morphine and Cocaine-Related-Disorders

Abusive use of drugs is a public health problem worldwide. The use of these substances by pregnant or lactating women can have many serious side effects in newborns. Among the commonest causes of addiction in drug users is cocaine in powdered form, inhaled, intravenously injected or smoked form (crack). Fast screening and a confirmation test using high specificity and sensitivity instruments such as LC-MS or GC/MS, can provide data to qualify and quantify chemical substances present in biological samples such as breast milk or meconium. Cocaine and/or crack can be detected through biomarkers or the unchanged molecule, enabling the form of cocaine use to be distinguished through the analytes. These methods must be carefully developed and validated according to internationally recognized guidelines. Thus, the study of biological matrices in which it can be detected through the development of simple and quick analytical methods can help prevent intoxication and diagnose the symptoms of dependency such as seizures, especially in babies, providing appropriate medical care.

Topics: Biomarkers; Chromatography, Liquid; Cocaine-Related Disorders; Crack Cocaine; Female; Forensic Toxicology; Humans; Lactation; Mass Spectrometry; Meconium; Milk, Human; Pregnancy

Despite extensive evidence of fetal and neonatal risk, a large number of pregnant women are involved in excessive alcohol and drug abuse, such as with cocaine, methamphetamine, opioids, and cannabinoids.

Topics: Adolescent; Adult; Alcohol-Related Disorders; Amphetamine-Related Disorders; Biomarkers; Cannabinoids; Child Welfare; Child, Preschool; Cocaine-Related Disorders; Esters; Fatty Acids; Female; Hair; Humans; Infant; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Substance Abuse Detection; Substance-Related Disorders

To identify associations between cocaine exposure during pregnancy and medical conditions in newborn infants from birth through hospital discharge.. Multisite, prospective, randomized study.. Brown University, University of Miami, University of Tennessee (Memphis), and Wayne State University. Subjects A total of 717 cocaine-exposed infants and 7442 nonexposed infants.. Results of physical examination and conditions observed during hospitalization.. Cocaine-exposed infants were about 1.2 weeks younger, weighed 536 g less, measured 2.6 cm shorter, and had head circumference 1.5 cm smaller than nonexposed infants (all P<.001). Results did not confirm previously reported abnormalities. Central and autonomic nervous system symptoms were more frequent in the exposed group: jittery/tremors (adjusted odds ratio, 2.17; 99% confidence interval, 1.44-3.29), high-pitched cry (2.44; 1.06-5.66), irritability (1.81; 1.18-2.80), excessive suck (3.58; 1.63-7.88), hyperalertness (7.78; 1.72-35.06), and autonomic instability (2.64; 1.17-5.95). No differences were detected in organ systems by ultrasound examination. Exposed infants had more infections (3.09; 1.76-5.45), including hepatitis (13.46; 7.46-24.29), syphilis (8.84; 3.74-20.88), and human immunodeficiency virus exposure (12.37; 2.20-69.51); were less often breastfed (0.26; 0.15-0.44); had more child protective services referrals (48.92; 28.77-83.20); and were more often not living with their biological mother (18.70; 10.53-33.20).. Central and autonomic nervous system symptoms were more frequent in the exposed cohort and persisted in an adjusted analysis. They were usually transient and may be a true cocaine effect. Abnormal anatomic outcomes previously reported were not confirmed. Increased infections, particularly sexually transmitted diseases, pose a serious public health challenge. Exposure increased involvement of child protective services and out-of-home placement.

Topics: Abnormalities, Drug-Induced; Acute Disease; Adolescent; Adult; Birth Weight; Cocaine; Cocaine-Related Disorders; Female; Fetus; Gestational Age; Humans; Infant, Newborn; Meconium; Middle Aged; Neonatal Screening; Pregnancy; Prenatal Exposure Delayed Effects; Prevalence; Prospective Studies; United States

