD2 polymorphisms were compared between drug-exposed infants, treatment NAS medication and with control infants. Tertiary maternity hospital, Sydney, Australia. All infants were born in a good condition (25.7% &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;37 weeks gestation). Opiates (methadone and heroin) were used by 45 (93.8%) of drug-exposed mothers. The A2A2 allele was more common in drug-exposed infants (37 (77.0%) versus 23 (46.9%), p=0.003) but the A1A2 allele was more common in control infants (23 (46.9%) versus 4 (8.3%), p=0.00002). The-ins allele was more common in control (39 (79.6%) versus 20 (41.7%), p=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and unmedicated drug-exposed (14/25 (56%) versus 5/23 (21.7%), p=0.02) infants. The majority of infants (41 (83.7%) controls versus 41 (85.4%), p=1.000) expressed the least common, Ser polymorphism. DRD2 polymorphisms are detectable from DNA obtained from stored blood spots. The -ins allele is more common in control and unmedicated drug-exposed infants. Further study is recommended to explore postneonatal outcomes especially in relation to neuropsychiatric behaviours.
Defective regulation of apoptosis may be central to the development of autoimmune disorders. This... more Defective regulation of apoptosis may be central to the development of autoimmune disorders. This study investigated the possibility that the antirheumatic effect of hydroxycholoroquine (HCQ) may be achieved by up-regulation of apoptosis. Peripheral blood lymphocytes collected from normal controls and patients with systemic lupus erythematosus (SLE) were cultured in the presence or absence of a range of concentrations of HCQ. Cells undergoing apoptosis were identified by several standard methods, including morphologic changes, DNA fragmentation, and flow cytometry. For some experiments, lymphocytes were simultaneously stained with antibodies to T cell surface markers and with propidium iodide for dual-stain flow cytometric studies. HCQ was able to induce apoptosis in peripheral blood lymphocytes in a dose- and time-dependent manner. HCQ induced these changes in all T cell subpopulations studied. There was no significant difference between the controls and patients with SLE in terms of the percentage of apoptotic cells detected following treatment with HCQ. The present study demonstrated that HCQ induces apoptosis in peripheral blood lymphocytes, which leads to the speculation that HCQ may exert its antirheumatic effect through this mechanism.
Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after ... more Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS. Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1 018 421 live born infants without an NAS diagnosis. Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poiso...
The authors are commended for attempting to elucidate the poorly understood consequences of neona... more The authors are commended for attempting to elucidate the poorly understood consequences of neonatal abstinence syndrome (NAS), a current global public health concern. 1 Contrasting school test results from children diagnosed with NAS with matched controls and other children, the authors conclude that NAS is "strongly associated with poor and deteriorating school performance." Determining academic risk for substance-exposed children could inform the need for early intervention services; therefore, the information could be important. We are concerned that this conclusion is not supported by the methodological approach, potentially leading to inaccurate perceptions by the public and policymakers.
The Journal of Clinical Endocrinology & Metabolism, 2008
Context/Objective: Hyperinsulinism with islet cell hyperplasia is a frequent complication, of unk... more Context/Objective: Hyperinsulinism with islet cell hyperplasia is a frequent complication, of unknown cause, in hemolytic disease of the newborn, occurring in Rh(D)-positive infants of Rh-isoimmunized Rh(D)-negative mothers, but not in infants with other hemolytic disorders. We investigated the possibility that trans-placentally acquired anti-D Ig is the cause of both conditions.Design: Monolayer cultures of human islet cells were exposed to sera from Rh-isoimmunized mothers and newborns, where jaundice, hyperinsulinism, and hypoglycemia in the infant had ensued. Parallel cultures with anti-D, specific anti-D monoclonal antibodies, normal human Ig (15 μg/ml), and serum controls were also undertaken. Islet cell proliferation was determined by [3H]thymidine incorporation. Insulin storage and chronic and acute insulin secretion to glucose were analyzed by RIA. Rh(D) surface antigen expression was determined on islet cells by flow cytometric analysis.Results: Islet cell proliferation an...
We determined the safety, feasibility and sustainability of an outpatient model of care for infan... more We determined the safety, feasibility and sustainability of an outpatient model of care for infants exposed to intra-uterine drugs. Methods: This was a retrospective chart review of 774 drug-exposed infants born between
Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal ... more Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. Mean test scores (range 0-1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with...
