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June 1992, Vol 146, No. 6 >
Article | June 1992

Electroencephalographic and Behavioral-State Studies in Infants of Cocaine-Addicted Mothers FREE

Agustín Legido, MD; Robert R. Clancy, MD; Alan R. Spitzer, MD; Loretta P. Finnegan, MD
[+] Author Affiliations

Accepted for publication January 17, 1992.

Presented in part at the Child Neurology Society Meeting, Halifax, Nova Scotia, September 16, 1988, and abstracted in Annals of Neurology (1988;24:328).

Reprint requests to St. Christopher's Hospital for Children, Section of Neurology, Erie Avenue at Front Street, Philadelphia, PA 19134-1095 (Dr Legido).


Am J Dis Child. 1992;146(6):748-752. doi:10.1001/archpedi.1992.02160180108027.
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Article
References
Comments

• Objective.  —To evaluate cerebral cortical function with electroencephalography in infants of cocaine-addicted mothers.

Design.  —Patient series.

Setting.  —The Children's Hospital of Philadelphia (Pa).

Participants.  —Thirty-five consecutive infants of cocaine-addicted mothers hospitalized for a comprehensive health assessment and 51 healthy, age-matched infants studied with electroencephalography and respiratory thermistor because they were siblings of sudden infant death victims (comparison group).

Interventions.  —None.

Measurements/Main Results.  —Behavioral states during spontaneous daytime sleep were classified as active sleep or quiet sleep; quiet sleep was further characterized as immature, tracé alternant sleep or mature, continuous, slow wave sleep. No episodes of ictal apnea or nonictal apnea were recorded in infants of cocaine-addicted mothers; nonictal apnea was observed in one control patient. No electrographic seizures were recorded. There were no significant differences between the proportions of infants exposed to cocaine in utero and that of controls who displayed excessive sharp electroencephalographic transients, background abnormalities, immaturity, and hypermaturity. Electroclinical sleep discordance was present in 5.7% of infants of cocaine-addicted mothers vs 0% of controls. Cocaine-exposed infants displayed mature, continuous, slow wave sleep below 45 weeks of conceptional age in a significantly higher percentage than those in the comparison group.

Conclusions.  —Although frank electroencephalographic abnormalities were infrequent in infants whose mothers were addicted to cocaine, they differed significantly in their younger age of onset of continuous, slow wave sleep. Our findings provide continued reason for concern that infants of cocaine-addicted mothers may suffer subtle adverse neurologic, cognitive, or behavioral effects later in life. The longitudinal assessment of sleep disturbance and its relation to later development might permit tracking of the long-term effects of prenatal exposure to cocaine.(AJDC. 1992;146:748-752)