This was a prospective longitudinal multisite study of the effects of prenatal cocaine and/or opiate exposure on neurodevelopmental outcome in term and preterm infants at 1 month of age.. The sample included 658 exposed and 730 comparison infants matched on race, gender, and gestational age (11.7% born <33 weeks' gestational age). Mothers were recruited at 4 urban university-based centers and were mostly black and on public assistance. Exposure was determined by meconium assay and self-report with alcohol, marijuana, and tobacco present in both groups. At 1 month corrected age, infants were tested by masked examiners with the NICU Network Neurobehavioral Scale and acoustical cry analysis. Exposed and comparison groups were compared adjusting for covariates (alcohol, marijuana, tobacco, birth weight, social class, and site). Separate analyses were conducted for level of cocaine exposure.. On the NICU Network Neurobehavioral Scale, cocaine exposure was related to lower arousal, poorer quality of movement and self-regulation, higher excitability, more hypertonia, and more nonoptimal reflexes with most effects maintained after adjustment for covariates. Some effects were associated with heavy cocaine exposure, and effects were also found for opiates, alcohol, marijuana, and birth weight. Acoustic cry characteristics that reflect reactivity, respiratory, and neural control of the cry sound were also compromised by prenatal drug exposure, including cocaine, opiates, alcohol, and marijuana and by birth weight. Fewer cry effects remained after adjustment for covariates.. Cocaine effects are subtle and can be detected when studied in the context of polydrug use and level of cocaine exposure. Effects of other drugs even at low thresholds can also be observed in the context of a polydrug model. The ability to detect these drug effects requires a large sample and neurobehavioral tests that are differentially sensitive to drug effects. Long-term follow-up is necessary to determine whether these differences develop into clinically significant deficits.

Topics: Adult; Alcohol Drinking; Analysis of Variance; Child Development; Cocaine-Related Disorders; Female; Humans; Infant, Newborn; Life Style; Longitudinal Studies; Meconium; Nervous System; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prospective Studies; Smoking

In this study, a quantitative polarity switching liquid chromatography coupled with a tandem mass spectrometer (LC-MS/MS) method was developed to detect and quantify cocaine and metabolites (cocaethylene, benzoylecgonine and meta-hydroxybenzoylecgonine), phencyclidine (PCP) and barbiturates (phenobarbital and butalbital) in meconium. Accuracy and precision samples at 0.0125% and 75% of the upper limit of quantitation (ULOQ) were analyzed in triplicate over 5 days with accuracy above 84% and average %CV values below 11%. Within-run (n = 15) and between-run (n = 15) %CV values were ≤5%. Analytical measurement ranges were reproducible and linear (R ≥ 0.995) for cocaine and metabolites (20-2,000 ng/g), PCP (10-1,000 ng/g) and barbiturates (50-5,000 ng/g). Accuracy of 100 ± 20% was observed at (the limits of detection) 10 ng/g for cocaine and metabolites, 2.5 ng/g for PCP and 25 ng/g for barbiturates. No carryover was observed at 2X ULOQ and no interfering substances were identified. Sample preparation recoveries were 53-83%. Fifty-one authentic patient samples previously characterized correlated with the newly developed test having R2 values ≥0.996. This combined method allows accurate quantitation of the targeted drugs in a complex matrix while decreasing sample preparation and analysis time with reduced sample volume. Clinical data and positivity rates were similar to previously published positivity rates. Validation data and positivity rate agreement signifies a reliable and robust assay.

Topics: Barbiturates; Biotransformation; Chromatography, Liquid; Cocaine; Cocaine-Related Disorders; Female; Humans; Limit of Detection; Meconium; Pentobarbital; Phencyclidine; Phencyclidine Abuse; Predictive Value of Tests; Pregnancy; Reproducibility of Results; Substance Abuse Detection; Tandem Mass Spectrometry; Workflow

Topics: Adolescent; Adult; Cocaine-Related Disorders; Enzyme-Linked Immunosorbent Assay; Female; Gas Chromatography-Mass Spectrometry; Hospitals, University; Humans; Marijuana Abuse; Meconium; Pregnancy; Pregnancy Complications; Prevalence; Socioeconomic Factors; Substance Abuse Detection; Trinidad and Tobago; Young Adult

Prenatal cocaine exposure (PCE) is associated with blunted stress responsivity within the extrauterine environment. This study investigated the association between PCE and diurnal salivary cortisol levels in preadolescent children characterized by high biological and/or social risk (n = 725). Saliva samples were collected at their home. Analyses revealed no group differences in basal evening or morning cortisol levels; however, children with higher degrees of PCE exhibited blunted overnight increases in cortisol, controlling for additional risk factors. Race and caregiver depression were also associated with diurnal cortisol patterns. Although repeated PCE may contribute to alterations in the normal or expected stress response later in life, sociodemographic and environmental factors are likewise important in understanding hormone physiology, especially as more time elapses from the PCE. Anticipating the potential long-term medical, developmental, or behavioral effects of an altered ability to mount a normal protective cortisol stress response is essential in optimizing the outcomes of children with PCE.

