Neurological Correlates of Fetal Cocaine Exposure: Transient Hypertonia of Infancy and Early Childhood

¹ Division of Pediatric Neurology, Department of Neurology, College of Physicians and Surgeons, Columbia University, Harlem Hospital Center, New York, New York
² Department of Pediatrics, College of Physicians and Surgeons, Columbia University, Harlem Hospital Center, New York, New York
³ Department of Pediatrics, College of Physicians and Surgeons, Columbia University, Department of Neurology, College of Physicians and Surgeons, Columbia University, Harlem Hospital Center, New York, New York
⁴ Department of Neurology, College of Physicians and Surgeons, Columbia University, Harlem Hospital Center, New York, New York
⁵ Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, Sergievsky Center and School of Public Health, Columbia University

Objective. To assess whether prenatal cocaine exposure has any long-term effects on neuro-development.

Design. A prospective cohort study with examiners blind to drug exposure and human immunodeficiency virus (HIV) status.

Subjects. Of 144 high-risk infants enrolled in a perinatal HIV neurodevelopmental study, 119 (83%) infants with both neurological and urine toxicology measures were followed up to age 24 months.

Methods. Neurological and developmental assessments were analyzed at 6-month intervals grouped according to the presence of cocaine in urine toxicology: 51 infants were cocaine-positive. Adjusted odds ratios (ORs) and 95% confidence interval (CI) were obtained by logistic regression equations that adjusted for perinatal variables, including measures of fetal growth, gestation, HIV status, and infant toxicology results.

Setting. Harlem Hospital Center from 1988 to 1992.

Results. At age 6 months, 21 of 51 (41%) cocaine-positive children exhibited hypentonia of any type (hypertonic tetraparesis, hypertonic diparesis, and hypertonic hemiparesis) compared with 17 of 68 (25%) cocaine-negative infants (OR = 2.1, CI = 1.0-4.6). Cocaine-positive infants were four times more likely to show hypertonic tetraparesis (HTP) than cocaine-negative infants (OR = 4.0; CI = 1.5-10.8). The association remained significant in multivariate analyses. Hypertonia, consistent with cerebral palsy, diminished over time in both groups. In 97% of affected infants hypertonia resolved by 24 months. Arm hypertonia abated first; leg hypertonia remained in some children up to age 18 months. No differences in development scores between cocaine-positive and cocaine-negative were noted at any age interval. However, among cocaine-positive infants those with early HTP showed significantly lower mean developmental scores at 6 and 12 month compared to infants without HTP.

Conclusion. Cocaine positivity urine toxicology at birth is associated with hypertonia during infancy. Such cocaine-induced effects are usually symmetrical, transient, and the majority of exposed children outgrow hypertonia by 24 months of life. Among cocaine-positive infants, HTP may be a marker for later developmental impairments.

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