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ObjectivesTo determine incidence, associated factors, outcomes and geographical occurrence of born before arrival (BBA) in New South Wales, Australia.DesignA linked population data study involving population-based surveillance systems was undertaken for the years 2000–2011.SettingNew South Wales, Australia.ParticipantsAll women who underwent BBA compared with women who birthed in hospital/birth centre settings.ResultsDuring the time period, there were 1 097 653 births and a BBA rate of 4.6 per 1000 births. The BBA rate changed from 4.2 to 4.8 per 1000 births over time (p=0.06). Neonates BBA were more likely to be premature (12.5% compared with 7.3%), of lower birth weight (209.8 g mean difference) and/or be admitted to a special care nursery or neonatal intensive care unit (20.6% compared with 15.6%). The perinatal mortality rate was significantly higher in the BBA cohort (34.6 compared with 9.3 per 1000 births). Women in the BBA cohort were more likely to be in the lowest socioeconomic decile, multiparous, have higher rates of smoking (30.5% compared with 13.8%) and more likely to suffer a postpartum haemorrhage requiring transfusion than the non-BBA cohort (1.5% compared with 0.7%). The most commonly occurring complications for neonates were suspected infection (6.9%), hypothermia (6.9%), respiratory distress (5.4%), congenital abnormality (4.0%) and neonatal withdrawal symptoms (2.4%). BBA more commonly occurred in geographical areas where the distance to a maternity unit is >2 hours drive and in coastal regions where there is also a high rate of homebirth.ConclusionBBA occurs more frequently in multiparous women of lower socioeconomic status. There potentially is an effect of geography on the occurrence of BBA, as geographical area of high homebirth and BBA coexists, indicating that freebirth followed by an unplanned transfer to hospital may be occurring.

AIM: To determine whether neonates born to mothers who are volatile substance abusers are at risk for an abstinence syndrome. METHODS: A consecutive sample of infants born to volatile substance abusing mothers was studied over four years, in a university affiliated medical centre with a variable mix of primary, secondary, and tertiary care patients. Infants were clinically scored with the Finnegan Neonatal Abstinence Scoring System. Those who fulfilled a priori scoring criteria were treated with phenobarbital and scoring was continued. RESULTS: There were 48 babies of whom 32 fulfilled the criteria for pharmacotherapy. All eight babies with the characteristic odour, and 15 of the 21 born to mothers with that odour, fulfilled these criteria. The typical symptoms were excessive and high pitched cry, sleeplessness, hyperactive Moro reflex, tremor, hypotonia, and poor feeding. Mean age of onset of treatment was 27.1 hours and mean duration was 5.8 days. Treatment was judged effective in 17 of 27, while benefit was borderline in three and absent in seven. CONCLUSIONS: It is suggested that there is an identifiable neonatal volatile substance abuse abstinence syndrome. The characteristic chemical odour in the neonate or mother is a marker for its occurrence, and phenobarbital treatment seems to be effective. The Finnegan Scoring System seems to be useful for grading its severity.

Background Anecdotally there is increasing trend of drug usage in pregnancy and hence neonatal withdrawal (NAS). There are difficulties in early detection because of a) Reluctance of expectant mothers, late booking and poor attendance at antenatal follow up due to fear of social services. Objectives 1) Establish prevalence in L&D Hospital. 2) Establish outcomes of urine toxicology (chain of custody in place) and implication on management. 3) Establish transparency in drug users regarding information of drug use. Methods Retrospective collection of urine toxicology requests to chemical pathology from Feb 2009 to Oct 2012. Requests were based on self-revelation of drug use by pregnant women and of those suspected during antenatal follow up. Data collection using antenatal database (CMIS), South England neonatal database (SEND) and pathology request database, ensuring no loss of data. Results Total requests: 106. 37% were negative (Some may represent false negatives). Out of 63% positive results, 54% were multidrug users. 72% positive results were not consistent with the substance of use suggested or suspected. None with negative results withdrew and discharged in 2–3 days once results available reducing length of stay. 40% Pregnant on methadone program. Only 11% had an employment or were students. 70% women were single or separated and 25% didn’t disclose their marital status. 19% required treatment.

Selective serotonin reuptake inhibitors (SSRIs) are often prescribed during pregnancy. It has long been debated whether adverse neonatal effects described after maternal SSRI use1–4 are caused by serotonin toxicity or withdrawal.5 Recently, the information of a database analysis of 93 suspected cases of SSRI induced neonatal withdrawal has been regarded as enough information to confirm a possible causal relation.6 We describe six infants with neonatal symptoms …

Editor—Paroxetine is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) group. Its use during pregnancy can lead to premature birth and neonatal withdrawal symptoms. A girl was born after 35+2 weeks gestation (birth weight 2690 g) and admitted because of prematurity. The pregnancy and delivery had been uneventful (Apgar score 9/10/10), with no apparent reason for prematurity. There were no problems in the first few days and she drank quickly (bottle feeding). Thereafter she …