Tronick E Z, Frank D A, Cabral H, Mirochnick M, Zuckerman B
Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Pediatrics. 1996 Jul;98(1):76-83.
To determine in a representative sample of full-term urban newborns of English-speaking mothers whether an immediate or late dose-response effect could be demonstrated between prenatal cocaine exposure and newborn neurobehavioral performance, controlling for confounding factors.
The Neonatal Behavioral Assessment Scale (NBAS) was administered by masked examiners to a total sample of 251 clinically healthy, full-term infants at 2 days and/or 17 days. Three in utero cocaine exposure groups were defined: heavily exposed (n = 44, > 75th percentile self-reported days of use during pregnancy and/or > 75th percentile of meconium benzoylecognine concentration); lightly exposed (n = 79, less than both 75th percentiles); and unexposed (n = 101, no positive biological or self-report marker). At the 3-week examination there were 38 heavily exposed, 73 lightly exposed, and 94 unexposed infants. Controlling for infant birth weight, gestational age, infant age at the time of examination, mothers' age, perinatal risk, obstetric medication, and alcohol, marijuana, and cigarette use, a regression analysis evaluated the effects of levels of cocaine exposure on NBAS performance.
No neurobehavioral effects of exposure on the newborn NBAS cluster scores or on the qualifier scores were found when confounders were controlled for at 2 to 3 days of age. At 3 weeks, after controlling for covariates, a significant dose effect was observed, with heavily exposed infants showing poorer state regulation and greater excitability.
These findings demonstrate specific dose-related effects of cocaine on 3-week neurobehavioral performance, particularly for the regulation of arousal, which was not observed in the first few days of life.
在以英语为母语的母亲所生的足月城市新生儿的代表性样本中，确定产前可卡因暴露与新生儿神经行为表现之间是否能显示出即时或延迟的剂量反应效应，并控制混杂因素。
由经过盲法培训的检查人员对总共251名临床健康的足月婴儿在出生2天和/或17天时进行新生儿行为评估量表（NBAS）测试。确定了三个子宫内可卡因暴露组：重度暴露组（n = 44，孕期自我报告使用天数高于第75百分位数和/或胎粪中苯甲酰爱康宁浓度高于第75百分位数）；轻度暴露组（n = 79，两项指标均低于第75百分位数）；未暴露组（n = 101，无阳性生物学或自我报告指标）。在3周检查时，重度暴露组有38名婴儿，轻度暴露组有73名婴儿，未暴露组有94名婴儿。在控制婴儿出生体重、胎龄、检查时的婴儿年龄、母亲年龄、围产期风险、产科用药以及酒精、大麻和香烟使用情况后，通过回归分析评估可卡因暴露水平对NBAS表现的影响。
在2至3日龄时控制混杂因素后，未发现暴露对新生儿NBAS聚类分数或限定分数有神经行为影响。在3周时，控制协变量后，观察到显著的剂量效应，重度暴露的婴儿表现出较差的状态调节能力和更高的兴奋性。
这些发现表明可卡因对3周龄时的神经行为表现有特定的剂量相关效应，特别是对觉醒的调节，而在生命的最初几天未观察到这种效应。
