Neurologic and Ophthalmologic Findings in Children Exposed to Cocaine in Utero

Abstract

We studied a cohort of 73 children exposed to cocaine in utero to characterize the spectrum of neurologic and ophthalmologic abnormalities; 36 children with no documented in utero drug exposure were selected as a control group. Most referrals of cocaine-exposed children to the child neurologist were made in the 1st year of life (81%). Reasons for referral were hypertonia (29%), seizures (22%), developmental delay (11%), tremulousness (11%), and hypotonia (4%). The most common abnormal finding in the cocaine-exposed children was hypertonia/hyperreflexia (63%), which was rarely seen in the control group. In addition, hypertonia/hyperreflexia was underdiagnosed by referring physicians. Similarly, hypotonia was seen on neurologic examination of cocaine-exposed children more frequently than documented by referral (16% versus 4%). Hypotonia was rarely seen in the control group. Twelve (43%) of 28 cocaine-exposed children seen by a pediatric ophthalmologist had structural ophthalmologic abnormalities. Neurologic and ophthalmologic findings suggesting structural lesions of the nervous system must be considered in cocaine-exposed children. (J Child Neurol 1996;11:25-30).

Get full access to this article

View all access options for this article.

References

National Institute on Drug Abuse: NIDA Household Survey on Drug Abuse 1988 Population Estimates. Rockville, MD, Department of Health and Human Services Administration, 1989, pp 89-1636.

Chasnoff IJ : Drug use and women: Establishing a standard of care. Ann N Y Acad Sci 1989;562:208-210.

Young SL , Vosper HJ , Phillips SA : Cocaine: Its effects on maternal and child health. Pharmacotherapy 1992; 12:2-17.

Vega WA , Kolody B. , Hwang J. , et al: Prevalence and magnitude of perinatal substance exposures in California. N Engl J Med 1993;329:850-854.

Dixon SD : Effects of transplacental exposure to cocaine and methamphetamine on the neonate . West J Med 1989; 150:436-442.

Roland EH , Volpe JJ : Effect of maternal cocaine use on the fetus and newborn: Review of the literature . Pediatr Neurosci 1989; 15:88-94.

Chasnoff IJ , Burns WJ , Schnoll SH , et al: Cocaine use in pregnancy. N Engl J Med 1985;313:666-669.

Chasnoff IJ , Griffith DR , MacGregor S. , et al: Temporal patterns of cocaine use in pregnancy. Perinatal outcome . JAMA 1989; 261:1741-1744.

Hadeed AJ , Siegel SR : Maternal cocaine use during pregnancy: Effect on the newborn infant . Pediatrics 1989;84:205-210.

10.

MacGregor SN , Keith LG , Chasnoff IJ , et al: Cocaine use during pregnancy: Adverse perinatal outcome. Am J Obstet Gynecol 1987 ;157:686-690.

11.

Bingol N. , Fuchs M. , Diaz V. , et al: Teratogenicity of cocaine in humans [published erratum appears in J Pediatr 1987;110:350]. J Pediatr 1987;110:93-96.

12.

Chasnoff IJ , Bussey ME , Savich R. , et al: Perinatal cerebral infarction and maternal cocaine use. J Pediatr 1986; 108:456-459.

13.

Chasnoff IJ , Chisum GM , Kaplan WE : Maternal cocaine use and genitourinary tract malformations. Teratology 1988;37:201-204.

14.

Chasnoff IJ , Hunt CE , Kletter R. , et al: Prenatal cocaine exposure is associated with respiratory pattern abnormalities. Am J Dis Child 1989;143:583-587.

15.

American Academy of Pediatrics Committee on Substance Abuse : Drug-exposed infants. Pediatrics 1990;86:639-642.

16.

Anday EK , Cohen ME , Kelley NE , et al: Effect of in utero cocaine exposure on startle and its modification . Dev Pharmacol Ther 1989;12:137-145.

17.

Chasnoff IJ , Griffith DR , Freier C. , et al: Cocaine/polydrug use in pregnancy: Two-year follow-up. Pediatrics 1992;89:284-289.

18.

Kramer LD , Locke GE , Ogunyemi A. , et al: Neonatal cocaine-related seizures. J Child Neurol 1990;5:60-64.

19.

Chiriboga CA , Bateman DA , Brust JC , et al: Neurologic findings in neonates with intrauterine cocaine exposure. Pediatr Neurol 1993;9:115-119.

20.

Konkol R. , Murphey L. , Ferriero D. , et al: Cocaine metabolites in the neonate: Potential for toxicity. J Child Neurol 1994;9:242-248.

21.

McCance KE : The consequences of maternal substance abuse for the child exposed in utero . Psychosomatics 1991;32:268-274.

22.

Parker S. , Zuckerman B. , Bauchner H. , et al: Jitteriness in full-term neonates: Prevalence and correlates . Pediatrics 1990; 85:17-23.

23.

Messing RO , Closson RG , Simon RP : Drug-induced seizures: A 10-year experience. Neurology 1984;34:1582-1586.

24.

Wojak JC , Flamm ES : Intracranial hemorrhage and cocaine use. Stroke 1987;18: 712-715.

25.

Hoyt CS , Jastrzebski G. , Marg E. : Delayed visual maturation in infancy. Br J Ophthalmol 1983;67:127-130.

26.

Good WV , Ferriero DM , Golabi M. , et al: Abnormalities of the visual system in infants exposed to cocaine . Ophthalmology 1992;99:341-346.

27.

Jan J. , Good W. : Children with sensory defect nystagmus, normal appearing fundi, and normal electroretinograms. Dev Med Child Neurol, in press.