Neurologic manifestations of in utero cocaine exposure in near-term and term infants.
ABSTRACT To determine whether the incidence of neurosonographic and neurologic abnormalities is higher in cocaine-exposed infants at birth.
In utero exposure to cocaine was investigated in 39 term and near-term infants with positive urine screens for cocaine only and 39 matched control infants without drug exposure admitted to the regular term newborn nursery. Serial evaluations were performed on each infant on postnatal days 1 and 2 and included a cranial sonogram, a neurologic and behavioral assessment for drug withdrawal, and Doppler interrogation of the anterior and middle cerebral arteries.
There were no differences between groups in neurosonographic abnormalities. Grade I or II intraventricular hemorrhage occurred in 11% of cocaine-exposed and 11% of control infants. There were no cases of grade III intraventricular hemorrhage, cystic periventricular leukomalacia, or neonatal stroke. Head size was smaller in cocaine-exposed infants, ie, 32.7 +/- 0.1 cm versus 33.8 +/- 0.1 cm. The neurologic examination was similar between groups with regard to tone, reflexes, and cranial nerves. Behavioral scores were higher on both days, in cocaine-exposed versus control infants, ie, 4.4 +/- 0.5 versus 2.7 +/- 0.03 on day 1 and 5.0 +/- 0.5 versus 1.71 +/- 0.31 on day 2. Cerebral blood flow velocity measurements in the anterior cerebral artery were similar between groups on both days of examination. However, cocaine-exposed infants demonstrated a significant increase in flow velocity from day 1 to day 2, ie, 0.48 +/- 0.03 to 0.57 +/- 0.04. There was a concomitant decrease in the pulsatility index from day 1 to day 2 in the cocaine-exposed, ie, 0.74 +/- 0.02 to 0.69 +/- 0.02, but not in the control infants. No differences were noted in the flow velocities in the middle cerebral arteries between groups.
Term and near-term infants admitted to a regular nursery who are exposed to cocaine in utero: (1) do not exhibit an increased incidence of neurosonographic abnormalities; (2) do exhibit altered behavior consistent with drug withdrawal; and (3) do demonstrate changes in flow velocity in the anterior cerebral artery consistent with the vasoconstrictive effects of the drug. However, these changes were not accompanied by changes in the neurologic examination or altered care. The long-term neurodevelopmental implications of these subtle abnormalities in the neonatal period remain to be determined.
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ABSTRACT: Complex methodologic challenges face researchers studying the effects of prenatal cocaine exposure on infant outcome. These include unavoidable imprecision in ascertaining the gestational timing and dose of cocaine to which the fetus was exposed and difficulties in identifying and quantifying the confounding, mediating, and moderating variables. Review of research on neonatal behavioral and cranial ultrasound findings following in utero cocaine exposure is used to illustrate these issues. We conclude that there are measurable but not dramatic dose-related effects of prenatal cocaine exposure on infant central nervous system structure and function. The effects of dose of prenatal cocaine exposure on later child development remain to be determined. Such research would be facilitated by a scientific consensus delineating relative doses of prenatal cocaine exposure.Annals of the New York Academy of Sciences 02/2006; 846(1):40 - 50. · 4.38 Impact Factor
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ABSTRACT: Background: Preterm neonates are exposed to mul- tiple painful procedures after birth and exhibit acute physi- ological responses to pain. Occurrence of early intraven- tricular hemorrhage within 24 to 72 hours after birth suggests a role of pain and stress in the multifactorial cau- sation of severe intraventricular hemorrhage and peri- ventricular leukomalacia. We proposed that such neu- rologic outcomes in preterm neonates who require ventilatory support may be reduced by morphine anal- gesia or midazolam sedation compared with a placebo. Objectives: To define the incidence of clinical out- comes in the target study population, to estimate the ef- fect size and adverse effects associated with analgesia and sedation, and to calculate the sample size for a defini- tive test of this hypothesis. Methods: Sixty-seven preterm neonates were randomized in a pilot clinical trial from 9 centers. Neonates of 24 to 32 weeks' gestation were eligible if they had been intubated and required ventilatory support for less than 8 hours and if they were enrolled within 72 hours after birth. Exclusion crite- ria included major congenital anomalies, severe intrapar- tum asphyxia, and participation in other research studies. Severity of illness was assessed by the Clinical Risk Index for Babies, and neonates were randomized to receive con- tinuous infusions of morphine sulfate, midazolam hydro- chloride, or 10% dextrose (placebo). Masked study medi- cations were continued as long as clinically necessary, then weaned and stopped according to predefined criteria. Lev- els of sedation (COMFORT scores) and responses to pain (Premature Infant Pain Profile scores) were measured be- fore, during, and 12 hours after discontinuation of drug in- fusion. Cranial ultrasound examinations were performed as part of routine practice, and poor neurologic outcomes were defined as neonatal death, severe intraventricular hem- orrhage (grade III or IV), or periventricular leukomalacia. Results: No significant differences occurred in the de- mographic, clinical, and socioeconomic variables related to mothers and neonates in the 3 groups or in the sever- ity of illness at birth as measured by Clinical Risk Index for Babies scores. Two neonates in the placebo group and 1 neonate in the midazolam group died; no deaths oc- curred in the morphine group. Poor neurologic out- comes occurred in 24% of neonates in the placebo group, 32% in the midazolam group, and 4% in the morphine group (likelihood ratio x 2 = 7.04, P = .03). Secondary clini- cal outcomes and neurobehavioral outcomes at 36 weeks' postconceptional age were similar in the 3 groups. Re- sponses elicited by endotracheal tube suction (Prema- ture Infant Pain Profile scores) were significantly re- duced during the morphine (P,.001) and midazolam (P = .002) infusions compared with the placebo group. Conclusions: This pilot trial suggests that preemptive analgesia given by continuous low-dose morphine infu- sion may reduce the incidence of poor neurologic out- comes in preterm neonates who require ventilatory sup- port. Limitations in the sample size of this pilot study suggest that these results should be confirmed in a large multicenter randomized trial. Arch Pediatr Adolesc Med. 1999;153:331-338Archives of Pediatrics and Adolescent Medicine 04/1999; 153(4). · 4.25 Impact Factor
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ABSTRACT: BACKGROUND: Prenatal exposure to cocaine has been associated with a wide spectrum of structural abnormalities in infant brains. The growing use of crack, a smokable and extremely addictive form of cocaine, could exacerbate the situation. OBJECTIVE: The purpose of this study was to determine the frequency, type and severity of cerebral lesions detected by transfontanellar US in newborns exposed to crack during gestation. MATERIALS AND METHODS: This was a retrospective study, involving a review of the medical records of children who were born to crack-using women and who were subjected to transfontanellar US imaging during their first days of life. RESULTS: Transfontanellar US revealed abnormalities in 45/129 newborns examined (34.9%). The changes detected were subependymal cysts in 24 infants (18.6%), lenticulostriate vasculopathy in 18 infants (14%), subependymal hemorrhage in 9 infants (7%), and choroid plexus cysts in 9 infants (7%). CONCLUSION: All of the abnormalities found by US examination were discrete and likely without clinical significance for the babies. However, prospective studies with a long period of tracking are needed to determine whether there are later consequences on the neurodevelopment of children with prenatal exposure to crack.Pediatric Radiology 11/2012; · 1.65 Impact Factor