Topics: Analysis of Variance; Caregivers; Child; Circadian Rhythm; Cocaine-Related Disorders; Female; Gas Chromatography-Mass Spectrometry; Humans; Hydrocortisone; Immunoassay; Infant, Newborn; Linear Models; Male; Meconium; Pregnancy; Prenatal Exposure Delayed Effects; Racial Groups; Risk Factors; Salivary Glands; Social Environment; Socioeconomic Factors; Stress, Physiological

Methadone is standard pharmacotherapy for opioid-dependent pregnant women, yet the relationship between maternal methadone dose and neonatal abstinence syndrome (NAS) severity is still unclear. This research evaluated whether quantification of fetal methadone and drug exposure via meconium would reflect maternal dose and predict neonatal outcomes.. Prospective clinical study.. An urban drug treatment facility treating pregnant and post-partum women and their children.. Forty-nine opioid-dependent pregnant women received 30-110 mg methadone daily.. Maternal methadone dose, infant birth parameters and NAS assessments were extracted from medical records. Thrice-weekly urine specimens were screened for opioids and cocaine. Newborn meconium specimens were quantified for methadone, opioid, cocaine and tobacco biomarkers.. There was no relationship between meconium methadone concentrations, presence of opioids, cocaine and/or tobacco in meconium, maternal methadone dose or NAS severity. Opioid and cocaine were also found in 36.7 and 38.8 of meconium specimens, respectively, and were associated with positive urine specimens in the third trimester. The presence of opioids other than methadone in meconium correlated with increased rates of preterm birth, longer infant hospital stays and decreased maternal time in drug treatment.. Methadone and its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) concentrations in meconium did not predict infant birth parameters or NAS severity. Prospective urine testing defined meconium drug detection windows for opiates and cocaine as 3 months, rather than the currently accepted 6 months. The presence of opioids in meconium could be used as a biomarker for infants at elevated risk in the newborn period.

Topics: Adult; Analgesics, Opioid; Cocaine; Cocaine-Related Disorders; Female; Gestational Age; Humans; Infant, Newborn; Length of Stay; Meconium; Methadone; Narcotics; Neonatal Abstinence Syndrome; Opiate Substitution Treatment; Opioid-Related Disorders; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Exposure Delayed Effects; Prospective Studies; Substance Abuse Detection; Young Adult

Cocaine use during pregnancy is difficult to ascertain, and maternal reports are likely to be inaccurate. Presently, the dose-response characteristics between maternal cocaine use and fetal exposure and adverse effects are unknown. Clinically, some babies are harmed, whereas others are not adversely affected. Taking advantage of the fact that cocaine and its metabolite benzoylecgonine (BE) accumulate and can be detected months after exposure in maternal and neonatal hair, an analytical test for cocaine and BE was developed by the authors. The aim of this study was to describe the characteristics of maternal and neonatal hair cocaine as biomarkers of fetal exposure. Of nearly 10,000 cases, all mother-child pairs in whom at least one had cocaine and/or BE detected in hair were identified. The relationship between maternal and neonatal levels was studied. When available, these data were also compared with meconium levels of cocaine. Median cocaine concentration was 10-fold higher in hair of the mothers compared with the neonates (3.56 ng/mg vs 0.31 ng/mg of hair). Infants' cocaine in hair was positively correlated with maternal cocaine and BE in hair (r2 = 0.41 and r2 = 0.22, respectively, P < 0.001 for both correlations). Infants' BE was also correlated with maternal cocaine and BE concentrations in hair (r2 = 0.50 and r2 = 0.27, P < 0.001 for both correlations). Thirty-nine (40%) babies had negative cocaine and BE results despite their mothers being positive. Mothers whose infants were cocaine-positive had a median hair cocaine concentration of 7.34 ng/mg, significantly higher than those whose infants were negative (1.25 ng/mg). Maternal cocaine levels below 0.24 ng/mg may serve as a relative threshold for detectable fetal exposure during the third trimester of pregnancy. Fetal hair grows in the last trimester. Hence, a positive neonatal hair indicates maternal use after pregnancy became known, a strong indicator of maternal addiction. Transplacental exposure to cocaine of babies of addicted mothers is highly variable. The dose-response relationship of both cocaine and BE between maternal and neonatal hair suggests that the placenta protects some fetuses but not others. More research is needed to understand the mechanisms leading to placental defense against cocaine.

