title: Prenatal substance exposure: neurobiologic organization at 1 month.
abstract: OBJECTIVE
  To examine the autonomic nervous system and neurobehavioral response to a sustained visual attention challenge in 1-month-old infants with prenatal substance exposure.
  
  
  METHODS
  We measured heart rate, respiratory sinus arrhythmia, and neurobehavior during sustained visual orientation tasks included in the Neonatal Intensive Care Unit Network Neurobehavioral Scale in 1129 1-month-old infants with prenatal substance exposure. Four groups were compared: infants with prenatal cocaine and opiate exposure, infants with cocaine exposure, infants with opiate exposure, and infants with exposure to other substances (ie, alcohol, marijuana, and tobacco).
  
  
  RESULTS
  The infants with prenatal exposure to both cocaine and opiates had the highest heart rates and lowest levels of respiratory sinus arrhythmia during a sustained visual attention challenge compared with the other 3 groups. Infants with prenatal cocaine and opiate exposure had poorer quality of movement and more hypertonicity during the Neonatal Intensive Care Unit Network Neurobehavioral Scale examination. They also had more nonoptimal reflexes and stress/abstinence signs compared with infants with prenatal exposure to cocaine only and those with prenatal exposure to alcohol, tobacco, and marijuana.
  
  
  CONCLUSIONS
  Problems with arousal regulation were identified in infants with prenatal substance exposure. Autonomic dysregulation has been implicated as a mechanism by which these difficulties occur. Our results suggest that infants with prenatal exposure to both cocaine and opiates have the greatest autonomic response to the challenge of a sustained visual attention task, possibly putting these infants at risk for problems associated with physiologic and behavioral regulation, a necessary prerequisite for early learning.
authors.affiliation: Brown Center for the Study of Children at Risk, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, RI. Electronic address: econradt@wihri.org.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Conradt
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sheinkopf
authors.forename: Barry M
authors.initials: BM
authors.lastname: Lester
authors.forename: Ed
authors.initials: E
authors.lastname: Tronick
authors.forename: Linda L
authors.initials: LL
authors.lastname: LaGasse
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Henrietta
authors.initials: H
authors.lastname: Bada
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.forename: Toni M
authors.initials: TM
authors.lastname: Whitaker
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hammond
mesh_terms: D000434:Alcoholic Beverages / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001288:Attention; D001341:Autonomic Nervous System / Q000187:drug effects*; D002188:Cannabis / Q000009:adverse effects; D003042:Cocaine / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D015931:Intensive Care, Neonatal / Q000379:methods; D008019:Life Style; D008297:Male; D018811:Maternal Exposure; D009538:Nicotine / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications; D011297:Prenatal Exposure Delayed Effects; D012907:Smoking / Q000009:adverse effects; D019966:Substance-Related Disorders
chemical_list: D000701:Analgesics, Opioid; D009538:Nicotine; D003042:Cocaine
keywords: ECG; Electrocardiography; HR; Heart rate; NNNS; Neonatal Intensive Care Unit Network Neurobehavioral Scale; PMA; Postmenstrual age; RSA; Respiratory sinus arrhythmia