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Visual outcome in infants born to drug-misusing mothers prescribed methadone in pregnancy
  1. Laura McGlone1,
  2. Ruth Hamilton2,3,
  3. Daphne L McCulloch4,
  4. Jane R MacKinnon5,
  5. Michael Bradnam2,3,
  6. Helen Mactier6
  1. 1Neonatal Unit, Royal Hospital for Sick Children, Glasgow, UK
  2. 2Departments of Clinical Physics, Royal Hospital for Sick Children, Glasgow, UK
  3. 3College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  4. 4Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
  5. 5Department of Ophthalmology, Raigmore Hospital, Inverness and previously Royal Hospital for Sick Children, Glasgow, UK
  6. 6Neonatal Unit, Princess Royal Maternity, Glasgow, UK
  1. Correspondence to Dr Laura McGlone, Neonatal Unit, Royal Hospital for Sick Children, Dalnair Street, Yorkhill, Glasgow G38SJ, UK; lauramcglone{at}doctors.org.uk

Abstract

Background Flash visual evoked potentials (VEPs) were abnormal in a cohort of 100 neonates exposed to maintenance methadone in utero. This prospective cohort study now describes clinical visual and electrophysiological outcomes at 6 months.

Methods Visual assessment included modified Atkinson test battery; strabismus, nystagmus, reduced visual acuity, delayed visual maturation or refractive error (>3 dioptres) defined a fail. Pattern-onset VEPs were recorded to 120′, 60′ and 15′ checks.

Results 81 drug-exposed and 26 comparison infants (79% and 52% of the original cohorts) were assessed at a median age of 27 weeks (range 26–30). 90% of drug-exposed infants had been additionally exposed to illicit drugs and 41% to excess alcohol in utero. 40% of the drug-exposed cohort failed clinical visual assessment: the relative risk of abnormal assessment was 5.1 (95% CI 1.3 to 20; p=0.02). Nystagmus was particularly common. VEP peak times were slower and amplitudes smaller in drug-exposed infants, of whom 70% had one or more abnormal VEP parameter. Abnormal visual outcome at 6 months was not associated with the pattern of additional drug exposure or a history of neonatal abstinence.

Conclusions Abnormal visual electrophysiology in infants born to drug-misusing mothers prescribed maintenance methadone persists to 6 months of age, and is associated with abnormal clinical visual assessment.

  • Child Health (Paediatrics)
  • Drugs
  • Electrophysiology

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