Chairman: We will move on to the second part of the meeting. I welcome Dr. Adrienne Foran, consultant neonatologist from the Rotunda Hospital. Deputy Catherine Byrne has raised the issue of babies born to mothers with substance abuse issues. We said we would use this meeting as an opportunity to examine the matter. Dr. Foran, you are very welcome. Thank you for being here.

Dr. Adrienne Foran: I thank Deputy Catherine Byrne for bringing up this important issue. I am a consultant neonatologist in the Rotunda Hospital and in the Children's University Hospital, Temple Street. I am also a member of the national clinical advisory group for neonatology. Recently, I was appointed as clinical director of Temple Street hospital.

The Rotunda and Coombe hospitals are in a unique position. They tend to have the largest volume of these patients. The document before the committee goes through the matter in more detail but in the interests of time, I will try to summarise it.

Neonatal abstinence tends to pertain to those babies who are withdrawing from mothers who are substance abusers, generally of opiates, including heroin and methadone, as well as other hypnotics. What we have seen in the past five or ten years is that the majority of these mothers are polydrug users. One of the greatest challenges in delivering a maternity service arises where the mother is on a benzodiazepine, for example, Valium or sleeping tablets. She may not always declare it. The half-life of these drugs is far longer than for others, so the baby may not actually withdraw for two to three weeks and by then the baby is home. The way we manage that and how we identify it are major challenges.

There is a policy in the UK and in some centres in the United States to encourage these mothers to abstain during pregnancy. We have found, through research between the Coombe and the Rotunda undertaken by our chief pharmacist, Brian Cleary, that this is probably not a good model. What tends to happen is that if we ask the mother to abstain she actually disengages from the services, does not attend her antenatal clinic and gets into far more trouble during the pregnancy. A good deal of research suggests that keeping these women on a methadone programme is actually safer for mother and baby.

Approximately 100 per year come to our services in the Rotunda. I have given the committee our clinical specialist midwife report. Some 68 of these delivered in 2014. Up to 10% of our deliveries, approximately 1,000 babies per year of the 9,000 delivered in the Rotunda, are admitted to the neonatal unit. Of the 68 deliveries, 33 were admitted for a variety of reasons, not always for neonatal abstinence syndrome. It may have been because they were born more premature or because they had problems with blood sugar. Approximately one third, that is, ten or 11 of that figure - sometimes it could be 15 or 20 - would have had full-blown neonatal abstinence syndrome.

One difficulty is that it is not necessarily the dose of the drug or the number of drugs the mother is on. Some babies have a genetic predisposition to withdraw more acutely while others withdraw more chronically. There are major social issues dealing with these mothers. They often come from troubled backgrounds. They do not have very good parental models. They may have had other children who are already in care. There are complex social issues. Having a drug liaison midwife has made a major difference....

[For the full debate click on this link to the Oireachtas website]