NEUROLOGIC MANIFESTATIONS OF IN-UTERO COCAINE EXPOSURE IN NEAR-TERM AND TERM INFANTS

Objective. To determine whether the incidence of neurosonographic and neurologic abnormalities is higher in cocaine-exposed infants at birth . Methods. In utero exposure to cocaine was investigated in 39 term an d near-term infants with positive urine screens for cocaine only and 3 9 matched control infants without drug exposure admitted to the regula r term newborn nursery. Serial evaluations were performed on each infa nt on postnatal days 1 and 2 and included a cranial sonogram, a neurol ogic and behavioral assessment for drug withdrawal, and Doppler interr ogation of the anterior and middle cerebral arteries. Results. There w ere no differences between groups in neurosonographic abnormalities. G rade I or II intraventricular hemorrhage occurred in 11% of cocaine-ex posed and 11% of control infants. There were no cases of grade III int raventricular hemorrhage, cystic periventricular leukomalacia, or neon atal stroke. Head size was smaller in cocaine-exposed infants, ie, 32. 7 +/- 0.1 cm versus 33.8 +/- 0.1 cm. The neurologic examination was si milar between groups with regard to tone, reflexes, and cranial nerves . Behavioral scores were higher on both days, in cocaine-exposed versu s control infants, ie, 4.4 +/- 0.5 versus 2.7 +/- 0.3 on day 1 and 5.0 +/- 0.5 versus 1.71 +/- 0.31 on day 2. Cerebral blood flow velocity m easurements in the anterior cerebral artery were similar between group s on both days of examination. However, cocaine-exposed infants demons trated a significant increase in flow velocity from day 1 to day 2, ie , 0.48 +/- 0.03 to 0.57 +/- 0.04. There was a concomitant decrease in the pulsatility index from day 1 to day 2 in the cocaine-exposed, ie, 0.74 +/- 0.02 to 0.69 +/- 0.02, but not in the control infants. No dif ferences were noted in the flow velocities in the middle cerebral arte ries between groups. Conclusions. Term and near-term infants admitted to a regular nursery who are exposed to cocaine in utero: (1) do not e xhibit an increased incidence of neurosonographic abnormalities; (2) d o exhibit altered behavior consistent with drug withdrawal; and (3) do demonstrate changes in flow velocity in the anterior cerebral artery consistent with the vasoconstrictive effects of the drug. However, the se changes were not accompanied by changes in the neurologic examinati on or altered care. The long-term neurodevelopmental implications of t hese subtle abnormalities in the neonatal period remain to be determin ed.