REFERENCES

1 +
Ryan L, Ehrlich S, Finnegan L.  Cocaine abuse in pregnancy: effects on the fetus and newborn . Neurotoxicol Teratol . 1987;;9:295-299.
2 +
Frank DA, Zuckerman BS, Amaro H, et al.  Cocaine use during pregnancy: prevalence and correlates . Pediatrics . 1988;;82:888-895.
3 +
Bingol N, Fuchs M, Diaz V, Stone RK, Gromisch DS.  Teratogenicity of cocaine in humans . J Pediatr . 1987;;110:93-96.
4 +
Domínguez R, Aguirre Vila-Coro A, Slopis JM, Bohan TP.  Brain and ocular abnormalities in infants with in utero exposure to cocaine and other street drugs . AJDC . 1991;;145:688-695.
5 +
Oro AS, Dixon SD.  Perinatal cocaine and methamphetamine exposure: maternal and neonatal correlates . J Pediatr . 1987;;111:571-578.
6 +
Chasnoff IJ, Burns KA, Burns WJ.  Cocaine use in pregnancy: perinatal morbidity and mortality . Neurotoxicol Teratol . 1987;;9:291-293.
7 +
Chasnoff IJ, Griffith DR.  Cocaine: clinical studies of pregnancy and newborn . Ann N Y Acad Sci . 1989;;562:260-266.
8 +
Hume RF, O'Donnell KJ, Stanger CL, Killam AP, Gingras JL.  In utero cocaine exposure: observations of fetal behavior state may predict neonatal outcome . Am J Obstet Gynecol . 1989;;161:685-690.
9 +
Mastrogiannis DS, Decavalas GO, Verma U, Tejani N.  Perinatal outcome after recent cocaine usage . Obstet Gynecol . 1990;;76:8-11.
10 +
Dixon SD, Bejar R.  Echoencephalographic findings in neonates associated with maternal cocaine and methamphetamine use: incidence and clinical correlates . J Pediatr . 1989;;115:770-778.
11 +
Spires MC, Gordon EF, Choudhuri M, Maldonado E, Chan R.  Intracranial hemorrhage in a neonate following prenatal cocaine exposure . Pediatr Neurol . 1989;;5:324-326.
12 +
Kramer LD, Locke GE, Ogunyemi A, Nelson L.  Neonatal cocaine-related seizures . J Child Neurol . 1990;;5:60-64.
13 +
Kohrman MH, Kerr SL, O'Donnell JK, Mazyrka NK, Montgomery ME.  The risk of sudden infant death syndrome and apparent life-threatening events in infants exposed to cocaine . Ann Neurol . 1990;;28:456.
14 +
Schwartz D, Morris M, Civitello B, Spydell J, Anday E.  Lack of effect of in utero cocaine on auditory brainstem evoked potentials . Pediatr Res . 1990;;27:348. Abstract.
15 +
Salamy A, Eldredge L, Anderson J, Bull D.  Brain-stem transmission time in infants exposed to cocaine in utero . J Pediatr . 1990;;117:627-629.
16 +
Brown ER, Cole J, Parkers S, Coulter D, Corwin M, Aboagyne K.  Effect of prenatal cocaine exposure of EEG activity of narcotic-addicted infants . Pediatr Res . 1989;;25:353. Abstract.
17 +
Doberczak TM, Shanzer S, Senie RT, Kandall SR.  Neonatal neurologic and electroencephalographic effects of intrauterine cocaine exposure . J Pediatr . 1988;;113:354-358.
18 +
Clancy RR, Spitzer AR.  Cerebral cortical function in infants at risk for sudden infant death syndrome . Ann Neurol . 1985;;18:41-47.
19 +
Tharp BR.  Neonatal and pediatric electroencephalography . In: Aminof MJ, ed. Electrodiagnosis in Clinical Neurology . New York, NY: Churchill Livingstone Inc; 1980;:67-117.
20 +
Anders T, Emde R, Parmelee A, eds. A Manual of Standardized Terminology, Techniques and Criteria for Scoring of States of Sleep and Wakefulness in Newborn Infant . Los Angeles, Calif: UCLA Brain Information Service BRI; 1971;.
21 +
Clancy RR.  Interictal sharp EEG transients in neonatal seizures . J Child Neurol . 1989;;4:30-38.
22 +
Clancy RR, Legido A.  Postnatal epilepsy after EEG-confirmed neonatal seizures . Epilepsia . 1991;;32:69-76.
23 +
Finnegan LP, ed. Drug Dependence in Pregnancy: Clinical Management of Mother and Child . Washington, DC: US Government Printing Office; 1979;. US Dept of Health, Education, and Welfare publication ADM 79/678.
24 +
Shah NS, May DA, Yates JD.  Disposition of levo-(H)-cocaine in pregnant and nonpregnant mice . Toxicol Appl Pharmacol . 1980;;53:279-284.
25 +