Paediatric and perinatal epidemiology, Jan 5, 2016
This study analyses the incidence of Neonatal Abstinence Syndrome (NAS) in a large geographically... more This study analyses the incidence of Neonatal Abstinence Syndrome (NAS) in a large geographically defined population in Australia. Database linkage analysis of all births between 2000 and 2011 in New South Wales (NSW), Australia. The diagnosis of NAS was derived from hospital coding P96.1, 'Neonatal withdrawal symptoms from maternal use of drugs of addiction'. Temporal trends were studied by comparing epoch 1 (2000-05) with epoch 2 (2006-11). The relationship with changes in maternal factors was further analysed. The NAS was coded in 3842 of 1 022 263 live born infants (0.38%). NAS incidence peaked at 5.07 per 1000 live births in 2002, decreasing to 3.18 in 2011 and was negatively correlated with maternal age (r = -0.7). The rate of NAS in epoch 2 (3.4 per 1000 births, 95% CI 3.28, 3.58) was significantly lower than in epoch 1 (4.1 per 1000 births, 95% CI 3.96, 4.33). Epoch 2 mothers were significantly older (mean 29.8 years vs. 28.3 years), less likely to be multiparous (OR...
Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after ... more Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS. Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1 018 421 live born infants without an NAS diagnosis. Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poiso...
Opiates are one of the most common drugs of dependence used by women of child-bearing age. Infant... more Opiates are one of the most common drugs of dependence used by women of child-bearing age. Infants may withdraw from maternal drugs for up to 6 months 1 and more than half of these babies 2 will need some form of medical treatment. Many of these infants are otherwise healthy 3 and have no other need to be in hospital. Discharge planning for the narcotic-dependent infant and mother, however, may be difficult because the socioeconomic milieu surrounding these families is frequently disadvantaged and parenting behaviours may be dysfunctional. Medical and nursing staff are commonly reluctant to discharge infants while they are still on pharmacological treatment because compliance with outpatient appointments is traditionally low. Such babies (and, often, their mothers) are thus commonly kept in hospital for lengthy periods, causing frustration for both staff and parents. We established a hospital-based weekly follow-up clinic in 1998 in an attempt to streamline the care of infants with the neonatal abstinence syndrome (NAS). Prior to this, the support team needed to maintain post-discharge care by frequent communications with a large number of individual paediatricians and family doctors, and community services and surveillance by home visits. The clinic's aim was to provide supportive, non-judgmental and coordinated care for these infants and their families after discharge from hospital, and this retrospective review examines the clinic's impact on the care of the term narcotic-dependent infant. METHODS We retrospectively reviewed the records of known narcoticdependent women and their term infants who were born at the Royal Hospital for Women from January 1995 to July 1999. These years were divided into two periods: (i) period A, from January 1995 to December 1997, was prior to the establishment of the clinic; and (ii) period B, from January 1998 to July 1999, was after. A specialized drug and alcohol support team, the Chemical Use in Pregnancy Service (CUPS) team, which comprises two drug and alcohol clinical nurse consultants, coordinates the perinatal care of substance-dependent women in the Southeastern Sydney Area Health Service. The CUPS team was first established at the Royal Hospital for Women during January 1995 and is responsible for the education and training of hospital staff in the recognition and management of substance-dependent women and infants. Pregnant women are interviewed by midwifery staff at the first antenatal point of contact, be it the antenatal clinic or delivery suite, and substance-dependent women are most commonly identified by detailed drug and alcohol-screening histories. Referrals to the CUPS team are also made from drug and alcohol services. Drug screens are not routinely performed on either the mother or the infant. All case records of narcotic-dependent mothers kept by the CUPS team were reviewed for the present study. These details were then cross-referenced with nursery
