Brain ultrasonography findings in neonates with exposure to cocaine during pregnancy

BACKGROUND

Cocaine exposure during pregnancy has been reported to have detrimental effects on the fetus.

OBJECTIVE

To describe the findings on cranial ultrasonography (CUS) as part of a neonatal screening programme for exposed neonates.

MATERIALS AND METHODS

The study was a semiprospective analysis of a 12-year cohort of neonates born to mothers who had used cocaine during their pregnancy and who had follow-up according to a strict clinical protocol.

RESULTS

In total, 154 neonates (78 boys, 76 girls) were included, of whom 29 (19%) were born preterm, and 125 (81%) were born full-term. Abnormalities on CUS were seen in 37 neonates (24%; 95% CI 18-31%). The abnormalities were classified as minor in 20 (13%; 95% CI 9-19%) and mildly abnormal in 17 (11%; 95% CI 7-17%). None of the infants showed severe abnormalities. The abnormalities were not associated with the duration or maximum amount of cocaine use during pregnancy.

CONCLUSION

None of the infants had severe abnormalities. Detected abnormalities were not correlated with the duration or maximum amount of cocaine use. Given these findings, we feel that routine cranial ultrasonography in this population is not warranted.

Acute appendicitis during pregnancy

From this study, we note: (1) misdiagnosis of appendicitis in pregnancy is comparable to that of the general female population; (2) with a maternal mortality of zero per cent, the operation is safe even when complicated by perforation; (3) fetal mortality is minimal; (4) clinical judgement rather than laboratory data must be relied on for diagnosis; and (5) the pregnant patient presenting with abdominal pain should be assessed and treated as one would any patient with the same complaint. The general use of this principle may explain the marked improvement in maternal and fetal mortality and morbidity in recent years.

Neonatal necrotizing enterocolitis--a personal experience

An increasing incidence of neonatal necrotizing enterocolitis over a 2 1/2 year period is demonstrated. Following a brief discussion of pathogenic and etiologic factors, 41 cases are reviewed retrospectively. Clinical, laboratory, and radiographic diagnostic aids are discussed. Surgical and nonsurgical methods of therapy and their results are presented. In conclusion, guidelines and indications for conservative and operative treatment are outlined.