Roe DA, Litle BB, Bawdon RE, Gisltrap LC.  Metabolism of cocaine by human placentas: implications for fetal exposure . Am J Obstet Gynecol . 1990;;163:715-718.
26 +
Ritchie JM, Greene NM.  Local anesthesia . In: Gilman AG, Goodman LS, Gilman A, eds. The Pharmacologic Basis of Therapeutics . New York, NY: Macmillan Publishing Co Inc; 1980;:302-321.
27 +
Herning RI, Hooker WD, Jones RT.  Cocaine effects on electroencephalographic cognitive event-related potentials and performance . Electroencephalogr Clin Neurophysiol . 1987;;66:32-42.
28 +
Herning RI, Jones RT, Hooker WD, Mendelson J, Blackwell L.  Cocaine increases EEG Beta: a replication and extension of Hans Berger's historic experiments . Electroencephalogr Clin Neurophysiol . 1985;;60:470-477.
29 +
Pascual-Leone A, Dhuna AK.  Electroencephalogram in chronic cocaine addicts . Ann Neurol . 1990;;28:250.
30 +
Stripling JS, Gramlich CA, Cunningham MG.  Effect of cocaine and lidocaine on the development of kindled seizures . Pharmacol Biochem Behav . 1989;;32:463-468.
31 +
Lesse H, Collins JP.  Effects of cocaine on propagation of limbic seizure activity . Pharmacol Biochem Behav . 1979;;11:689-694.
32 +
Spear LP, Kirstein CL, Frambes NA.  Cocaine effects on the developing central nervous system: behavioral, psychopharmacological, and neurochemical studies . Ann N Y Acad Sci . 1989;;562:290-307.
33 +
Dow-Edwards DL.  Long-term neurochemical and neurobehavioral consequences of cocaine use during pregnancy . Ann N Y Acad Sci . 1989;;562:280-289.
34 +
Henderson MG, McMillen BA.  Effects of prenatal exposure to cocaine or related drugs on rat developmental and neurological indices . Brain Res Bull . 1990;;24:207-212.
35 +
Mathews S, Tyrala EE, Rao GS.  Effect of intra-uterine exposure of cocaine on acetylcholine esterase (ACE) in primary cultures of embryonic mouse brain cells . Pediatr Res . 1988;;23:418. Abstract.
36 +
Grimm VE.  Effect of teratogenic exposure on the developing brain: research strategies and possible mechanisms . Dev Pharmacol Ther . 1987;;10:328-345.
37 +
Hutchings DE, Don-Edwards D.  Animal models of opiate, cocaine and cannabis use . Clin Perinatol . 1991;;18:1-22.
38 +
Gingras JL, Muelenaer AA, Knight CG, McAdams LC, O'Donnell KJ, Dalley LB.  In utero cocaine exposure alters postnatal sleep maturation . Pediatr Res . 1991;;29:358. Abstract.
39 +
Scher MS.  A developmental marker of central nervous system maturation: part I . Pediatr Neurol . 1988;;4:265-273.
40 +
Thoman EB, McDowell K.  Sleep cyclicity in infants during the earliest postnatal weeks . Physiol Behav . 1989;;45:517-522.
41 +
Scher MS.  A development marker of central nervous system maturation: part II . Pediatr Neurol . 1988;;4:329-336.
42 +
Burchfield DJ, Graham EM, Abrams RM, Gerhardt KJ.  Cocaine alters behavioral states in fetal sheep . Dev Brain Res . 1990;;56:41-45.
43 +
Anders TF, Keener MA, Kraemer H.  Sleep-wake state organization, neonatal assessment and development in premature infants during the first year of life, Part II . Sleep . 1985;;8:193-206.
44 +
Adams RD, Victor M. Principles of Neurology . New York, NY: McGraw-Hill International Book Co; 1989;:306-307.
45 +
Wauquier A, Dugovic C.  Serotonin and sleep-wakefulness . Ann N Y Acad Sci . 1990;;600:447-459.
46 +
Day NL, Robles N.  Methodological issues in the measurement of substance use . Ann N Y Acad Sci . 1989;;562:8-13.
47 +
Singer LT, Garber R, Kliegman R.  Neurobehavioral sequelae of fetal cocaine exposure . J Pediatr . 1991;;119:667-672.
48 +
Belcher HME, Wallace PM.  Neurodevelopmental evaluation of children with intrauterine cocaine exposure . Pediatr Res . 1991;;29:7. Abstract.
49 +
Chasnoff IJ, Groffith DR, Freier C, Murray J.  Cocaine/polydrug use in pregnancy: two-year follow-up . Pediatrics . 1992;;89:284-289.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Ryan L, Ehrlich S, Finnegan L.  Cocaine abuse in pregnancy: effects on the fetus and newborn . Neurotoxicol Teratol . 1987;;9:295-299.
