NEUROSONOGRAPHIC ABNORMALITIES ASSOCIATED WITH MATERNAL HISTORY OF COCAINE USE IN NEONATES OF APPROPRIATE SIZE FOR THEIR GESTATIONAL-AGE

PURPOSE: To determine whether increased incidence of neurosonographic abnormalities (predominantly of the basal ganglia and thalamus) in coc aine-exposed neonates who are small for their gestational age is attri butable to the cocaine or to neonatal size. METHODS: Neonates whose si zes were appropriate for their gestational age with no evidence of hyp oxia or respiratory distress were identified prospectively by a matern al history of cocaine use. Scans were performed within 72 hours of bir th using a 7.5-MHz transducer following a standard protocol. The image s were analyzed without access to patient information. Forty study neo nates were compared with 34 control subjects who were appropriate in s ize for their gestational age, scanned using the same protocol. Compar isons were made using Fisher Exact Test, t test, and logistic regressi on. RESULTS: No control infant had neurosonographic abnormalities. In the study group, gestational age ranged from 27 to 41 weeks. Of the 40 study neonates, 14 (35%) had one neurosonographic abnormality; two ha d two abnormalities. The predominant lesion was focal echolucencies, m ainly in the area of the basal ganglia (10 of 40, 25%). Other findings were caudate echogenicity (3 of 40, 7.5%), ventricular dilation (2 of 40, 5%) and one ''moth-eaten'' appearance of the thalamus. Lesions we re more likely approaching term and were not related to prematurity or alcohol use. CONCLUSION: Apparently normal neonates with a maternal h istory of cocaine use are likely to have degenerative changes or focal infarctions in their basal ganglia attributable to cocaine. Neurosono graphy should be used to evaluate these neonates. The long-term signif icance of these lesions needs further evaluation.