The effects of prenatal cocaine exposure on intrauterine growth and neurologic function of 253 infants was evaluated prospectively at 1 to 7 days of age at the Division of Pediatric Neurology, College of Physicians and Surgeons, Columbia University, New York. Mothers with alcoholism, parenteral drug use, and AIDS, and infants with Apgars of <4 at 5 min, malformations, seizures, or stroke were excluded. Cocaine exposure was determined by radioimmunoassay of maternal hair collected in the last trimester. Of 240 woman and infant pairs with hair samples, 104 were cocaine-exposed and 136 unexposed. Cocaine-exposed infants had higher rates of intrauterine growth retardation (24% vs 8%), small head circumference <10th percentile (20% vs 5%), and neurologic abnormalities (hypertonia, tremor, and extensor leg posture). These abnormalities were doserelated, with increased odds of small head and neurologic impairment with increasing levels of cocaine exposure. 
COMMENT. Fetal cocaine exposure has adverse neurologic effects that follow a dose-response relationship. Higher levels of prenatal cocaine exposure are associated with higher rates of reduced head growth, abnormal tone and posture, and tremor in the neonatal period.
Motor development of cocaine-exposed children at age two years was studied in 199 subjects (98 prenatal cocaine-exposed and 101 unexposed) at the Dept of Pediatrics, Case Western Reserve University, Cleveland, OH . Scores on the Peabody Developmental Motor Scales showed that cocaine-exposed children performed significantly less well in gross and fine motor indices, with impaired balance and receipt and propulsion, poorer hand use and eye-hand coordination, and lower developmental motor quotients.
Prenatal cocaine exposure and ADHD
A significant proportion of foster children attending the Division of Neurology, ADD Clinic at Children's Memorial Hospital, Chicago, has a history of prenatal cocaine exposure. The earlier recognition of developmental delays related to cocaine abuse may lead to psychosocial and occupational therapy intervention and possible reduction of attentional and behavioral problems.