2 +
Frank DA, Zuckerman BS, Amaro H, et al.  Cocaine use during pregnancy: prevalence and correlates . Pediatrics . 1988;;82:888-895.
3 +
Bingol N, Fuchs M, Diaz V, Stone RK, Gromisch DS.  Teratogenicity of cocaine in humans . J Pediatr . 1987;;110:93-96.
4 +
Domínguez R, Aguirre Vila-Coro A, Slopis JM, Bohan TP.  Brain and ocular abnormalities in infants with in utero exposure to cocaine and other street drugs . AJDC . 1991;;145:688-695.
5 +
Oro AS, Dixon SD.  Perinatal cocaine and methamphetamine exposure: maternal and neonatal correlates . J Pediatr . 1987;;111:571-578.
6 +
Chasnoff IJ, Burns KA, Burns WJ.  Cocaine use in pregnancy: perinatal morbidity and mortality . Neurotoxicol Teratol . 1987;;9:291-293.
7 +
Chasnoff IJ, Griffith DR.  Cocaine: clinical studies of pregnancy and newborn . Ann N Y Acad Sci . 1989;;562:260-266.
8 +
Hume RF, O'Donnell KJ, Stanger CL, Killam AP, Gingras JL.  In utero cocaine exposure: observations of fetal behavior state may predict neonatal outcome . Am J Obstet Gynecol . 1989;;161:685-690.
9 +
Mastrogiannis DS, Decavalas GO, Verma U, Tejani N.  Perinatal outcome after recent cocaine usage . Obstet Gynecol . 1990;;76:8-11.
10 +
Dixon SD, Bejar R.  Echoencephalographic findings in neonates associated with maternal cocaine and methamphetamine use: incidence and clinical correlates . J Pediatr . 1989;;115:770-778.
11 +
Spires MC, Gordon EF, Choudhuri M, Maldonado E, Chan R.  Intracranial hemorrhage in a neonate following prenatal cocaine exposure . Pediatr Neurol . 1989;;5:324-326.
12 +
Kramer LD, Locke GE, Ogunyemi A, Nelson L.  Neonatal cocaine-related seizures . J Child Neurol . 1990;;5:60-64.
13 +
Kohrman MH, Kerr SL, O'Donnell JK, Mazyrka NK, Montgomery ME.  The risk of sudden infant death syndrome and apparent life-threatening events in infants exposed to cocaine . Ann Neurol . 1990;;28:456.
14 +
Schwartz D, Morris M, Civitello B, Spydell J, Anday E.  Lack of effect of in utero cocaine on auditory brainstem evoked potentials . Pediatr Res . 1990;;27:348. Abstract.
15 +
Salamy A, Eldredge L, Anderson J, Bull D.  Brain-stem transmission time in infants exposed to cocaine in utero . J Pediatr . 1990;;117:627-629.
16 +
Brown ER, Cole J, Parkers S, Coulter D, Corwin M, Aboagyne K.  Effect of prenatal cocaine exposure of EEG activity of narcotic-addicted infants . Pediatr Res . 1989;;25:353. Abstract.
17 +
Doberczak TM, Shanzer S, Senie RT, Kandall SR.  Neonatal neurologic and electroencephalographic effects of intrauterine cocaine exposure . J Pediatr . 1988;;113:354-358.
18 +
Clancy RR, Spitzer AR.  Cerebral cortical function in infants at risk for sudden infant death syndrome . Ann Neurol . 1985;;18:41-47.
19 +
Tharp BR.  Neonatal and pediatric electroencephalography . In: Aminof MJ, ed. Electrodiagnosis in Clinical Neurology . New York, NY: Churchill Livingstone Inc; 1980;:67-117.
20 +
Anders T, Emde R, Parmelee A, eds. A Manual of Standardized Terminology, Techniques and Criteria for Scoring of States of Sleep and Wakefulness in Newborn Infant . Los Angeles, Calif: UCLA Brain Information Service BRI; 1971;.
21 +
Clancy RR.  Interictal sharp EEG transients in neonatal seizures . J Child Neurol . 1989;;4:30-38.
22 +
Clancy RR, Legido A.  Postnatal epilepsy after EEG-confirmed neonatal seizures . Epilepsia . 1991;;32:69-76.
23 +
Finnegan LP, ed. Drug Dependence in Pregnancy: Clinical Management of Mother and Child . Washington, DC: US Government Printing Office; 1979;. US Dept of Health, Education, and Welfare publication ADM 79/678.
24 +
Shah NS, May DA, Yates JD.  Disposition of levo-(H)-cocaine in pregnant and nonpregnant mice . Toxicol Appl Pharmacol . 1980;;53:279-284.
25 +
