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 coc aine exposure and to determine whether that outcome would be modified by ea rly, intensive family case management. Cocaine-exposed infants identified a fter delivery at an urban hospital were alternately assigned to receive cas e management (n = 70) or routine follow-up (n = 48). A matched, non-drug-ex posed 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 perfo rmed using one-way analysis of variance. There were no statistical differen ces in mean cognitive, psychomotor, or language quotients between cocaine-e xposed 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 me an Bayley Mental Developmental Index score than those who were routinely ma naged. However, no differences were present at subsequent assessments. Amon g cocaine-exposed infants who remained with their mothers at 36 months, ver bal scores were significantly higher for case-managed compared with routine -managed infants. The negative effects of urban, low socioeconomic status m ay overshadow the impact of prenatal cocaine exposure on early childhood ou tcome for those infants born without prenatal complications.