title: Risk of intracranial hemorrhage and other adverse outcomes after cocaine exposure in a cohort of 323 very low birth weight infants.
abstract: We conducted a prospective cohort study of 323 consecutively born very low birth weight infants (< or = 1499 gm) to determine any association between prenatal cocaine exposure and (1) intracranial ultrasonographic abnormalities and (2) other adverse perinatal outcomes. The infants were assigned to either a cocaine-exposed group (n = 86) or a cocaine-nonexposed group (n = 146) on the basis of combined detection methods for prenatal maternal cocaine abuse including maternal history, maternal and infant urine immunoassay (Emit), and meconium analysis (high-performance liquid chromatography and gas chromatography-mass spectrometry). Ninety-one infants were not assigned because of early death before complete testing (n = 80) or missed tests (n = 11). The detected incidence of cocaine exposure in the assigned population was 37% (86/232). Meconium testing with high-performance liquid chromatography and gas chromatography-mass spectrometry was the sole means of detection in 30% (26/86) of cases. The cocaine-nonexposed infants did not differ from the cocaine-exposed infants in the incidence of intraventricular hemorrhage (36% vs 35%), grades III and IV intraventricular hemorrhage (14% vs 14%), or periventricular leukomalacia (4% vs 2%). Adverse outcomes increased by cocaine exposure were abruptio placentae (8% vs 18%; p = 0.046), surgical ligation of a patent ductus arteriosus (1% vs 7%; p = 0.02), and seizures (5% vs 17%; p = 0.004). We conclude that prenatal cocaine exposure does not increase the incidence or severity of intracranial hemorrhage or periventricular leukomalacia but does increase the risk of abruptio placentae, surgical ligation of a patent ductus arteriosus and seizures in very low birth weight infants.
authors.affiliation: Department of Pediatrics, University of Chicago, IL 60637.
authors.forename: A M
authors.initials: AM
authors.lastname: Dusick
authors.forename: R F
authors.initials: RF
authors.lastname: Covert
authors.forename: M D
authors.initials: MD
authors.lastname: Schreiber
authors.forename: G T
authors.initials: GT
authors.lastname: Yee
authors.forename: S P
authors.initials: SP
authors.lastname: Browne
authors.forename: C M
authors.initials: CM
authors.lastname: Moore
authors.forename: I R
authors.initials: IR
authors.lastname: Tebbett
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003042:Cocaine / Q000032:analysis; D015331:Cohort Studies; D004374:Ductus Arteriosus, Patent / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight / Q000652:urine; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000652:urine; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000652:urine; D014463:Ultrasonography
chemical_list: D003042:Cocaine