Ostrea E M, Ostrea A R, Simpson P M
Department of Pediatrics, Hutzel Hospital, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan 48201, USA.
Pediatrics. 1997 Jul;100(1):79-83. doi: 10.1542/peds.100.1.79.
To determine the mortality rate, during the first 2 years of life, in infants who were exposed to cocaine, opiate, or cannabinoid during gestation.
For a period of 11 months, a large group of infants were enrolled and screened at birth for exposure to cocaine, opiate, or cannabinoid by meconium analysis. Death outcome, within the first 2 years after birth, was determined in this group of infants using the death registry of the Michigan Department of Public Health.
A total of 2964 infants was studied. At birth, 44% of the infants tested positive for drugs: 30. 5% positive for cocaine, 20.2% for opiate, and 11.4% for cannabinoids. Compared to the drug negative group, a significantly higher percentage (P < .05) of the drug positive infants had lower weight and smaller head circumference and length at birth and a higher percent of their mothers were single, multigravid, multiparous, and had little to no prenatal care. Within the first 2 years of life, 44 infants died: 26 were drug negative (15.7 deaths per 1000 live births) and 18 were drug positive (13.7 deaths per 1000 live births). The mortality rate among cocaine, opiate, or cannabinoid positive infants were 17.7, 18.4, and 8.9 per 1000 live births, respectively. Among infants with birth weight </=2500 g, infants who were positive for both cocaine and morphine had a higher mortality rate (odds ratio = 5.9, confidence interval [CI] = 1.4 to 24) than drug negative infants. Eleven infants died from the sudden infant death syndrome (SIDS); 58% were positive for drugs, predominantly cocaine. The odds ratio for SIDS among drug positive infants was 1.5 (CI = 0.46 to 5.01) and 1.9 (CI = 0.58 to 6.2) among cocaine positive infants.
We conclude that prenatal drug exposure in infants, although associated with a high perinatal morbidity, is not associated with an overall increase in their mortality rate or incidence of SIDS during the first 2 years of life. However, a significantly higher mortality rate was observed among low birth weight infants (</=2500 g) who were positive for both cocaine and opiate.
确定在孕期接触过可卡因、阿片类药物或大麻素的婴儿在出生后头两年的死亡率。
在11个月的时间里，招募了一大组婴儿，并在出生时通过胎粪分析对其是否接触过可卡因、阿片类药物或大麻素进行筛查。利用密歇根州公共卫生部的死亡登记系统确定了这组婴儿在出生后两年内的死亡情况。
共研究了2964名婴儿。出生时，44%的婴儿药物检测呈阳性：30.5%可卡因阳性，20.2%阿片类药物阳性，11.4%大麻素阳性。与药物阴性组相比，药物阳性婴儿出生时体重更低、头围和身长更小的比例显著更高（P <.05），且其母亲中单身、多胎、经产妇以及几乎没有或没有接受过产前护理的比例更高。在出生后的头两年内，44名婴儿死亡：26名药物阴性（每1000例活产中有15.7例死亡），18名药物阳性（每1000例活产中有13.7例死亡）。可卡因、阿片类药物或大麻素阳性婴儿的死亡率分别为每1000例活产17.7例、18.4例和8.9例。在出生体重≤2500g的婴儿中，可卡因和吗啡均呈阳性的婴儿死亡率（优势比 = 5.9，置信区间[CI] = 1.4至24）高于药物阴性婴儿。11名婴儿死于婴儿猝死综合征（SIDS）；58%药物检测呈阳性，主要是可卡因阳性。药物阳性婴儿中SIDS的优势比为1.5（CI = 0.46至5.01），可卡因阳性婴儿中为1.9（CI = 0.58至6.2）。
我们得出结论，婴儿产前接触药物，虽然与围产期高发病率相关，但在出生后头两年内与他们的总体死亡率增加或SIDS发病率无关。然而，在出生体重低（≤2500g）且可卡因和阿片类药物均呈阳性的婴儿中观察到显著更高的死亡率。
