Paediatrician Professor Ian Wright. Photo by Paul Jones.

IHMRI researchers have found a worrying trend in the educational outcomes of babies born with Neonatal Abstinence Syndrome (NAS)

When a woman uses addictive drugs during pregnancy, her baby is likely to suffer from Neonatal Abstinence Syndrome (NAS) when born. Babies with NAS have similar withdrawal symptoms to adult drug users who are trying to quit, including vomiting, diarrhoea, tremors, fever and sweating.

Previous research by Professor Ian Wright from the University of Wollongong’s (UOW) School of Medicine, and his colleagues, found that newborn children diagnosed with NAS have an increased risk of a prolonged hospital stay. These children are also more likely to be re-hospitalised in childhood for maltreatment and trauma, as well as mental and behavioural disorders.

Although researchers suspected that children with NAS might be at risk of ongoing neurodevelopmental and cognitive problems, the difficulties of long-term follow up with these patients made it difficult to test this theory. Until now.

To help fill this knowledge gap, Professor Wright joined a research team led by Dr Ju-lee Oei from the University of New South Wales (UNSW), that also included Professor Ted Melhuish from UOW’s Early Start Research Institute.

The team conducted a long-term study using National Assessment Program for Literacy and Numeracy (NAPLAN) results to trace the downstream effect of NAS on educational outcomes. Introduced in 2008, NAPLAN is a compulsory curriculum-based test for all students in years three, five, seven and nine in Australia.

The researchers compared a group of 2,234 babies born with NAS in New South Wales between 2000 and 2006, with a control group of 4,330 children matched for gestation, socioeconomic status and gender, and with other NSW children born during the same time period. They then analysed the mean test results of each group in schooling years three, five and seven from NAPLAN data.

“The findings are stark,” says Professor Ian Wright. “By year three, mean test scores for children with NAS were significantly lower than the two other cohorts, and results deteriorate even more by high school. By year seven, children with NAS scored lower than other children in year five.”

The outlook for children born with NAS is complex. School performance is an important indicator of childhood development, and failure at school can lead poor outcomes in adult life, including psychiatric and physical illness, unemployment, delinquency, crime, drug use and intergenerational disadvantage. Dysfunctional parental behaviour stemming from continued drug use makes for a disruptive home environment, which may also affect a child’s performance at school—and this was acknowledged by the researchers.

With NAS one of the fastest growing public health problems in the world, this study could not be more timely.

“We believe that this study provides a compelling reason to support children with NAS beyond the withdrawal stage to minimise risk of school failure and its consequences,” states Professor Wright. “Interestingly, significant geographical variation exists in this data, suggesting that these outcomes are not inevitable for children exposed to drugs or staying with their families.”

“The high risk of poor academic performance in this vulnerable group of children is applicable to all countries. Strategies to address this risk, and prevent poor adult outcomes and intergenerational vulnerability, should be urgently addressed.”

Read the full paper: Oei JL, Melhuish E, Uebel H, et al. Neonatal Abstinence Syndrome and High School Performance. Paediatrics. 2017;139 (2):e20162651

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