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Brain and Ocular Abnormalities in Infants With In Utero Exposure to Cocaine and Other Street Drugs

Brain and Ocular Abnormalities in Infants With In Utero Exposure to Cocaine and Other Street Drugs Abstract • We describe 10 infants with developmental delay and congenital cerebral anomalies who were found to have had in utero exposure to vasoactive drugs. Nine infants had ophthalmological abnormalities; these included strabismus, nystagmus, and/or hypoplastic optic discs. Six mothers used cocaine, one used cocaine and heroin, one used only heroin, one used amphetamine, and one used phenylpropanolamine. Each of these cerebral anomalies (agenesis of the corpus callosum, septo-optic dysplasia, schizencephaly, hydranencephaly, congenital hydrocephalus, porencephaly, and cerebral infarctions) can be attributed to insults at different stages of development. There appears to be a relationship between the time of prenatal drug exposure and the type of cerebral anomaly, evoking malformations, disruptions, or fetal strokes. Since many or possibly all of these anomalies are thought to have a vascular origin, it seems appropriate to implicate prenatal exposure to vasoactive drugs. (AJDC. 1991;145:688-695) References 1. Miller JD, Cisin IH. National Survey on Drug Abuse: National Institute on Drug Abuse ; 1983. US Dept of Health and Human Services, Public Health Service, publication ADM 83-126316. 2. Chasnoff IJ. Drug use and women: establishing a standard of care . Ann Acad Sci. 1989;562:208-210.Crossref 3. Miller G. Addicted infants and their mothers . Zero to Three . 1989;10:20-23. 4. 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.Crossref 5. Hadeed AJ, Siegel SR. Maternal cocaine use during pregnancy: effect of the newborn infant . Pediatrics . 1989;84:205-210. 6. Madden JD, Payne TF, Miller S. Maternal cocaine abuse and effect on the newborn . Pediatrics . 1986;77:209-211. 7. Chavez GF, Mulinare J, Cordero JF. Maternal cocaine use during early pregnancy as a risk factor for congenital urogenital anomalies . JAMA . 1989;262:795-798.Crossref 8. Chasnoff IJ, Chisum GM, Kaplan WE. Maternal cocaine use and genitourinary tract malformations . Teratology . 1988;37:201-204.Crossref 9. Zuckerman B, Frank DA, Hingson R. Effects of maternal marijuana and cocaine use on fetal growth . N Engl J Med. 1989;320:762-768.Crossref 10. Chasnoff IJ, Bussey ME, Savich R, Stack CM. Perinatal cerebral infarction and maternal cocaine use . J Pediatr. 1986;108:456-459.Crossref 11. Kramer LD, Locke GE, Ogunyemi A, Nelson L. Neonatal cocaine-related seizures . J Child Neurol. 1990;5:60-64.Crossref 12. Telsey AM, Dixon S, Merritt TA. Cocaine exposure in a term neonate: necrotizing enterocolitis as a complication . Clin Pediatr (Phila) . 1988;27:547-550.Crossref 13. Van de Bor M, Walter FJ, Ebrahimi M. Decreased cardiac output in infants of mothers who abused cocaine . Pediatrics . 1990;85:30-32. 14. Chasnoff IJ, Burns KA, Burns WJ. Cocaine use in pregnancy: perinatal morbidity and mortality . Neurotoxicol Teratol . 1987;9:291-293.Crossref 15. Zelson C. Acute management of neonatal addiction . Addict Dis. 1975;2:159-168. 16. Manley DR. Strabismus . In: Harley RD, ed. Pediatric Ophthalmology . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1983;1:237. 17. Dominguez R, Aguirre A. Cerebral dysmorphogenesis in infants of substance abuse mothers. In: Proceedings of the 32nd Annual Meeting of the Society of Pediatric Radiology; April 6-9, 1989; San Antonio, Tex. Page 160. 18. Bingol N, Fuchs M, Diaz V, Stone RK, Gromisch DS. Teratogenicity of cocaine in humans . J Pediatr. 1987;110:93-96.Crossref 19. Isenberg SJ, Spierer A, Inkelis SH. Ocular sings of cocaine intoxication in neonates . Am J Ophthalmol . 1987;103:211-214. 20. Mahalik MP, Gautieri RF, Mann DE. Teratogenic potential of cocaine hydrochloride in CF-1 mice . J Pharm Sci. 1980;69:703-706.Crossref 21. Webster WS, Brown-Woodman PDC. Cocaine as a cause of congenital malformations of vascular origin: experimental evidence in the rat . Teratology . 