Acute neonatal effects of cocaine exposure during pregnancy.
OBJECTIVE
To identify associations between cocaine exposure during pregnancy and medical conditions in newborn infants from birth through hospital discharge.


METHODS
Multisite, prospective, randomized study.


METHODS
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.


METHODS
Results of physical examination and conditions observed during hospitalization.


RESULTS
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).


CONCLUSIONS
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.
Bauer
Charles R
CR
Department of Pediatrics, University of Miami School of Medicine, Miami, FL 33101, USA.
Langer
John C
JC
Shankaran
Seetha
S
Bada
Henrietta S
HS
Lester
Barry
B
Wright
Linda L
LL
Krause-Steinrauf
Heidi
H
Smeriglio
Vincent L
VL
Finnegan
Loretta P
LP
Maza
Penelope L
PL
Verter
Joel
J
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001724:Birth Weight / Q000187:drug effects; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000150:complications*; D005260:Female; D005333:Fetus / Q000187:drug effects; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008470:Meconium / Q000737:chemistry; D008875:Middle Aged; D015997:Neonatal Screening; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D015995:Prevalence; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
D003042:Cocaine