Topics: Cocaine; Cocaine-Related Disorders; Dose-Response Relationship, Drug; Female; Hair; Humans; Infant; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Pregnancy; Substance Abuse Detection; Time Factors

The objective of this study was to examine the effects of prenatal cocaine and polydrug exposure on language development of preschool children using a prospective longitudinal model, controlling for confounders.. Children who were exposed to cocaine in utero (n = 209) and nonexposed children (n = 189) were followed prospectively at birth and at 1, 2, 4, and 6 years of age and were compared on receptive, expressive, and total language scores across time using random coefficient models, controlling for confounders.. A significant, stable effect of cocaine exposure on language development was observed over time for all language domains, with cocaine exposure related to poorer language performance. Cigarette exposure was related to lower receptive language scores. Environmental influences on language scores were also observed. Both the cocaine-exposed and nonexposed children declined in language performance over time.. Prenatal cocaine exposure has a stable negative effect on language skills during the first 6 years of life. Both cocaine-exposed and nonexposed children showed decreased language growth over time; however, cocaine-exposed children demonstrated linguistic deficits compared with nonexposed peers and did not catch up. Cigarette and environmental influences were also noted.

Topics: Adult; Child; Child, Preschool; Cocaine; Cocaine-Related Disorders; Female; Humans; Infant; Language Development; Language Development Disorders; Longitudinal Studies; Meconium; Pregnancy; Prenatal Exposure Delayed Effects; Smoking

To determine the auditory brainstem response (ABR) patterns in infants with prenatal cocaine exposure as detected by meconium analysis.. Meconium drug analysis was done on term infants who were at risk for antenatal illicit drug exposure. Infants who tested positive for cocaine served as the exposed group; those who tested negative served as control subjects. An ABR was done on the infants within 6 days of life. Absolute latencies at 40 and 70 decibels (dB) of waves I, III, and V and interpeak latencies between I and III, III and V, and I and V were measured.. Among 58 infants in the study, 21 (35.6%) were positive, by meconium analysis, for cocaine and 5 (8.5%) were positive for cannabinoids. Four infants tested positive for cocaine, although their mothers denied illicit drug use. There was a significant difference in mean maternal age, gravidity, parity, birth weight, and head circumference among cocaine-exposed versus nonexposed infants. The ABR from cocaine-positive infants showed significantly prolonged mean absolute latencies in both ears as compared with nonexposed infants: right ear at 40 dB III (4.823 vs 4.447 milliseconds), 40 dB V (7.400 vs 6.968 milliseconds), 70 dB I (2.111 vs 1.631 milliseconds), and 70 dB III (4.122 vs 3.821 milliseconds); left ear at 40 dB III (4.820 vs 4.444 milliseconds), 40 dB V (7.460 vs 6.860 milliseconds), 70 dB I (2.063 vs 1.741 milliseconds), 70 dB III (4.026 vs 3.656 milliseconds), and 70 dB V (6.568 vs 6.258 milliseconds). The interpeak latency was not significantly different except in 1 cocaine-positive infant: left ear at 40 dB III to V (2.667 vs 2.417 milliseconds).. The ABR in neonates who are exposed prenatally to cocaine shows prolonged absolute peak latencies compared with nonexposed neonates and may indicate compromise of the auditory system from gestational exposure to cocaine that will need additional audiologic follow-up. Meconium analysis can more accurately detect the infants who are at risk.

Topics: Case-Control Studies; Cocaine; Cocaine-Related Disorders; Evoked Potentials, Auditory, Brain Stem; Female; Humans; Infant, Newborn; Meconium; Pregnancy; Prenatal Exposure Delayed Effects

The influence of prenatal cocaine exposure on children's language functioning was evaluated longitudinally at six time points from 4 months to 3 years of age. The Miami Prenatal Cocaine Study prospectively enrolled 476 full-term African-American infants at birth, categorized as cocaine-exposed (n = 253) or non-cocaine-exposed (n = 223) by maternal self-report and bioassays (maternal/infant urine, meconium). The Bayley Scales of Infant Development, scored using the Kent Scoring Adaptation for language, was administered at 4, 8, 12, 18, and 24 months. The Clinical Evaluation of Language Fundamentals-Preschool was administered at 3 years. In longitudinal analyses using Generalized Estimating Equations, cocaine-exposed children had lower overall language skills than non-cocaine-exposed children (D = -0.151; 95% CI = -0.269, -0.033; p =.012). Longitudinal findings remained stable after evaluation of potential confounding influences including other prenatal substance exposures and sociodemographic factors. Preliminary evidence also indicated possible mediation through an intermediary effect involving cocaine-associated deficits in fetal growth.

