Koren G, Klein J, McMartin K
Department of Pediatrics and The Research Institute, The Hospital for Sick Children, The University of Toronto, Canada.
Ther Drug Monit. 1998 Oct;20(5):478-80. doi: 10.1097/00007691-199810000-00006.
Intrauterine exposure to cocaine results in a variety of perinatal and long-term neurobehavioral sequlae. Maternal history and neonatal urinalysis miss most instances of exposure. After establishing the high sensitivity, specificity, and predictive value of neonatal hair testing for cocaine, the authors embarked on a study to evaluate the clinical use of the test. Between October 1991 and September 1997, they assessed the presence of cocaine in 509 hair samples; 422 were from neonates and were based on clinical suspicion of intrauterine exposure, although history and urine test results were negative. Thirty-two percent were positive, a rate fivefold higher than the incidence found by the authors in population-based studies. Neonates referred by children's aid workers had significantly higher percentages of positivity (60%). Because neonatal hair grows only during the last 4 months of pregnancy, positive neonatal hair test results reflect maternal addiction, and this warrants close follow-up of the baby after release because of the high rate of postnatal risks secondary to suboptimal parental care and because of the proven perinatal risks inflicted by the drug itself.
子宫内接触可卡因会导致各种围产期和长期的神经行为后遗症。母亲的病史和新生儿尿液分析会遗漏大多数接触情况。在确定了新生儿毛发检测可卡因具有高灵敏度、特异性和预测价值后，作者开展了一项研究以评估该检测的临床应用。在1991年10月至1997年9月期间，他们评估了509份毛发样本中可卡因的存在情况；其中422份来自新生儿，基于临床怀疑子宫内接触可卡因，尽管病史和尿液检测结果均为阴性。32%的样本呈阳性，这一比例比作者在基于人群的研究中发现的发病率高出五倍。儿童救助工作者转诊的新生儿阳性率显著更高（60%）。由于新生儿毛发仅在怀孕的最后4个月生长，新生儿毛发检测结果呈阳性反映了母亲成瘾，鉴于因父母照顾欠佳导致的产后高风险率以及该药物本身已证实的围产期风险，这就需要在婴儿出院后进行密切随访。
