School-age outcome of children with prenatal cocaine exposure following early case management.

The impact of prenatal cocaine exposure on neurodevelopmental outcome in childhood continues to be in question. Objectives of this study were to determine if there are differences in growth, behavioral, cognitive or verbal functioning or caregiver-child dyad interactions for inner-city, school-aged children with and without prenatal cocaine exposure, and if these measures would be affected by early family case management. From an initial sample of 118 cocaine-exposed children who were evaluated to 36 months of age, 47 were able to be contacted and 39 (83%) completed a follow-up evaluation at 84 +/- 11 months of age. Subjects had been assigned at birth to early case management (CM, 24) and routine care (RC, 15). Eighteen children from the initial non-cocaine-exposed comparison sample of 41 children were able to be contacted and 12 (67%) were evaluated at 85 +/- 16 months of age. Evaluation included growth measurements, Stanford-Binet IQ, receptive and expressive language quotients, parent-reported Child Behavior Checklists (CBCL), and assessment of caregiver-child interactions by scored videotaped free-play sessions. No differences were found in growth, mean IQ, language quotients, CBCL scores or videotaped caregiver-child play interactions as a function of cocaine exposure. Within the cocaine-exposed group, there were no outcome differences between CM and RC children. However, during the play sessions, CM caregivers had more positive affect in interactions with the child than RC. Within the RC dyads, birthmothers had significantly more positive interactions than non-birthmothers. In summary, no differences in growth, behavioral, cognitive, or language function were evident for inner-city, school-aged children related to prenatal cocaine exposure or early case management. CM caregivers demonstrated more positive interactions during a play session than RC; within the RC group, non birthmothers had the least positive affective interactions. Further study of influences on caregiver-child interactions may lead to effective intervention strategies for drug-exposed infants.

Neonatal nitric oxide use: predictors of response and financial implications.

OBJECTIVE: To determine predictors of sustained response to inhaled nitric oxide (INO) and the financial impact of INO commercialization. DESIGN/METHODS: We evaluated the records of extra-corporeal membrane oxygenation (ECMO)-eligible infants consecutively treated with INO. We calculated the charges for INO therapy and for ECMO for each patient so treated. PUBLISHED BY ELSEVIER SCIENCE LTD. RESULTS: In total, 52 (59%) of 88 infants avoided ECMO; all received INO for >48 hours; all survived. A total of 36 infants received ECMO; 21 infants after <24 hours of INO; seven infants after 24 to 48 hours; and eight infants >48 hours of INO; one infant died. In total, 51 infants had sustained responses to INO; 19 infants were nonresponders and 18 were transient responders. Infants with PPHN and those older than 24 hours were more likely to respond to INO. Total INO charges for all 88 infants were $1,048,000. Total ECMO charges for the 36 infants so treated were $1,710,000. CONCLUSIONS: INO has added a charge-saving therapy to selective infants who can avoid ECMO.