COCAINE EXPOSED INFANTS--CARDIAC PROBLEMS AND OUTCOME

怀孕期间使用可卡因的母亲所生的婴儿 更高的发病率。初步观察表明， 多种心血管异常，如左心室增大 肿块，持续性高血压，ST段的患病率更高 升高（提示透壁性缺血）和迷走神经张力升高。 这些异常在无症状的可卡因中观察到 在出生后的头两天内接触过的新生儿。确定 子宫内可卡因暴露对新生儿的心血管影响， 所提出的研究具有以下目的：目的1-检测 新生儿期心血管异常;目标2- 研究这些异常的自然历史，在前2年， 几个月的生活。一组无症状婴儿（n = 420）将在 在新生儿保育室学习接触或不接触 将通过阳性母体尿液筛查确定， 临床访谈，并将通过毒理学研究证实 婴儿尿或胎粪。研究对象将分为 三组l组包括接触可卡因的新生儿 怀孕期间;由于广泛同时使用 酒精、香烟和大麻， 这些婴儿将被包括在I组中。划定 可卡因对心血管的影响，他们的数据将与 另外两组：第二组将包括新生儿， 子宫内暴露于酒精、香烟和/或吸食大麻。 暴露于其他药物（包括可卡因）的受试者将 被排除在这个群体之外。组III包括对照新生儿 在胎儿期未接触任何药物的婴儿。出生时 在2个月大的时候，所有的婴儿都将被两个人评估- 三维和多普勒超声心动图，3通道霍尔特 ST段抬高和心脏频谱分析监测仪 周期和血压测量。的相互关系 这些异常及其对婴儿发病率的影响， 测定这些异常的持续存在可能会提供一个 了解这些患者的长期发病率。因此 对于了解心血管疾病的自然史至关重要 异常之前，措施可以针对他们的 治疗和预防。

Infants born to mothers who use cocaine during pregnancy have greater morbidity. Preliminary observations suggest the presence of multiple cardiovascular abnormalities such as greater left ventricular mass, persistent hypertension, greater prevalence of ST segment elevations (suggesting transmural ischemia) and higher vagal tone. These abnormalities were observed in asymptomatic cocaine exposed newborns during the first 2 days of life. To determine the cardiovascular effects of in-utero cocaine exposure on newborns, the proposed study has following aims: Aim l - To detect the cardiovascular abnormalities in the newborn period; Aim 2 - To study the natural history of these abnormalities during the first 2 months of life. A cohort of asymptomatic infants (n=420) will be studied in the newborn nursery. Cocaine exposure or nonexposure will be determined by the positive maternal urine screening and clinical interview and will be substantiated by toxicology studies of infants urine or meconium. The study subjects will be divided into three groups. Group l includes newborn infants exposed to cocaine during pregnancy; because of the widespread concurrent use of alcohol, cigarette and marijuana smoking among these mothers, these infants will be included under Group l. To delineate the cardiovascular effects of cocaine, their data will be compared with two other groups: Group II will include newborn infants with in utero exposure to alcohol, cigarette and/or marijuana smoking. Subjects exposed to other drugs, including cocaine, will be excluded from this group. Group III includes control newborn infants who are not exposed to any drugs during fetal life. At birth and at 2 months of age, all infants will be evaluated by two- dimensional and Doppler echocardiograms, 3 channel Holter monitors for ST segment elevations and spectral analysis of heart period, and blood pressure measurements. The inter-relationship of these abnormalities and their effect on infant morbidity will then be determined. Persistence of these abnormalities may provide an insight into the long term morbidity of these patients. Therefore, it is crucial to understand the natural history of the cardiovascular abnormalities before measures can be directed toward their treatment and prevention.