Tone abnormalities are associated with maternal cigarette smoking during pregnancy in in utero cocaine-exposed infants.

OBJECTIVE: Maternal cigarette smoking, alcohol use, and other factors confound studies of in utero cocaine exposure. Our goal was to determine whether in utero cocaine exposure is associated with an abnormal neurologic examination in infants, while controlling for concomitant cigarette smoke exposure and other confounding variables. DESIGN: Healthy newborns with birth weights > or =2000 g were prospectively enrolled into a race-matched study of cocaine-exposed and cocaine-unexposed infants. Urine and meconium samples were analyzed for illicit drugs, the cocaine metabolite, benzoylecgonine, and the nicotine metabolite, cotinine. A detailed neurological examination was performed at approximately 6 weeks of age by an examiner blinded to history. RESULTS: At 6 weeks of age, 40 cocaine-exposed infants and 56 cocaine-unexposed infants were examined. Tone abnormalities were the only neurologic abnormalities discovered, predominantly generalized hypertonia. Logistic models found that maternal urine cotinine levels were predictive of an abnormal neurologic examination, whereas cocaine exposure or benzoylecgonine levels were not. No interaction was found between maternal cigarette smoking and cocaine exposure. Race, ethanol exposure, prenatal care, homelessness, and head circumference were not predictive of an abnormal tone examination. The odds ratio for an abnormal examination was 2.9 (95% confidence interval: 1.04-8.25), if the maternal urine cotinine level was >200 ng/mL. CONCLUSION: Our findings suggest that maternal cigarette smoking may be the major predictor of tone abnormalities reported in cocaine-exposed infants.

Early prediction of neurologic outcome after perinatal depression.

Evaluation is presented of whether or not a detailed neuromotor examination at 3 months of age could predict later neurologic abnormalities among term infants with perinatal depression. In a prospective cohort, infants were neurologically evaluated at 3 and 12 months. Infants were scored from 0 to 5 according to a new neuromotor scoring system. The neuromotor score at 3 months (NMS-3) was compared with the NMS at 12 months (NMS-12). Seventy-four infants were enrolled in the study; nine were lost to follow-up, and five died before reaching 1 year. Sixty infants were examined (neurologic abnormalities = 52%, normal = 48% at 1 year). The NMS-3 correlated strongly with the NMS-12 and the results of the 12-month neurologic examination. All infants with a NMS-3 of 5 had neurologic abnormalities at 1 year. Infants with neonatal seizures had a significantly increased risk of developmental abnormalities at 1 year. Eighteen infants exhibited transient abnormalities. Using a simple scoring system, the results of the early neurologic examinations correlated strongly with outcome among term infants with perinatal depression. A subgroup of infants had transient abnormalities. These findings suggest that in term high-risk infants, the 1-year neurologic outcome can be predicted at 3 months of age using these parameters.

Proton MR spectroscopy for the evaluation of brain injury in asphyxiated, term neonates.

BACKGROUND AND PURPOSE: Neurologic and developmental outcomes of asphyxiated, term neonates are difficult to predict applying clinical or laboratory criteria. In this study, we investigated the association of MR spectroscopy (MRS) results with neurodevelopmental status at age 12 months. METHOD: Thirty-one term neonates, who were enrolled in a prospective study of the utility of MR imaging for the determination of neurologic and developmental status, underwent single-voxel proton MRS of the basal nuclei and intervascular boundary zones. Ratios of lactate, choline, creatine, and N-acetylaspartate (NAA) peaks were calculated and tested for association with neuromotor scores and Mental Development Index of the Bayley Scores of Infant Development obtained at age 12 months. RESULTS: Elevated lactate and diminished NAA were the most common findings in infants with neurologic and developmental abnormalities at age 12 months. Although many ratios had statistically significant associations with outcome (P<.05), the highest significance was obtained with lactate/choline ratios in the basal nuclei. A false-positive finding was seen in a patient who was born after a 36-week gestation period (high lactate/choline but normal neurodevelopmental status at 12 months) and in three patients with apparent watershed injury (high watershed lactate/choline but normal neurodevelopmental status at 12 months). A false-negative MRS finding (normal lactate/choline but abnormal outcome) was seen in a patient who had an apparent prenatal injury. CONCLUSION: Proton MRS appears to be a useful tool for assessing brain injury in neonates who have suffered hypoxia or ischemia. Correlation with gestational age and imaging findings are essential for proper interpretation of the spectra. Patients with apparent watershed injuries may have normal neurodevelopmental status at age 12 months.

