Objective: Published studies reveal conflicting data on the effect of in-utero cocaine exposure on infant development, with little data on VLBW infants. The aim of this study was to measure the effect of cocaine and other variables on the VLBW infant.

Study Design: Our study group was comprised of 86 VLBW infants born at Bronx Lebanon Hospital between January 1991 and December 1995. All received follow-up care at our high-risk clinic. Seventeen of these infants were exposed to cocaine in-utero, as confirmed by a positive urine screen or by maternal report. Control infants all had negative urine screens, as well as a negative maternal history for drugs. Physical and mental development were assessed using the Bayley Scales of Infant Development. Power analysis revealed that our population was adequate to detect a difference of 15% between the exposed and unexposed groups with a power of 80% and a 90% confidence level.

Results: Multiple linear regression analysis revealed that at one-year of age, the mental developmental scale (MDI) was positively correlated with gestational age (p=0.0000) and prenatal care (p=0.0026), while the physical development scale (PDI) was positively correlated with gestational age (p=0.0001) and negatively correlated with maternal alcohol use(p=0.0347). At two-years of age, both the MDI and the PDI were positively correlated with gestational age (p=0.0001) and prenatal care (p=0.0156 and p=0.0069). There was no significant difference between the cocaine and non-cocaine groups on mental and physical developmental scores at one-year and two-years of age. Bayley scales were also not correlated with IVH, BPD, smoking, maternal age, or foster care. Cocaine-using mothers were more likely to use alcohol (p=0.0001) and to have no prenatal care (p=0.0003). Conclusion: Exposure to alcohol in-utero and lack of prenatal care are greater developmental risk factors than exposure to cocaine. Lack of prenatal care may be related to a spectrum of social and environmental problems which may be detrimental to infant development. We speculate that cocaine use may serve as a marker for alcohol and other developmental risk factors.