Topics: Case-Control Studies; Child, Preschool; Cocaine; Cocaine-Related Disorders; Female; Humans; Infant; Infant, Newborn; Language Development Disorders; Language Tests; Longitudinal Studies; Meconium; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects

The study objective was to evaluate the quality of parent-child interactions in preschool-aged children exposed prenatally to cocaine. African-American mothers and their full-term newborns (n = 343) were enrolled prospectively at birth and classified as either prenatally cocaine-exposed (n = 157) or non-cocaine-exposed (n = 186) on the basis of maternal self-report and bioassays. Follow-up evaluations at 3 years of age (mean age, 40 mo) included a videotaped dyadic play session and maternal interviews to assess ongoing drug use and maternal psychological distress. Play interactions were coded using a modified version of Egeland et al's Teaching Task coding scheme. Regression analyses indicated cocaine-associated deficits in mother-child interaction, even with statistical adjustment for multiple suspected influences on interaction dynamics. Mother-child interactions were most impaired in cocaine-exposed dyads when the mother continued to report cocaine use at the 3-year follow-up. Multivariate profile analysis of the Egeland interaction subscales indicated greater maternal intrusiveness and hostility, poorer quality of instruction, lower maternal confidence, and diminished child persistence in the cocaine-exposed dyads.

Topics: Adult; Child, Preschool; Cocaine; Cocaine-Related Disorders; Cohort Studies; Depression; Female; Follow-Up Studies; Humans; Infant, Newborn; Maternal Behavior; Meconium; Mother-Child Relations; Mothers; Play and Playthings; Pregnancy; Prenatal Exposure Delayed Effects; Videotape Recording

Maternal use of cocaine during pregnancy remains a significant public health problem, particularly in urban areas of the United States and among women of low socioeconomic status. Few longitudinal studies have examined cocaine-exposed infants, however, and findings are contradictory because of methodologic limitations.. To assess the effects of prenatal cocaine exposure on child developmental outcomes.. Longitudinal, prospective, masked, comparison birth cohort study with recruitment in 1994-1996.. Obstetric unit of a large US urban teaching hospital.. Four hundred fifteen consecutively enrolled infants (218 cocaine-exposed and 197 unexposed) identified from a high-risk, low-socioeconomic status, primarily black (80%) population screened through clinical interview and urine and meconium samples for drug use. The retention rate was 94% at 2 years of age.. The Bayley Mental and Motor Scales of Infant Development, assessed at 6.5, 12, and 24 months of corrected age.. Controlled for confounding variables, cocaine exposure had significant effects on cognitive development, accounting for a 6-point deficit in Bayley Mental and Motor Scales of Infant Development scores at 2 years, with cocaine-exposed children twice as likely to have significant delay (mental development index <80) (odds ratio, 1.98; 95% confidence interval, 1.21-3.24; P =.006). For motor outcomes, there were no significant cocaine effects.. Cocaine-exposed children had significant cognitive deficits and a doubling of the rate of developmental delay during the first 2 years of life. Because 2-year outcomes are predictive of later cognitive outcomes, it is possible that these children will continue to have learning difficulties at school age.

Topics: Apgar Score; Birth Weight; Cocaine-Related Disorders; Cognition; Developmental Disabilities; Female; Gestational Age; Humans; Infant; Longitudinal Studies; Male; Meconium; Neuropsychological Tests; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Psychomotor Performance; Socioeconomic Factors; Statistics, Nonparametric