Roe DA, Litle BB, Bawdon RE, Gisltrap LC.  Metabolism of cocaine by human placentas: implications for fetal exposure . Am J Obstet Gynecol . 1990;;163:715-718.
26 +
Ritchie JM, Greene NM.  Local anesthesia . In: Gilman AG, Goodman LS, Gilman A, eds. The Pharmacologic Basis of Therapeutics . New York, NY: Macmillan Publishing Co Inc; 1980;:302-321.
27 +
Herning RI, Hooker WD, Jones RT.  Cocaine effects on electroencephalographic cognitive event-related potentials and performance . Electroencephalogr Clin Neurophysiol . 1987;;66:32-42.
28 +
Herning RI, Jones RT, Hooker WD, Mendelson J, Blackwell L.  Cocaine increases EEG Beta: a replication and extension of Hans Berger's historic experiments . Electroencephalogr Clin Neurophysiol . 1985;;60:470-477.
29 +
Pascual-Leone A, Dhuna AK.  Electroencephalogram in chronic cocaine addicts . Ann Neurol . 1990;;28:250.
30 +
Stripling JS, Gramlich CA, Cunningham MG.  Effect of cocaine and lidocaine on the development of kindled seizures . Pharmacol Biochem Behav . 1989;;32:463-468.
31 +
Lesse H, Collins JP.  Effects of cocaine on propagation of limbic seizure activity . Pharmacol Biochem Behav . 1979;;11:689-694.
32 +
Spear LP, Kirstein CL, Frambes NA.  Cocaine effects on the developing central nervous system: behavioral, psychopharmacological, and neurochemical studies . Ann N Y Acad Sci . 1989;;562:290-307.
33 +
Dow-Edwards DL.  Long-term neurochemical and neurobehavioral consequences of cocaine use during pregnancy . Ann N Y Acad Sci . 1989;;562:280-289.
34 +
Henderson MG, McMillen BA.  Effects of prenatal exposure to cocaine or related drugs on rat developmental and neurological indices . Brain Res Bull . 1990;;24:207-212.
35 +
Mathews S, Tyrala EE, Rao GS.  Effect of intra-uterine exposure of cocaine on acetylcholine esterase (ACE) in primary cultures of embryonic mouse brain cells . Pediatr Res . 1988;;23:418. Abstract.
36 +
Grimm VE.  Effect of teratogenic exposure on the developing brain: research strategies and possible mechanisms . Dev Pharmacol Ther . 1987;;10:328-345.
37 +
Hutchings DE, Don-Edwards D.  Animal models of opiate, cocaine and cannabis use . Clin Perinatol . 1991;;18:1-22.
38 +
Gingras JL, Muelenaer AA, Knight CG, McAdams LC, O'Donnell KJ, Dalley LB.  In utero cocaine exposure alters postnatal sleep maturation . Pediatr Res . 1991;;29:358. Abstract.
39 +
Scher MS.  A developmental marker of central nervous system maturation: part I . Pediatr Neurol . 1988;;4:265-273.
40 +
Thoman EB, McDowell K.  Sleep cyclicity in infants during the earliest postnatal weeks . Physiol Behav . 1989;;45:517-522.
41 +
Scher MS.  A development marker of central nervous system maturation: part II . Pediatr Neurol . 1988;;4:329-336.
42 +
Burchfield DJ, Graham EM, Abrams RM, Gerhardt KJ.  Cocaine alters behavioral states in fetal sheep . Dev Brain Res . 1990;;56:41-45.
43 +
Anders TF, Keener MA, Kraemer H.  Sleep-wake state organization, neonatal assessment and development in premature infants during the first year of life, Part II . Sleep . 1985;;8:193-206.
44 +
Adams RD, Victor M. Principles of Neurology . New York, NY: McGraw-Hill International Book Co; 1989;:306-307.
45 +
Wauquier A, Dugovic C.  Serotonin and sleep-wakefulness . Ann N Y Acad Sci . 1990;;600:447-459.
46 +
Day NL, Robles N.  Methodological issues in the measurement of substance use . Ann N Y Acad Sci . 1989;;562:8-13.
47 +
Singer LT, Garber R, Kliegman R.  Neurobehavioral sequelae of fetal cocaine exposure . J Pediatr . 1991;;119:667-672.
48 +
Belcher HME, Wallace PM.  Neurodevelopmental evaluation of children with intrauterine cocaine exposure . Pediatr Res . 1991;;29:7. Abstract.
49 +
Chasnoff IJ, Groffith DR, Freier C, Murray J.  Cocaine/polydrug use in pregnancy: two-year follow-up . Pediatrics . 1992;;89:284-289.

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