Neurosonographic abnormalities associated with maternal history of cocaine use in neonates of appropriate size for their gestational age

• Published in: American journal of neuroradiology : AJNR Vol. 15; no. 4; pp. 697 - 702
• Main Authors: Dogra, VS, Shyken, JM, Menon, PA, Poblete, J, Lewis, D, Smeltzer, JS
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01-04-1994; American Society of Neuroradiology
• Subjects: Alcohol Drinking; Basal Ganglia Diseases - diagnostic imaging; Biological and medical sciences; Birth Weight; Body Constitution; Body Height; Brain Diseases - diagnostic imaging; Caudate Nucleus - diagnostic imaging; Cerebral Ventricles - diagnostic imaging; Cocaine - urine; Dilatation, Pathologic - diagnostic imaging; Drug addictions; Echoencephalography; Female; Gestational Age; Head - anatomy & histology; Humans; Infant, Newborn; Infant, Premature; Medical sciences; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Substance-Related Disorders; Thalamic Diseases - diagnostic imaging; Toxicology; Human; Drug addiction; Nervous system diseases; Birth height; Toxicity; Exploration; Maternal diseases; Nuclear magnetic resonance imaging; Gestational age; Cerebral disorder; Pregnancy; Newborn; Central nervous system disease; Cocaine; Drug of abuse; Brain (vertebrata)
• ISSN: 0195-6108; 1936-959X

To determine whether increased incidence of neurosonographic abnormalities (predominantly of the basal ganglia and thalamus) in cocaine-exposed neonates who are small for their gestational age is attributable to the cocaine or to neonatal size.
Neonates whose sizes were appropriate for their gestational age with no evidence of hypoxia or respiratory distress were identified prospectively by a maternal history of cocaine use. Scans were performed within 72 hours of birth using a 7.5-MHz transducer following a standard protocol. The images were analyzed without access to patient information. Forty study neonates were compared with 34 control subjects who were appropriate in size for their gestational age, scanned using the same protocol. Comparisons were made using Fisher Exact Test, t test, and logistic regression.
No control infant had neurosonographic abnormalities. In the study group, gestational age ranged from 27 to 41 weeks. Of the 40 study neonates, 14 (35%) had one neurosonographic abnormality; two had two abnormalities. The predominant lesion was focal echolucencies, mainly in the area of the basal ganglia (10 of 40, 25%). Other findings were caudate echogenicity (3 of 40, 7.5%), ventricular dilation (2 of 40, 5%) and one "moth-eaten" appearance of the thalamus. Lesions were more likely approaching term and were not related to prematurity or alcohol use.
Apparently normal neonates with a maternal history of cocaine use are likely to have degenerative changes or focal infarctions in their basal ganglia attributable to cocaine. Neurosonography should be used to evaluate these neonates. The long-term significance of these lesions needs further evaluation.