King T A, Perlman J M, Laptook A R, Rollins N, Jackson G, Little B
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063, USA.
Pediatrics. 1995 Aug;96(2 Pt 1):259-64.
To determine whether the incidence of neurosonographic and neurologic abnormalities is higher in cocaine-exposed infants at birth.
In utero exposure to cocaine was investigated in 39 term and near-term infants with positive urine screens for cocaine only and 39 matched control infants without drug exposure admitted to the regular term newborn nursery. Serial evaluations were performed on each infant on postnatal days 1 and 2 and included a cranial sonogram, a neurologic and behavioral assessment for drug withdrawal, and Doppler interrogation of the anterior and middle cerebral arteries.
There were no differences between groups in neurosonographic abnormalities. Grade I or II intraventricular hemorrhage occurred in 11% of cocaine-exposed and 11% of control infants. There were no cases of grade III intraventricular hemorrhage, cystic periventricular leukomalacia, or neonatal stroke. Head size was smaller in cocaine-exposed infants, ie, 32.7 +/- 0.1 cm versus 33.8 +/- 0.1 cm. The neurologic examination was similar between groups with regard to tone, reflexes, and cranial nerves. Behavioral scores were higher on both days, in cocaine-exposed versus control infants, ie, 4.4 +/- 0.5 versus 2.7 +/- 0.03 on day 1 and 5.0 +/- 0.5 versus 1.71 +/- 0.31 on day 2. Cerebral blood flow velocity measurements in the anterior cerebral artery were similar between groups on both days of examination. However, cocaine-exposed infants demonstrated a significant increase in flow velocity from day 1 to day 2, ie, 0.48 +/- 0.03 to 0.57 +/- 0.04. There was a concomitant decrease in the pulsatility index from day 1 to day 2 in the cocaine-exposed, ie, 0.74 +/- 0.02 to 0.69 +/- 0.02, but not in the control infants. No differences were noted in the flow velocities in the middle cerebral arteries between groups.
Term and near-term infants admitted to a regular nursery who are exposed to cocaine in utero: (1) do not exhibit an increased incidence of neurosonographic abnormalities; (2) do exhibit altered behavior consistent with drug withdrawal; and (3) do demonstrate changes in flow velocity in the anterior cerebral artery consistent with the vasoconstrictive effects of the drug. However, these changes were not accompanied by changes in the neurologic examination or altered care. The long-term neurodevelopmental implications of these subtle abnormalities in the neonatal period remain to be determined.
确定出生时暴露于可卡因的婴儿神经超声及神经学异常的发生率是否更高。
对39名足月和近足月仅尿液可卡因筛查呈阳性的婴儿以及39名匹配的未暴露于药物的对照婴儿进行宫内可卡因暴露情况调查，这些对照婴儿入住足月新生儿常规病房。在出生后第1天和第2天对每名婴儿进行系列评估，包括颅脑超声检查、药物戒断的神经学和行为评估，以及大脑前动脉和大脑中动脉的多普勒检查。
两组在神经超声异常方面无差异。11%暴露于可卡因的婴儿和11%的对照婴儿发生了Ⅰ级或Ⅱ级脑室内出血。没有Ⅲ级脑室内出血、脑室周围白质软化或新生儿卒中的病例。暴露于可卡因的婴儿头围较小，即32.7±0.1厘米对33.8±0.1厘米。两组在肌张力、反射和颅神经方面的神经学检查相似。在第1天和第2天，暴露于可卡因的婴儿的行为评分均高于对照婴儿，即第1天为4.4±0.5对2.7±0.03，第2天为5.0±0.5对1.71±0.31。在检查的两天中，两组大脑前动脉的脑血流速度测量结果相似。然而，暴露于可卡因的婴儿从第1天到第2天血流速度显著增加，即从0.48±0.03增加到0.57±0.04。暴露于可卡因的婴儿从第1天到第2天搏动指数随之降低，即从0.74±0.02降至0.69±0.02，而对照婴儿则无此变化。两组大脑中动脉的血流速度无差异。
入住常规病房的足月和近足月宫内暴露于可卡因的婴儿：（１）神经超声异常发生率未增加；（２）确实表现出与药物戒断相符的行为改变；（３）确实表现出大脑前动脉血流速度变化，与药物的血管收缩作用相符。然而，这些变化并未伴有神经学检查改变或护理改变。这些新生儿期细微异常的长期神经发育影响仍有待确定。