Effect of environmental tobacco smoke exposure on respiratory symptoms in children. SCARPOL Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution, Climate and Pollen.

AIMS: This study determines the prevalence of exposure to environmental tobacco smoke and its relation to respiratory and allergic symptoms among schoolchildren in Switzerland. METHODS: We studied 4470 children aged 6-14 years as part of a multicentre study (SCARPOL study--Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution, Climate and Pollen) conducted in Switzerland between 1992 and 1993. Environmental tobacco smoke exposure, maternal smoking during pregnancy and respiratory symptoms were assessed by means of a self-administered parental questionnaire. RESULTS: Forty-seven percent of all children were exposed to environmental tobacco smoke. Sixteen percent of the mothers smoked during pregnancy. Children exposed to environmental tobacco smoke at home had an increased risk of respiratory infections (odds ratio (OR) 1.19, 95% confidence intervals (CI) 1.03, 1.37). The risk increased if they were exposed to maternal smoking (OR 1.25, CI 1.06, 1.48) and if the mother also smoked during pregnancy (OR 1.42, CI 1.14, 1.76). Wheezing (OR 1.36, CI 1.03, 1.80) and repeated coughing (OR 1.36, CI 1.14, 1.61) were only associated with maternal smoking. Children exposed to more than 20 cigarettes per day were at highest risk for respiratory problems. CONCLUSION: Almost half of all schoolchildren in Switzerland, especially those from lower socioeconomic classes, are exposed to environmental tobacco smoke. Children with environmental tobacco smoke exposure suffer significantly more often from respiratory symptoms. Maternal smoking during pregnancy additional to current smoking further increases the risk of respiratory morbidity. These findings underline the importance of prevention strategies to reduce the prevalence of smoking and its impact on children's health.

Prediction of neuromotor outcome in perinatal asphyxia: evaluation of MR scoring systems.

PURPOSE: We developed a scoring system for the assessment of perinatal asphyxia as depicted on MR images. METHODS: Four scoring systems were derived to evaluate MR images obtained in asphyxiated neonates: the basal ganglia (BG) score, the watershed (W) score, the combined basal ganglia/watershed (BG/W) score, and the sum of the BG and W scores, the summation (S) score. In addition, three MR sequences, T1-weighted, first-echo T2-weighted, and second-echo T2-weighted, were assessed for each patient for each scoring system. Neuromotor examinations were performed at ages 3 and 12 months, and cognitive development was tested at age 12 months. Statistical analysis was then performed to test the relationship between the MR scores and the outcome scores. RESULTS: The BG/W score, obtained with the first-echo T2-weighted sequence, was the most useful overall score for predicting neuromotor outcome at 3 and 12 months and cognitive outcome at 12 months. T1-weighted and first-echo T2-weighted sequences showed a stronger association with outcome in patients imaged during the first postnatal week, whereas second-echo T2-weighted sequences showed a stronger association with outcome in patients imaged during the second postnatal week. CONCLUSION: It appears that, with the use of the BG/W score, MR imaging discriminates accurately between patients with good and poor neuromotor and cognitive outcome at 3 and 12 months. In terms of our scoring systems, the first-echo T2-weighted sequence appears to discriminate best between patients with good and poor 3- and 12-month outcomes. Proper use of the imaging sequences and scoring systems described in this article can increase the knowledge base upon which treatment decisions are made in asphyxiated neonates.