Adverse health effects are associated with intrauterine cocaine/crack exposure. To investigate the impact of fetal cocaine and crack exposure on neonatal outcome we enrolled 386 mother infants pairs, including 130 matched controls. The course of pregnancy and delivery was followed and neonatal outcome was assessed by physical and neurologic exams, the Brazelton Neonatal Behavior Assessment Scale and the Neonatal Stress Scale. These variables were subjected to principle component analysis and summarized as the neonatal outcome summary measure.

The cocaine exposed neonates experienced significantly more adverse effects than the matched controls. Birth weight length and head circumference were significantly lower in the drug exposed infants(p < 0.001). They demonstrated significantly abnormal neurologic exams manifested by increased tone, jitteriness and restlessness. Scores on the Neonatal Stress Scale and the performance on the Brazelton Neonatal Assessment Score was significantly inferior in the drug exposed infants. The predictors of neonatal outcome were organized into three groups 1) social history variables 2) obstetrical variables 3) drug history variables and were subjected to multiple hierarchial stepwise setwise regression. Predictors of negative neonatal outcome included the following: Maternal age (p=0.02), poor paternal relation with mother(p=0.002), crack use (p=0.004), cocaine use(0.009), alcohol use (p=0.80), cigarette use (p=0.69), marijuana use (p=0.05).

In summary, the single most important predictor of neonatal outcome is the frequency, quantity and type of cocaine used. These findings reflect the early neonatal outcome. However one must carefully evaluate the negative influence of psychosocial and environmental factors when evaluating the neurodevelopmental outcomes of the drug exposed child. Studies into childhood are ongoing.