To compare the sensitivity and specificity of maternal interview, maternal hair analysis, and meconium analysis in detecting perinatal exposure to cocaine, opiate, and cannabinoid.. The use of cocaine, opiate, and cannabinoid during pregnancy was determined prospectively in 58 women by 3 methods: structured maternal interview, maternal hair analysis, and meconium analyses. The results of the 3 methods were compared with one another.. The maternal interview showed the lowest sensitivity in detecting cocaine and opiate exposures (65% and 67%, respectively), but it had the highest sensitivity in detecting cannabinoid exposure (58%). Both hair and meconium analyses had high sensitivity for detecting cocaine or opiate exposures. Hair analysis had a sensitivity of 100% for cocaine and 80% for opiate detection. However, it had a false-positive rate of 13% for cocaine and 20% for opiate, probably as a result of passive exposure. Meconium analysis had a sensitivity of 87% for cocaine and 77% for opiate detection, but unlike hair analysis, it had no false-positive test results for cocaine. Both hair and meconium analyses had low sensitivity in detecting cannabinoid exposure (21%-22.7%), most probably because of the sporadic use of cannabinoid.. Meconium and hair analyses had the highest sensitivities for detecting perinatal use of cocaine and opiate, but not for cannabinoid. The principal drawback of hair analysis is its potential for false-positive test results associated with passive exposure to drugs. Maternal interview is a time-consuming test of low sensitivity. The high sensitivity of meconium analysis and the ease of collection make this test ideal for perinatal drug screening.

Topics: Adult; Cocaine-Related Disorders; Female; Hair; Humans; Infant, Newborn; Interviews as Topic; Marijuana Abuse; Meconium; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prospective Studies; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders

To assess whether there is an association of level of fetal cocaine exposure to developmental precursors of speech-language skills at 1 year of age, after controlling for confounding factors.. In a prospective, longitudinal, quasi-experimental, matched cohort design, 3 cocaine exposure groups were defined by maternal self-report and infant meconium assay: nonexposure (n = 131), heavier exposure (n = 66), >the 75th percentile for maternal self-report and >the 70th percentile of benzoylecgonine concentration, and all others as lighter exposure (n = 68). At 1 year of age, the Preschool Language Scale-3 was administered by examiners unaware of infant drug status.. Independent of confounding drug, medical, and environmental factors, more heavily exposed infants had lower auditory comprehension scores than nonexposed infants and lower total language scores than lighter and nonexposed infants. More heavily exposed infants were also more likely to be classified as mildly delayed by total language score than nonexposed infants. There were positive linear relationships between the concentration of benzoylecgonine in meconium and all outcomes and between maternal report of severity of prenatal cocaine use with poorer auditory comprehension indicating a relationship between amount of exposure and poorer outcomes.. This study documents significant behavioral teratogenic effects of fetal cocaine exposure on attentional abilities underlying auditory comprehension skills considered to be precursors of receptive language. Pediatricians are in a unique position to monitor early development of cocaine-exposed infants and make timely referrals for intervention.

Topics: Analysis of Variance; Cocaine; Cocaine-Related Disorders; Female; Humans; Infant; Infant, Newborn; Language Development Disorders; Language Tests; Longitudinal Studies; Male; Meconium; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Regression Analysis; Statistics, Nonparametric

Topics: Adult; Cocaine-Related Disorders; Delivery, Obstetric; Female; Humans; Infant, Newborn; Meconium; Midwifery; Pregnancy; Pregnancy Complications

To assess whether there is an association between the level of in utero cocaine exposure and findings on neonatal cranial ultrasound, controlling for potentially confounding variables.. In a prospective longitudinal study, three cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or of meconium benzoylecogonine concentration) or lighter cocaine exposure (all others). Neonatal ultrasounds from 241 well, term infants were read by a single radiologist who was masked to the exposure group.. Infants with lighter cocaine exposure did not differ from the unexposed infants on any ultrasound findings. After controlling for infant gender, gestational age, and birth weight z scores and for maternal parity, blood pressure in labor, ethnicity, and use of cigarettes, alcohol, and marijuana during pregnancy, the more heavily cocaine-exposed infants were more likely than the unexposed infants to show subependymal hemorrhage in the caudothalamic groove (covariate adjusted odds ratio: 3.88; 95% confidence interval: 1.45, 10.35).. This is the first study to demonstrate that ultrasound findings suggestive of vascular injury to the neonatal central nervous system are related to the level of prenatal cocaine exposure. Inconsistency in previous research in identifying an association between prenatal cocaine exposure and neonatal cranial ultrasound findings may reflect failure to consider dose effects.

Topics: Cocaine; Cocaine-Related Disorders; Dose-Response Relationship, Drug; Echoencephalography; Female; Fetus; Humans; Infant, Newborn; Intracranial Hemorrhages; Longitudinal Studies; Meconium; Odds Ratio; Pregnancy; Pregnancy Complications; Prospective Studies; Risk Factors