Singer L T, Yamashita T S, Hawkins S, Cairns D, Baley J, Kliegman R
Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Pediatr. 1994 May;124(5 Pt 1):765-71. doi: 10.1016/s0022-3476(05)81372-1.
This study sought to determine whether very low birth weight (VLBW) infants (< 1500 gm) with fetal cocaine exposure differed from non-cocaine-exposed VLBW infants in incidence of neonatal medical complications and in later developmental outcome. Forty-one cocaine-exposed, VLBW infants, followed in a longitudinal study, were compared with 41 non-cocaine-exposed, VLBW infants of comparable race, social class, age, and incidence of bronchopulmonary dysplasia. Cocaine-exposed infants were identified on the basis of combined findings of maternal and/or infant urine immunoassay and on the basis of maternal self-report. At birth, groups did not differ on medical risk factors except that cocaine-exposed infants had a higher incidence of mild (grades I to II) intraventricular hemorrhage. Cocaine-using women were also more likely to use other drugs, especially alcohol, marijuana, and tobacco. At follow-up, at mean corrected ages of 16.5 +/- 8 months for 30 cocaine-exposed infants and 18.5 +/- 7 months for 37 non-cocaine-exposed infants, standardized assessments of cognitive (Mental Development Index) and motor (Psychomotor Development Index) development were administered. Cocaine-exposed infants had lower mean cognitive (83 +/- 27 vs 91 +/- 19), and motor (85 +/- 25 vs 96 +/- 18) scores; the incidence of developmental delay was significantly higher even after control for the effects of intraventricular hemorrhage and chronologic age. Cocaine-exposed VLBW infants were also more likely to be living with relatives or in foster homes. We conclude that these VLBW, cocaine-exposed infants were at increased risk of intraventricular hemorrhage, were more likely to be placed outside maternal care, and had higher incidences of cognitive and motor delays at follow-up.
本研究旨在确定胎儿接触可卡因的极低出生体重（VLBW，<1500克）婴儿与未接触可卡因的极低出生体重婴儿在新生儿医学并发症发生率及后期发育结局方面是否存在差异。在一项纵向研究中，对41名接触可卡因的极低出生体重婴儿与41名种族、社会阶层、年龄及支气管肺发育不良发生率相当的未接触可卡因的极低出生体重婴儿进行了比较。接触可卡因的婴儿是根据母亲和/或婴儿尿液免疫测定的综合结果以及母亲的自我报告确定的。出生时，两组在医学风险因素方面无差异，只是接触可卡因的婴儿轻度（I至II级）脑室内出血的发生率较高。使用可卡因的女性也更有可能使用其他药物，尤其是酒精、大麻和烟草。随访时，对30名接触可卡因婴儿的平均矫正年龄为16.5±8个月，对37名未接触可卡因婴儿的平均矫正年龄为18.5±7个月，进行了认知（心理发展指数）和运动（心理运动发展指数）发育的标准化评估。接触可卡因的婴儿平均认知（83±27对91±19）和运动（85±25对96±18）得分较低；即使在控制了脑室内出血和实际年龄的影响后，发育迟缓的发生率仍显著较高。接触可卡因的极低出生体重婴儿也更有可能与亲属生活在一起或住在寄养家庭。我们得出结论，这些极低出生体重、接触可卡因的婴儿脑室内出血风险增加，更有可能脱离母亲照顾，且随访时认知和运动迟缓的发生率较高。
