       Document 0636
 DOCN  M9630636
 TI    Neurological correlates of fetal cocaine exposure: transient hypertonia
       of infancy and early childhood.
 DT    9603
 AU    Chiriboga CA; Vibbert M; Malouf R; Suarez MS; Abrams EJ; Heagarty MC;
       Brust JC; Hauser WA; Department of Neurology, College of Physicians and
       Surgeons,; Columbia University, New York, New York 10032, USA.
 SO    Pediatrics. 1995 Dec;96(6):1070-7. Unique Identifier : AIDSLINE
       MED/96095156
 AB    OBJECTIVE. To assess whether prenatal cocaine exposure has any long-term
       effects on neurodevelopment. DESIGN. A prospective cohort study with
       examiners blind to drug exposure and human immunodeficiency virus (HIV)
       status. SUBJECTS. Of 144 high-risk infants enrolled in a perinatal HIV
       neurodevelopmental study, 119 (83%) infants with both neurological and
       urine toxicology measures were followed up to age 24 months. METHODS.
       Neurological and developmental assessments were analyzed at 6-month
       intervals grouped according to the presence of cocaine in urine
       toxicology: 51 infants were cocaine-positive. Adjusted odds ratios (ORs)
       and 95% confidence interval (CI) were obtained by logistic regression
       equations that adjusted for perinatal variables, including measures of
       fetal growth, gestation, HIV status, and infant toxicology results.
       SETTING. Harlem Hospital Center from 1988 to 1992. RESULTS. At age 6
       months, 21 of 51 (41%) cocaine-positive children exhibited hypertonia of
       any type (hypertonic tetraparesis, hypertonic diparesis, and hypertonic
       hemiparesis) compared with 17 of 68 (25%) cocaine-negative infants (OR =
       2.1, CI = 1.0-4.6). Cocaine-positive infants were four times more likely
       to show hypertonic tetraparesis (HTP) than cocaine-negative infants (OR
       = 4.0; CI = 1.5-10.8). The association remained significant in
       multivariate analyses. Hypertonia, consistent with cerebral palsy,
       diminished over time in both groups. In 97% of affected infants
       hypertonia resolved by 24 months. Arm hypertonia abated first; leg
       hypertonia remained in some children up to age 18 months. No differences
       in development scores between cocaine-positive and cocaine-negative were
       noted at any age interval. However, among cocaine-positive infants those
       with early HTP showed significantly lower mean developmental scores at 6
       and 12 month compared to infants without HTP. CONCLUSION. Cocaine
       positivity urine toxicology at birth is associated with hypertonia
       during infancy. Such cocaine-induced effects are usually symmetrical,
       transient, and the majority of exposed children outgrow hypertonia by 24
       months of life. Among cocaine-positive infants, HTP may be a marker for
       later developmental impairments.
 DE    Adult  Chi-Square Distribution  *Cocaine/URINE  Cohort Studies
       Comparative Study  Female  Human  HIV Seronegativity  HIV
       Seropositivity/EPIDEMIOLOGY  HIV-1/IMMUNOLOGY  Infant  Infant, Newborn
       Infant, Small for Gestational Age  Male  Muscle Hypertonia/*CHEMICALLY
       INDUCED/EPIDEMIOLOGY/URINE  Nervous System Diseases/*CHEMICALLY
       INDUCED/EPIDEMIOLOGY/URINE  New York City/EPIDEMIOLOGY  Odds Ratio
       Pregnancy  *Prenatal Exposure Delayed Effects  Prospective Studies
       Substance Dependence/*COMPLICATIONS  Support, U.S. Gov't, P.H.S.
       JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

