PEDIATRICS Vol. 98 No. 4 October 1996, pp. 735-740
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Prenatal Cocaine and Neonatal Outcome: Evaluation of Dose-Response Relationship

Virginia Delaney-Black MD1, Chandice Covington RN, PhD2, Enrique Ostrea Jr. MD1, Al Romero MD3, Dawn Baker RN, MSN4, Maria-Theresa Tagle RN, MSN4, Beth Nordstrom-Klee 5, Maria A. Silvestre MD6, Mary Lu Angelilli MD6, Cheryl Hack MD6, and Jacqueline Long RN, MSN5

1 Department of Pediatrics, School of Medicine; Department of Pediatrics, Children's Hospital of Michigan; Department of Pediatrics, Hutzel Hospital, Detroit, Michigan
2 Department of Family and Community Medicine and Mental Health, College of Nursing, Wayne State University, Detroit, Michigan
3 Department of Pediatrics, Hutzel Hospital, Detroit, Michigan
4 Department of Family and Community Medicine and Mental Health, College of Nursing, Wayne State University; Department of Pediatrics, Hutzel Hospital, Detroit, Michigan
5 Department of Family and Community Medicine and Mental Health, College of Nursing, Wayne State University, Michigan
6 Department of Pediatrics, School of Medicine; Department of Pediatrics, Children's Hospital of Michigan

Objective. The aim of this study was to evaluate the hypothesis that prenatal cocaine exposure would negatively affect newborn behavior.

Methods. A prospective observational study of term infants recruited from the low-risk nursery used a structured, standardized interview to obtain maternal data. Cocaine exposure was determined by radioimmunoassay of the infant's meconium stool. An examiner blinded to the infant's cocaine status administered the Brazelton Neonatal Behavioral Assessment Scales.

Results. The sample was composed of 23 exposed and 29 nonexposed infants. On six of the seven Brazelton Neonatal Behavioral Assessment Scale clusters, cocaine-exposed infants performed less well than control infants, with significant differences observed for autonomic stability. In addition, a dose-response relationship was suggested. Significant negative, within-group relationships were evident in the exposed group, indicating poorer performance with increasing meconium cocaine concentration for orientation (r = -.40) and regulation of state (r = -.40). Regression model testing of the influence of meconium cocaine concentration on neurobehavioral outcomes, after controlling for significant confounders, identified a significant independent, negative effect of meconium cocaine concentration on two clusters—motor and regulation of state.

Conclusion. In otherwise healthy full-term infants, prenatal cocaine exposure identified by quantitative analysis of cocaine concentration in meconium had a significant, independent negative association with motor and regulation of state that remained after controlling for other significant confounders. A dose-response relationship was evident.

Submitted on January 19, 1995
Accepted on December 14, 1995




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