Chiriboga C A, Vibbert M, Malouf R, Suarez M S, Abrams E J, Heagarty M C, Brust J C, Hauser W A
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Pediatrics. 1995 Dec;96(6):1070-7.
To assess whether prenatal cocaine exposure has any long-term effects on neurodevelopment.
A prospective cohort study with examiners blind to drug exposure and human immunodeficiency virus (HIV) status.
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.
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.
Harlem Hospital Center from 1988 to 1992.
At age 6 months, 21 of 51 (41%) cocaine-positive children exhibited hypertonia 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.
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.
评估产前可卡因暴露是否对神经发育有任何长期影响。
一项前瞻性队列研究，检查人员对药物暴露和人类免疫缺陷病毒（HIV）状态不知情。
在一项围产期HIV神经发育研究中登记的144名高危婴儿中，119名（83%）同时接受了神经学和尿液毒理学检测的婴儿被随访至24个月龄。
根据尿液毒理学中是否存在可卡因，每隔6个月对神经学和发育评估进行分析：51名婴儿可卡因检测呈阳性。通过逻辑回归方程获得调整后的优势比（OR）和95%置信区间（CI），该方程对围产期变量进行了调整，包括胎儿生长、妊娠、HIV状态和婴儿毒理学结果的测量。
1988年至1992年期间的哈莱姆医院中心。
在6个月龄时，51名可卡因阳性儿童中有21名（41%）出现任何类型的张力亢进（张力亢进性四肢瘫、张力亢进性双瘫和张力亢进性偏瘫），而68名可卡因阴性婴儿中有17名（25%）出现这种情况（OR = 2.1，CI = 1.0 - 4.6）。可卡因阳性婴儿出现张力亢进性四肢瘫（HTP）的可能性是可卡因阴性婴儿的四倍（OR = 4.0；CI = 1.5 - 10.8）。在多变量分析中，这种关联仍然显著。与脑瘫一致的张力亢进在两组中均随时间减弱。在97%的受影响婴儿中，张力亢进在24个月时消失。手臂张力亢进首先减轻；一些儿童的腿部张力亢进一直持续到18个月龄。在任何年龄间隔，可卡因阳性和阴性婴儿的发育得分均未发现差异。然而，在可卡因阳性婴儿中，与没有HTP的婴儿相比，早期出现HTP的婴儿在6个月和12个月时的平均发育得分显著较低。
出生时尿液毒理学检测可卡因呈阳性与婴儿期张力亢进有关。这种由可卡因引起的影响通常是对称的、短暂的，并且大多数暴露儿童在24个月龄时张力亢进症状会消失。在可卡因阳性婴儿中，HTP可能是后期发育障碍的一个标志。