1990;41:689-697.Crossref 22. Church MW, Dintcheff BA, Gessner PK. Dose-dependent consequences of cocaine on pregnancy outcome in the Long-Evans rat . Neurotoxicol Teratol . 1988;10:51-58.Crossref 23. Brent RL. Relationship between uterine vascular clamping, vascular disruption syndrome, and cocaine teratogenicity . Teratology. 1990;41:757-760.Crossref 24. Mast, J, Carpanzano C, Hier L. Cocaine as a teratogen: a controlled retrospective review . Ann Neurol. 1989;26:458-459 25. Herman DC, Barkley GB, Bullock JD. Ophthalmic finding in hydranencephaly . J Pediatr Ophthalmol Strabismus . 1988;25:106-111. 26. Nelson L, Ehrlich S, Calhoun JH, Matteucci T, Finnegan LP. Occurrence of strabismus in infants born to drug-dependent women . AJDC . 1987;141:175-178. 27. Chavez CJ, Ostrea EM, Stryker JC, Strauss ME. Ocular abnormalities in infants as sequelae of prenatal drug addiction . Pediatr Res. 1979;13:367. 28. Ferriero DM, Dobori JA, Good WV, Golabi M. Retinal defects in cocaine-exposed infants . Ann Neurol. 1989;26:458. 29. Jawarski M, Hersh JH, Donat J, Shearer LT, Weisskopf B. Computed tomography of the head in the evaluation of microcephaly . Pediatrics . 1986;78:1064-1069. 30. Woods JR, Plessinger MA, Clark KE. Effect of cocaine on uterine blood flow and fetal oxygenation . JAMA . 1987;257:957-961.Crossref 31. Lange RA, Cigarroa RG, Yancy CW, et al. Cocaine-induced coronary-artery vasoconstriction . N Engl J Med. 1989;321:1557-1562.Crossref 32. Chokshi SK, Gal D, Whelton JA, Isner JM. Evidence that fetal distress in newborns of cocaine users is due to vascular spasm and may be attenuated by pre-treatment with diltiazem . Circulation . 1989;80( (suppl 2) ):11-185. Abstract. 33. Nails G, Disher A, Daryabagi J, Zant Z, Eisenman J. Subcortical cerebral hemorrhages associated with cocaine abuse: CT and MR findings . J Comput Assist Tomogr . 1989;13:1-5.Crossref 34. Weiner N. Norepinephrine epinephrine and the sympathomimeticamines . In: Gilman AG, Goodman LS, Gilman A, eds. The Pharmacological Basis of Therapeutics . 6th ed. New York, NY: Macmillan Publishing Co Inc; 1980:138-175. 35. Edwards M, Russo L, Harwood-Nuss A. Cerebral infarction with a single oral dose of phenylpropanolamine . Am J Emerg Med. 1987;5:163-164.Crossref 36. Leeds NE, Malhotra V, Zimmerman RD. The radiology of drug addiction affecting the brain . Semin Roentgenol . 1983;18:227-233.Crossref 37. Yolkow ND, Valentine A, Kulkarni M. Radiological and neurological changes in the drug abuse patient: a study with MRI . J Neuroradiol . 1988;15:288-293. 38. Sandor P, DeJong W, DeWied D. Endorphinergic mechanisms in cerebral blood flow autoregulation . Brain Res. 1986;386:122-129.Crossref 39. Sandor P, Cox-van Put J, de Jong W, DeWied D. Continuous measurement of cerebral blood volume in rats with the photoelectric technique: effect of morphine and naloxone . Life Sci. 1986;39:1657-1665.Crossref 40. Byrd SE, Naidich TP. Common congenital brain anomalies, I: imaging in neuroradiology . Radiol Clin North Am . 1988;26:755-772. 41. Barkovich A, Norman D. MR imaging of schizencephaly . AJNR . 1988;150:1391-1396. 42. Skarf B, Hoyt CS. Optic nerve hypoplasia in children: association with anomalies of the endocrine and CNS . Arch Ophthalmol . 1984;102:62-67.Crossref 43. Padget DH. The development of the cranial arteries in the human embryo . Carnegie Inst Contr Embryol . 1948;32:205-261. 44. Diebler C, Dulac O. Vascular disorders . Pediatric Neurology and Neuroradiology . Hydleberg, NY: Springer-Verlag; 1987:185-194. 45. Dekaban A. Large defects in cerebral hemispheres associated with cortical dysgenesis . J Neuropathol Exp Neurol. 1965;24:512-530.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Brain and Ocular Abnormalities in Infants With In Utero Exposure to Cocaine and Other Street Drugs

