Fatal "crack" cocaine ingestion in an infant

This report describes a 10-month-old infant girl who died of cocaine poison ing. The infant was found apneic and in ventricular fibrillation after the parents summoned rescue personnel and claimed she had ingested rat poison. The parents later admitted that 2 hours before calling for assistance, the infant's 2-year-old brother was found eating "crack" cocaine and also feedi ng it to the infant. Investigators found "crack" cocaine throughout the hou se and in the infant's crib. At autopsy, the infant had two pieces of "crac k" cocaine in the duodenum. The brain exhibited a markedly thinned corpus c allosum. Toxicologic examination showed high concentrations of cocaine in t he blood and in other specimens. The manner of death was classified as homi cide because the infant was willfully placed in a hazardous environment wit h an easily accessible toxic substance, medical attention was deliberately delayed for 2 hours, and medical personnel were deceived when they were fal sely told she had ingested rat poison. These features were thought to const itute neglect. The toxicologic characteristics of this case are unique. The re are numerous reports of passive cocaine inhalation in infants and childr en less than 5 years of age, but ingestion of cocaine in this age group has rarely been documented. This age group also has no reported deaths due to cocaine ingestion and no cases of "crack" cocaine ingestion. The high conce ntrations of cocaine seen in this case, combined with the "crack" cocaine f ound in the duodenum, indicate ingestion as the route of exposure. The thin ned corpus callosum in this case may be a consequence of intrauterine cocai ne exposure.