Elsevier

Neurotoxicology and Teratology

Volume 22, Issue 5, September–October 2000, Pages 653-666
Neurotoxicology and Teratology

Neurobehavioral outcomes of cocaine-exposed infants

https://doi.org/10.1016/S0892-0362(00)00092-1Get rights and content

Abstract

The present study investigated the neurobehavioral outcomes of fetal cocaine exposure. Attempts were made to control, by design or statistical analysis, for significant confounders. Timing and amount of drug exposures were considered, and biologic measures of exposure were quantified to classify exposure severity.

One hundred sixty-one non-cocaine and 158 cocaine-exposed (82 heavily and 76 lightly exposed) infants were seen at a mean-corrected age of 43 weeks post-conception and administered the Neurobehavioral Assessment (NB Assessment). Heavily cocaine-exposed infants had more jitteriness and attentional problems than lightly and non-exposed infants. They also had more movement and tone abnormalities, and sensory asymmetries than non-exposed infants. Heavily exposed infants were more likely to be identified with an abnormality than non-exposed infants and there was a trend toward heavily exposed infants being more likely to be identified with an abnormality than lightly exposed infants. Furthermore, there was a trend for heavily exposed infants to be less likely to be testable than non-exposed infants.

After the confounding and mediating factors were considered, heavily cocaine-exposed infants were four times as likely to be jittery and nearly twice as likely to demonstrate any abnormality than lightly and non-exposed infants, but all other effects were no longer significant. Higher concentrations of the cocaine metabolites of cocaine, cocaethylene, and benzoylecgonine (BZE) were related to higher incidence of movement and tone abnormalities, jitteriness, and presence of any abnormality. Higher cocaethylene levels were related to attentional abnormalities and higher meta-hydroxybenzoylecgonine (m-OH-BZE) was related to jitteriness. Drug effects on attention were mediated by maternal psychological distress, suggesting that this factor should be considered in future studies of drug exposure effects.

Section snippets

Subjects

A total of 415 infants (218 cocaine-exposed, 197 non-exposed) were recruited at birth to participate in a longitudinal study of the sequelae of fetal drug exposure from October, 1994 through June, 1996. All mothers and infants were recruited from MetroHealth Medical Center, a large, urban county teaching hospital in Cleveland, OH, and identified from a high-risk population screened for drug use. Urine samples were obtained immediately before or after labor and delivery and analyzed for the

Sample characteristics

Demographic and medical characteristics of the cocaine-exposed and the non-cocaine-exposed infants and mothers seen for the NB assessment are presented in Table 1, Table 2. Cocaine-using mothers were older, had more children, and received less prenatal care. The majority of both groups were African–American, of low socioeconomic status and unemployed. Cocaine-using women had less education, lower vocabulary scores, were more likely to be unemployed, less likely to be married, had higher

Acknowledgements

Supported by grants RO1-07259, RO1-07957, R29-07358 and RO1-07358 from the National Institute on Drug Abuse and the General Clinical Research Center RR00080. Thanks are extended to the participating families, to Drs. Phil Fragassi, Mary Lou Kumar, and Laurel Schauer and to the staff of the Center for the Advancement of Mothers and Children at MetroHealth Medical Center; also to Terri Lotz-Ganley for manuscript preparation; Joanne Robinson, Kristen Weigand, Laurie Ellison, Adela Kuc, Marilyn

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