The Brazelton Neonatal Behavioral Assessment Scales (BNBAS) were administered to 23 infants exposed to cocaine in utero and 29 nonexposed infants recruited from the low-risk nursery, Wayne State University Hospital, Detroit. Cocaine exposure was determined by quantitative analysis of the infant’s meconium stool. Exposed infants performed less well than controls on 6 of the 7 BNBAS clusters, particularly in tests for autonomic stability. A dose-response relationship was evident, with a negative effect of meconium cocaine concentration on motor, orientation, and regulation of state. [1]

COMMENT. Significant adverse behavioral effects may be demonstrated in neonates born to cocaine addicted mothers. Quantitative determination of cocaine exposure by meconium analysis is essential, since screening by history alone is found to be inadequate.

Three additional studies of the effects of prenatal cocaine on neurobehavior are summarized as follows. The Brazelton NBAScale, used at the Western Psychiatric Institute, University of Pittsburgh, showed impaired scores in motor maturity and tone, autonomic instability, and an increased number of abnormal reflexes on the 2nd day postpartum, but not at day 3 [2]. Heavy cocaine exposure early in pregnancy was related to faster responsiveness on an infant visual expectancy test but poorer recognition memory and information processing in 464 inner-city, black infants tested at 6, 12, and 13 months in the Psychology Department, Wayne State University, Detroit, MI [3]. The motor development of 28 infants exposed to cocaine in utero compared to that of an unexposed group followed from birth through 15 months at Boston University, Department of Physical Therapy and Child Development Unit, Children’s Hospital, Boston, showed impairments in performance at 4 and 7 months of age but not at 15 months. However, all infants, both exposed and unexposed, were motor impaired when compared to norms, a reflection of the effects of poverty and malnutrition in inner-city infants [4]. The combination of cocaine exposure and poor nutrition is a cumulative risk factor for impaired infantile motor performance in minority subjects and potentially detrimental to later neurocognitive development.