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References (51)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1991.02160060106030
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Abstract

Abstract • We describe 10 infants with developmental delay and congenital cerebral anomalies who were found to have had in utero exposure to vasoactive drugs. Nine infants had ophthalmological abnormalities; these included strabismus, nystagmus, and/or hypoplastic optic discs. Six mothers used cocaine, one used cocaine and heroin, one used only heroin, one used amphetamine, and one used phenylpropanolamine. Each of these cerebral anomalies (agenesis of the corpus callosum, septo-optic dysplasia, schizencephaly, hydranencephaly, congenital hydrocephalus, porencephaly, and cerebral infarctions) can be attributed to insults at different stages of development. There appears to be a relationship between the time of prenatal drug exposure and the type of cerebral anomaly, evoking malformations, disruptions, or fetal strokes. Since many or possibly all of these anomalies are thought to have a vascular origin, it seems appropriate to implicate prenatal exposure to vasoactive drugs. (AJDC. 1991;145:688-695) References 1. Miller JD, Cisin IH. National Survey on Drug Abuse: National Institute on Drug Abuse ; 1983. US Dept of Health and Human Services, Public Health Service, publication ADM 83-126316. 2. Chasnoff IJ. Drug use and women: establishing a standard of care . Ann Acad Sci. 1989;562:208-210.Crossref 3. Miller G. Addicted infants and their mothers . Zero to Three . 1989;10:20-23. 4. 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.Crossref 5. Hadeed AJ, Siegel SR. Maternal cocaine use during pregnancy: effect of the newborn infant . Pediatrics . 1989;84:205-210. 6. Madden JD, Payne TF, Miller S. Maternal cocaine abuse and effect on the newborn . Pediatrics . 1986;77:209-211. 7. Chavez GF, Mulinare J, Cordero JF. Maternal cocaine use during early pregnancy as a risk factor for congenital urogenital anomalies . JAMA . 1989;262:795-798.Crossref 8. Chasnoff IJ, Chisum GM, Kaplan WE. Maternal cocaine use and genitourinary tract malformations . Teratology . 1988;37:201-204.Crossref 9. Zuckerman B, Frank DA, Hingson R. Effects of maternal marijuana and cocaine use on fetal growth . N Engl J Med. 1989;320:762-768.Crossref 10. Chasnoff IJ, Bussey ME, Savich R, Stack CM. Perinatal cerebral infarction and maternal cocaine use . J Pediatr. 1986;108:456-459.Crossref 11. Kramer LD, Locke GE, Ogunyemi A, Nelson L. Neonatal cocaine-related seizures . J Child Neurol. 1990;5:60-64.Crossref 12. Telsey AM, Dixon S, Merritt TA. Cocaine exposure in a term neonate: necrotizing enterocolitis as a complication . Clin Pediatr (Phila) . 1988;27:547-550.Crossref 13. Van de Bor M, Walter FJ, Ebrahimi M. Decreased cardiac output in infants of mothers who abused cocaine . Pediatrics . 1990;85:30-32. 14. Chasnoff IJ, Burns KA, Burns WJ. Cocaine use in pregnancy: perinatal morbidity and mortality . Neurotoxicol Teratol . 1987;9:291-293.Crossref 15. Zelson C. Acute management of neonatal addiction . Addict Dis. 1975;2:159-168. 16. Manley DR. Strabismus . In: Harley RD, ed. Pediatric Ophthalmology . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1983;1:237. 17. Dominguez R, Aguirre A. Cerebral dysmorphogenesis in infants of substance abuse mothers. In: Proceedings of the 32nd Annual Meeting of the Society of Pediatric Radiology; April 6-9, 1989; San Antonio, Tex. Page 160. 18. Bingol N, Fuchs M, Diaz V, Stone RK, Gromisch DS. Teratogenicity of cocaine in humans . J Pediatr. 1987;110:93-96.Crossref 19. Isenberg SJ, Spierer A, Inkelis SH. Ocular sings of cocaine intoxication in neonates . Am J Ophthalmol . 1987;103:211-214. 20. Mahalik MP, Gautieri RF, Mann DE. Teratogenic potential of cocaine hydrochloride in CF-1 mice . J Pharm Sci. 1980;69:703-706.Crossref 21. Webster WS, Brown-Woodman PDC. Cocaine as a cause of congenital malformations of vascular origin: experimental evidence in the rat . Teratology . 