title: Incidence of passive exposure to crack/cocaine and clinical findings in infants seen in an outpatient service.
abstract: OBJECTIVE
  Passive exposure to crack/cocaine and the associated clinical symptoms may present a significant health risk to very young infants and children. This study was designed to determine the incidence of cocaine exposure, presumed to be passive, in ill infants younger than 1 year of age, using a threshold of detection for cocaine and/or its major metabolite, benzoylecognine (BE), that is lower than the current National Institute on Drug Abuse standard. The study also investigates the morbidity associated with passive cocaine exposure in this population.
  
  
  METHODS
  We prospectively obtained 124 samples of urine from 122 children younger than 1 year of age for routine clinical indications from the emergency department at Yale-New Haven Hospital. Samples were analyzed by radioimmunoassay (RIA) for cocaine, with cross-reactivity for BE. The presence of BE in a portion of the RIA-positive samples also was detected in additional analyses by enzyme-multiplied immunoassay technique or by gas chromatography-mass spectrometry. A chart review was conducted on all 122 patients by reviewers blind to the urine toxicology results. Presenting complaints, symptoms, vital signs, and diagnosis were obtained for all visits before the first birthday. Birth history, including maternal drug history and birth weight, demographics, and number of medical visits in the first year, were recorded as well.
  
  
  RESULTS
  Of the 124 samples, 45 (36.3%) were positive (>/=50 ng/mL of BE equivalents) for cocaine and/or cocaine metabolite by RIA testing. The positive results, determined by RIA, were highly correlated with patients who had lower and upper respiratory symptoms and sought medical care more often.
  
  
  CONCLUSIONS
  The incidence of unsuspected, passive cocaine exposure in ill infants seeking medical care primarily through an emergency service may be as high as 1 in 3 to 6 infants from our predominantly inner city population. Current immunoassay methods, specific for BE, and their routine threshold of detection (200 to 300 ng/mL) may not be sensitive enough to detect cocaine and BE in the urine samples of children younger than 1 year of age who are exposed passively. The development of upper and lower respiratory symptoms is correlated significantly with positive urine results in this study. The increased use of health care resources correlated with passive cocaine exposure in this sample may serve as an indirect marker for the increased medical needs of these infants.
authors.affiliation: Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Lustbader
authors.forename: L C
authors.initials: LC
authors.lastname: Mayes
authors.forename: B A
authors.initials: BA
authors.lastname: McGee
authors.forename: P
authors.initials: P
authors.lastname: Jatlow
authors.forename: W L
authors.initials: WL
authors.lastname: Roberts
mesh_terms: D003042:Cocaine / Q000652:urine*; D003237:Connecticut / Q000453:epidemiology; D016578:Crack Cocaine; D004784:Environmental Monitoring; D017248:Enzyme Multiplied Immunoassay Technique; D062665:Epidemiological Monitoring; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D009294:Narcotics / Q000652:urine*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D011863:Radioimmunoassay; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015813:Substance Abuse Detection
chemical_list: D016578:Crack Cocaine; D009294:Narcotics; D003042:Cocaine