A detailed neurologic examination was performed in 6-week-old infants enrolled in a study of effects of in utero cocaine exposure, while controlling for concomitant cigarette smoking exposure and other variables, and results are reported from the University of California, San Francisco, CA. Examination of 40 cocaine-exposed compared to 56 unexposed infants showed that hypertonia correlated with maternal cigarette smoking during pregnancy but not with in utero cocaine exposure. Using maternal urine conitine levels as a measure of nicotine exposure, the odds ratio for an abnormal neurologic examination was 2.9, if maternal urine conitine was >200 ng/ml. As the concentration of cotinine increased, the risk of hypertonia increased. Maternal cigarette smoking may be the major predictor of abnormal hypertonia reported in cocaine-exposed infants. 
COMMENT. Neonatal hypertonia, commonly reported among in utero cocaine-exposed infants, is correlated with maternal cigarette smoking during pregnancy, and is not caused by the cocaine exposure per se. This generalized hypertonia is found to resolve by 2 years of age, and is not predictive of later development of cerebral palsy. It may be a marker for adverse childhood cognitive or behavioral disorders such as ADHD, complications previously reported in association with prenatal exposure to tobacco smoke or cocaine.
Effects of cocaine and cocaine + alcohol on cognitive function of adults. Cocaine and alcohol each selectively and negatively affect neurocognitive performance of neurobehavioral tests after 1 to 3 days forced abstinence. The effects are found to persist after 4 weeks of abstinence. The concomitant abuse of cocaine and alcohol has additive negative effects on brain function.