Aim: To determine the short-term outcomes of Australian buprenorphine-exposed mother/infant dyads... more Aim: To determine the short-term outcomes of Australian buprenorphine-exposed mother/infant dyads. Methods: Retrospective record review of drug-exposed mothers and infants in Australia. Groups were based on drug exposure: buprenorphine (55, 3.8%), non-buprenorphine opiates (O, 686, 48.6%) and non-opiates (NO, 671, 47.5%). Results: More than 30% of buprenorphine mothers continued to use heroin (21, 38%) and benzodiazepines (16, 29%). They were more likely to have child at risk concerns (29, 52.7%, P = 0.019) and have previous children placed in out-of-home care (9, 16.3%, P = 049). Buprenorphine babies were less likely to be preterm (16% vs. 25% (O), P = 0.001 and 23% (NO), P = 0.004) and had higher birthweights (median: 3165 g vs. 2842.5 g (O), P < 0.001 and 2900 g (NO), P = 0.004). Buprenorphine and non-buprenorphine opioid babies had similar maximum Finnegan scores (median 10 vs. 11(O), P = 0.144). The number of babies needing abstinence treatment (45% vs. 51% (O), P = 0.411) and length of hospital stay (median days 9 vs. 11(O), P = 0.067) were similar, but buprenorphine infants required lower maximum morphine doses (mg/kg/day) (median 0.4 mg vs. 0.5 mg (O), P = 0.009). Conclusions: Short-term medical outcomes of infants of buprenorphine-using mothers are similar to those of non-buprenorphine opiateusing mothers, but interpretation of these results is confounded by the high rates of polydrug exposure in the buprenorphine group. This and other social concerns noted in buprenorphine mothers and infants warrant further study.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2011
To determine the characteristics of dopamine D2 receptor gene (DRD2) polymorphisms in drug-expose... more To determine the characteristics of dopamine D2 receptor gene (DRD2) polymorphisms in drug-exposed and unexposed neonates and the relationship to neonatal abstinence syndrome (NAS). Retrospective case-control analysis between drug-exposed and unexposed infants between DRD2 polymorphisms, drug exposure and NAS treatment. Drug-exposed (n=48) and drug-free (n=49) infants born between March 1999 and December 2006. Analysis of DNA for the Taq1A, -141Ins/Del and Ser311Cys DRD2 polymorphisms. Drug exposure was determined by antenatal maternal drug and alcohol history. Frequency measures of DRD2 polymorphisms were compared between drug-exposed infants, treatment NAS medication and with control infants. Tertiary maternity hospital, Sydney, Australia. All infants were born in a good condition (25.7% &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;37 weeks gestation). Opiates (methadone and heroin) were used by 45 (93.8%) of drug-exposed mothers. The A2A2 allele was more common in drug-exposed infants (37 (77.0%) versus 23 (46.9%), p=0.003) but the A1A2 allele was more common in control infants (23 (46.9%) versus 4 (8.3%), p=0.00002). The-ins allele was more common in control (39 (79.6%) versus 20 (41.7%), p=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and unmedicated drug-exposed (14/25 (56%) versus 5/23 (21.7%), p=0.02) infants. The majority of infants (41 (83.7%) controls versus 41 (85.4%), p=1.000) expressed the least common, Ser polymorphism. DRD2 polymorphisms are detectable from DNA obtained from stored blood spots. The -ins allele is more common in control and unmedicated drug-exposed infants. Further study is recommended to explore postneonatal outcomes especially in relation to neuropsychiatric behaviours.
Defective regulation of apoptosis may be central to the development of autoimmune disorders. This... more Defective regulation of apoptosis may be central to the development of autoimmune disorders. This study investigated the possibility that the antirheumatic effect of hydroxycholoroquine (HCQ) may be achieved by up-regulation of apoptosis. Peripheral blood lymphocytes collected from normal controls and patients with systemic lupus erythematosus (SLE) were cultured in the presence or absence of a range of concentrations of HCQ. Cells undergoing apoptosis were identified by several standard methods, including morphologic changes, DNA fragmentation, and flow cytometry. For some experiments, lymphocytes were simultaneously stained with antibodies to T cell surface markers and with propidium iodide for dual-stain flow cytometric studies. HCQ was able to induce apoptosis in peripheral blood lymphocytes in a dose- and time-dependent manner. HCQ induced these changes in all T cell subpopulations studied. There was no significant difference between the controls and patients with SLE in terms of the percentage of apoptotic cells detected following treatment with HCQ. The present study demonstrated that HCQ induces apoptosis in peripheral blood lymphocytes, which leads to the speculation that HCQ may exert its antirheumatic effect through this mechanism.
Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after ... more Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS. Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1 018 421 live born infants without an NAS diagnosis. Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poiso...
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Papers by John M Feller