ABSTRACT
We evaluated the prevalence of illicit substance abuse by comparing drug screening results derived from meconium, urine pairs, and maternal interview. Mother/infant pairs (580) were entered into this blinded, prospective study. Prevalence of illicit substance abuse was 3.4%. The lack of prenatal care correlated with the use of cocaine (p < 0.001). Neonates born to cocaine-using mothers were more likely to be premature, to have a lower birth weight, decreased length, and smaller head circumference using unpaired t test (overall p < 0.05 using Bonferroni method for simultaneous inference). For mother/infant pairs who had positive drug screening for cocaine, the interview, maternal urine sample, and meconium sample showed equal sensitivity, although the newborn urine showed poor correlation. We suggest that the newborn urine sample could be deleted from newborn drug screening, and lack of perinatal care may serve as a marker of substance abuse.
Subject(s)
Cocaine , Marijuana Abuse/epidemiology , Neonatal Screening/methods , Substance Abuse Detection/methods , Substance-Related Disorders/epidemiology , Female , Humans , Infant, Newborn , Interviews as Topic , Male , Marijuana Abuse/diagnosis , Meconium/chemistry , Pregnancy , Pregnancy Outcome/epidemiology , Prevalence , Prospective Studies , Substance-Related Disorders/diagnosis , UrinalysisABSTRACT
BACKGROUND: In adults--but not neonates--neutropenia has been reported to complicate treatment with intravenous immunoglobulin, but the mechanism is unknown. PURPOSE: To describe for the first time the case of a newborn infant who, after intravenous immunoglobulin, demonstrated serum antineutrophil antibodies and neutropenia. PATIENTS AND METHODS: The 1,425-g, 36-week-gestation boy was healthy except for intrauterine growth retardation. Intravenous immunoglobulin (1g/dose x 3) was administered to treat alloimmune thrombocytopenia. Neutrophil-specific antibodies were detected by a granulocyte immunofluorescence assay. RESULTS: After the intravenous immunoglobulin, the platelet count normalized but the neutrophil count declined to 450/mm3. Neutrophil-specific antibodies were detected in the serum of the infant but not in the maternal serum. Furthermore, cross-matching revealed that the maternal serum did not react with the infant's granulocytes. Two of three random lots of intravenous immunoglobulin contained detectible anti-neutrophil antibodies. CONCLUSIONS: After intravenous immunoglobulin, the infant's serum contained one or more anti-neutrophil antibodies that were not maternal in origin. We speculate that the neutropenia resulted from the administration of intravenous immunoglobulin containing antineutrophil antibodies.
