Frank D A, McCarten K M, Robson C D, Mirochnick M, Cabral H, Park H, Zuckerman B
Boston University School of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Pediatrics. 1999 Nov;104(5 Pt 1):1101-5. doi: 10.1542/peds.104.5.1101.
To assess whether there is an association between the level of in utero cocaine exposure and findings on neonatal cranial ultrasound, controlling for potentially confounding variables.
In a prospective longitudinal study, three cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or of meconium benzoylecogonine concentration) or lighter cocaine exposure (all others). Neonatal ultrasounds from 241 well, term infants were read by a single radiologist who was masked to the exposure group.
Infants with lighter cocaine exposure did not differ from the unexposed infants on any ultrasound findings. After controlling for infant gender, gestational age, and birth weight z scores and for maternal parity, blood pressure in labor, ethnicity, and use of cigarettes, alcohol, and marijuana during pregnancy, the more heavily cocaine-exposed infants were more likely than the unexposed infants to show subependymal hemorrhage in the caudothalamic groove (covariate adjusted odds ratio: 3.88; 95% confidence interval: 1.45, 10.35).
This is the first study to demonstrate that ultrasound findings suggestive of vascular injury to the neonatal central nervous system are related to the level of prenatal cocaine exposure. Inconsistency in previous research in identifying an association between prenatal cocaine exposure and neonatal cranial ultrasound findings may reflect failure to consider dose effects.
评估子宫内可卡因暴露水平与新生儿头颅超声检查结果之间是否存在关联，并控制潜在的混杂变量。
在一项前瞻性纵向研究中，根据母亲报告和婴儿胎粪检测确定了三个可卡因暴露组：未暴露组、重度可卡因暴露组（自我报告使用天数或胎粪中苯甲酰爱康宁浓度高于第75百分位数）或轻度可卡因暴露组（其他所有情况）。由一名对暴露组情况不知情的放射科医生对241名健康足月儿的新生儿超声检查结果进行解读。
轻度可卡因暴露的婴儿在任何超声检查结果上与未暴露的婴儿均无差异。在控制了婴儿性别、胎龄、出生体重z评分以及母亲的产次、分娩时血压、种族和孕期吸烟、饮酒及使用大麻情况后，重度可卡因暴露的婴儿比未暴露的婴儿更有可能出现丘脑尾状核沟室管膜下出血（协变量调整比值比：3.88；95%置信区间：1.45，10.35）。
这是第一项表明提示新生儿中枢神经系统血管损伤的超声检查结果与产前可卡因暴露水平相关的研究。以往关于产前可卡因暴露与新生儿头颅超声检查结果之间关联的研究结果不一致，可能反映出未考虑剂量效应。