1990;41:689-697.Crossref 22. Church MW, Dintcheff BA, Gessner PK. Dose-dependent consequences of cocaine on pregnancy outcome in the Long-Evans rat . Neurotoxicol Teratol . 1988;10:51-58.Crossref 23. Brent RL. Relationship between uterine vascular clamping, vascular disruption syndrome, and cocaine teratogenicity . Teratology. 1990;41:757-760.Crossref 24. Mast, J, Carpanzano C, Hier L. Cocaine as a teratogen: a controlled retrospective review . Ann Neurol. 1989;26:458-459 25. Herman DC, Barkley GB, Bullock JD. Ophthalmic finding in hydranencephaly . J Pediatr Ophthalmol Strabismus . 1988;25:106-111. 26. Nelson L, Ehrlich S, Calhoun JH, Matteucci T, Finnegan LP. Occurrence of strabismus in infants born to drug-dependent women . AJDC . 1987;141:175-178. 27. Chavez CJ, Ostrea EM, Stryker JC, Strauss ME. Ocular abnormalities in infants as sequelae of prenatal drug addiction . Pediatr Res. 1979;13:367. 28. Ferriero DM, Dobori JA, Good WV, Golabi M. Retinal defects in cocaine-exposed infants . Ann Neurol. 1989;26:458. 29. Jawarski M, Hersh JH, Donat J, Shearer LT, Weisskopf B. Computed tomography of the head in the evaluation of microcephaly . Pediatrics . 1986;78:1064-1069. 30. Woods JR, Plessinger MA, Clark KE. Effect of cocaine on uterine blood flow and fetal oxygenation . JAMA . 1987;257:957-961.Crossref 31. Lange RA, Cigarroa RG, Yancy CW, et al. Cocaine-induced coronary-artery vasoconstriction . N Engl J Med. 1989;321:1557-1562.Crossref 32. Chokshi SK, Gal D, Whelton JA, Isner JM. Evidence that fetal distress in newborns of cocaine users is due to vascular spasm and may be attenuated by pre-treatment with diltiazem . Circulation . 1989;80( (suppl 2) ):11-185. Abstract. 33. Nails G, Disher A, Daryabagi J, Zant Z, Eisenman J. Subcortical cerebral hemorrhages associated with cocaine abuse: CT and MR findings . J Comput Assist Tomogr . 1989;13:1-5.Crossref 34. Weiner N. Norepinephrine epinephrine and the sympathomimeticamines . In: Gilman AG, Goodman LS, Gilman A, eds. The Pharmacological Basis of Therapeutics . 6th ed. New York, NY: Macmillan Publishing Co Inc; 1980:138-175. 35. Edwards M, Russo L, Harwood-Nuss A. Cerebral infarction with a single oral dose of phenylpropanolamine . Am J Emerg Med. 1987;5:163-164.Crossref 36. Leeds NE, Malhotra V, Zimmerman RD. The radiology of drug addiction affecting the brain . Semin Roentgenol . 1983;18:227-233.Crossref 37. Yolkow ND, Valentine A, Kulkarni M. Radiological and neurological changes in the drug abuse patient: a study with MRI . J Neuroradiol . 1988;15:288-293. 38. Sandor P, DeJong W, DeWied D. Endorphinergic mechanisms in cerebral blood flow autoregulation . Brain Res. 1986;386:122-129.Crossref 39. Sandor P, Cox-van Put J, de Jong W, DeWied D. Continuous measurement of cerebral blood volume in rats with the photoelectric technique: effect of morphine and naloxone . Life Sci. 1986;39:1657-1665.Crossref 40. Byrd SE, Naidich TP. Common congenital brain anomalies, I: imaging in neuroradiology . Radiol Clin North Am . 1988;26:755-772. 41. Barkovich A, Norman D. MR imaging of schizencephaly . AJNR . 1988;150:1391-1396. 42. Skarf B, Hoyt CS. Optic nerve hypoplasia in children: association with anomalies of the endocrine and CNS . Arch Ophthalmol . 1984;102:62-67.Crossref 43. Padget DH. The development of the cranial arteries in the human embryo . Carnegie Inst Contr Embryol . 1948;32:205-261. 44. Diebler C, Dulac O. Vascular disorders . Pediatric Neurology and Neuroradiology . Hydleberg, NY: Springer-Verlag; 1987:185-194. 45. Dekaban A. Large defects in cerebral hemispheres associated with cortical dysgenesis . J Neuropathol Exp Neurol. 1965;24:512-530.Crossref

Journal

American Journal of Diseases of Children – American Medical Association

Published: Jun 1, 1991

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