Cardiovascular effects of cocaine in neonates exposed prenatally

Acute Cocaine Toxicity: Pharmacology and Clinical Presentations in Adult and Pediatric Populations

Cocaine remains the most prevalent drug responsible for emergency department (ED) visits. A majority of acute cocaine toxicity cases involve young, habitual, adult cocaine users and often present with a range of cardiac, neurologic, gastrointestinal (GI) or renal symptoms. In addition, atypical populations (neonates, infants, toddlers, young children and adolescents) are presenting in EDs with varying symptoms that are unknowingly associated with cocaine exposure. Unfortunately, juvenile presentations are generally anecdotal in nature, and while enlightening, are difficult to quantify epidemiologically. Outlining the types of symptom presentation in these young populations may assist healthcare providers in expediting proper treatment for such demographic groups. Therefore, this review examines the current knowledge regarding cocaine's pharmacologic activity as it relates to its potential toxicity, and outlines the clinical manifestations of cocaine exposure and toxicity in adult and pediatric populations. We conclude from the available clinical reports that there must be a higher index of suspicion in the pediatric population to identify exposed infants and children. Improved recognition and identification in both typical and atypical populations will result in better characterization of acute cocaine toxicity.

Electrocardiographic findings associated with cocaine use in humans: a systematic review

Cocaine remains highly prevalent and accessible in the general population, continues to represent one of the most commonly reported substances in drug-related presentations to emergency departments, and is frequently implicated in drug-related deaths. Fatal cardiac arrhythmias are often suspected in the latter cases. In spite of this, its complex effects on the human cardiac conduction system remain poorly elucidated. In this article we sought to systematically review the medical literature to identify the electrocardiographic findings that have been linked to cocaine use in humans in an effort to highlight what physicians can expect to encounter when managing patients using the drug. The evidence is discussed, common findings are emphasized and clinical recommendations are proposed.

Perinatal isolated atrial flutter associated with maternal cocaine and opiate use in a late preterm infant

Atrial flutter is a serious form of neonatal tachyarrhythmia. Maternal drug use of cocaine and/or opiate is associated with central and autonomic nervous signs in fetuses and newborn infants. The fetal cardiovascular effects of cocaine and opiate exposure are not well characterized. We present the case of isolated atrial flutter in a late preterm infant who has been perinatally exposed to cocaine and opiate.

Short- and long-term adverse effects of cocaine abuse during pregnancy on the heart development

The effect of cocaine on the developing fetus is a topic of considerable interest and debate. One of the potential effects of fetal cocaine exposure is damage to the developing heart. This review provides an overview of the current understanding of the short- and long-term effects of fetal cocaine exposure on the heart in both humans and animal models. Human studies are still preliminary but have suggested that fetal cocaine exposure impacts on the developing heart. Studies in animal models provide strong evidence for a programming effect resulting in detrimental long-term changes to the heart induced by fetal cocaine exposure. In the rat model, fetal cocaine results in apoptosis in the term heart, left ventricular remodeling and myocyte hypertrophy, as well as increased sensitivity to ischemia/reperfusion injury in the adult male offspring. The rat model has also shown evidence of epigenetic modifications in response to intrauterine cocaine. Increased DNA methylation of promoter regions leads to a long-term decrease in the expression of the cardioprotective gene, PKCepsilon. The current data shows fetal cocaine exposure has significant immediate and long-term cardiac consequences in animal models and while human studies are still incomplete they suggest this phenomenon may also be significant in humans exposed to cocaine during development.

The search for congenital malformations in newborns with fetal cocaine exposure

CONTEXT

The association between prenatal cocaine exposure and congenital anomalies is not definitive.

OBJECTIVE

To determine whether prenatal cocaine exposure results in an increased number or identifiable pattern of abnormalities.

DESIGN

A prospective, longitudinal cohort enrolled between 1991 and 1993.

SETTING

Rural public health population delivering at a regional tertiary medical center.

PATIENTS

Two hundred seventy-two offspring of 154 prenatally identified crack/cocaine users and 154 nonusing controls were matched on race, parity, location of prenatal care (that related to level of pregnancy risk), and socioeconomic status. Drug use was determined through repeated in-depth histories and urine screens. Infants not examined within 7 days of birth were excluded.

OUTCOME MEASURES

Assessments were made by experienced examiners masked to maternal drug history. Included were 16 anthropometric measurements and a checklist of 180 physical features defined and agreed upon in advance.

RESULTS

There were no differences on major risk variables between the included and excluded infants. There were significantly more premature infants in the cocaine-exposed group. Cocaine-exposed infants were significantly smaller in birth weight, length, and head circumference but did not differ on remaining anthropometric measurements. There was no difference in type or number of abnormalities identified between the exposed and nonexposed groups. There was no relationship between amount or timing of exposure and any of the outcomes.

CONCLUSIONS

This prospective, large-scale, blinded, systematic evaluation for congenital anomalies in prenatally cocaine-exposed children did not identify an increased number or consistent pattern of abnormalities.