NEONATAL DRUG-ADDICTION

In the twenty years since the first case of neonatal drug addiction (r esulting from the mother's use during pregnancy of morphine, heroin, m ethadone, cocaine) was referred to our attention, there has been a ste ady increase in the number of cases per year. Heroin alone or in assoc iation with methadone now represents the drug used by approximately 80 % of addicted mothers. Over the past few years the mean age of mothers has increased; the number of drug users who do not appear to be addic ts has also increased and a number of cases have lately been discovere d only on the basis of neonatal symptoms, without any previous anamnes tic indication. Neonatal abstinence syndrome (NAS) is the most strikin g effect of fetal exposure to drugs. Symptoms are easily recognised; p harmacological treatment can consist of either sedatives or replacemen t drugs whose dosage depends on the severity of withdrawal symptoms ev aluated using a score system. NAS symptoms are usually resolved within a few days although some signs, especially irritability and tremors, may persist until 3 months of age. The main concern at present regards the future of these neonates. The most severe risk to which they are exposed, after HIV infection, is social; during the past few years in over 50% of cases parental authority has been suspended by the juvenil e court. No long-term neurologic or cognitive deficits are directly as sociated with heroin or methadone use during pregnancy.