Neurological complications in the child due to maternal cocaine use

ABSTRACT

Major clinical disorders have been associated with fetal in utero exposure to cocaine and although factors such as prematurity, other drugs or alcohol used concomitantly, infections and a chaotic environment may all be contributory, the abuse of cocaine has been associated with several neurological complications. Perry et al. (1984) demonstrated a "down-regulation" of placental neurotransmitter receptors in infants with intrauterine exposure to drugs of abuse. Abnormalities or depletion of receptor sites in the fetal brain interfere with normal respiratory control, causing more frequent periods of apnea, and an increase in sudden infant death syndrome (SIDS) in infants of cocaine using mothers has been reported by some authors but not by others. Mahalik et al. (1980) proposed that vasoconstruction secondary to increased catecholamines, and the resulting hypoxia, was a probable contributing factor to the teratogenic potential of cocaine. Fetal vasoconstruction, hypoxia, placental vasoconstriction, abruptio placenta and teratogenicity of the drug itself all play a role in the pathogenesis of embryo-logical defects. The severity of problems is related to the time and extent of exposure. Intracerebral hemorrhages, cerebral infarctions and vasculitis have all been documented. We recently reported 3 infants with craniosynostosis. Other bony anomalies reported include skull defects exencephaly and encephalocele. We have also observed agenesis of the corpus callosum with porencephaly and Dandy-Walker variant malformation in one child. Neural tube defects and cortical atrophy have been observed. Small head circumferences, increased irritability with inability to calm the child, poor cuddling, hypertonicity, tremulousness, abnormal sleep patterns, overall poor stste regulation and attention deficit hyperactivity disorder with associated learning disability has been observed. Little is known of the potential long-term side effects of exposure to cocaine and more work in this area is needed. (AU)