Thirty-six-month outcome of prenatal cocaine exposure for term or near-term infants: impact of early case management.
Gestational cocaine use is associated with serious pregnancy complications having fetal and neonatal implications. However, many cocaine-abusing women deliver uneventfully at term. The purpose of this study was to assess the neurodevelopmental outcome for term or near-term infants after prenatal cocaine exposure and to determine whether that outcome would be modified by early, intensive family case management. Cocaine-exposed infants identified after delivery at an urban hospital were alternately assigned to receive case management (n = 70) or routine follow-up (n = 48). A matched, non-drug-exposed group of infants was identified for comparison (n = 41). Infants aged up to 36 months were serially evaluated in a multidisciplinary clinic with cognitive, psychomotor, and language testing. Group comparisons were performed using one-way analysis of variance. There were no statistical differences in mean cognitive, psychomotor, or language quotients between cocaine-exposed and non-drug-exposed infant groups aged up to 36 months. At 6 months of age, case-managed cocaine-exposed infants had a significantly higher mean Bayley Mental Developmental Index score than those who were routinely managed. However, no differences were present at subsequent assessments. Among cocaine-exposed infants who remained with their mothers at 36 months, verbal scores were significantly higher for case-managed compared with routine-managed infants. The negative effects of urban, low socioeconomic status may overshadow the impact of prenatal cocaine exposure on early childhood outcome for those infants born without prenatal complications.
Kilbride
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Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, 64108, USA. hkilbride@cmh.edu
Castor
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Hoffman
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E
Fuger
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KL
D000328:Adult; D000367:Age Factors; D019090:Case Management; D019970:Cocaine-Related Disorders / Q000150:complications; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000209:etiology*; D005072:Evoked Potentials, Auditory / Q000502:physiology; D005074:Evoked Potentials, Visual / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008425:Maternal Behavior / Q000523:psychology; D009460:Neurologic Examination; D011247:Pregnancy; D011248:Pregnancy Complications; D011297:Prenatal Exposure Delayed Effects; D012720:Severity of Illness Index