Abstract 88 Poster Session III, Monday, 5/3 (poster 354)

Reports of the effect of prenatal cocaine-opiate exposure on neurologic and behavioral state of infants are limited and conflicting. The MLS is a multi-site (Brown U, U of Miami, U of TN, Wayne State U) longitudinal study evaluating infants exposed to cocaine-opiate in utero and a non-exposed comparison group matched within site for gestational age, gender and race. Of 1335 infants, 629 exposed (EXP) and 706 comparison (COMP) had a neurologic exam (NEURO) in the newborn period and the NICHD Neonatal Network Neurobehavioral Scales (NNNS) at 1 mo corrected age performed by masked and certified examiners. The NEURO exam (11 components) and NNNS summary scores (12 components) were compared between EXP and COMP by t-tests and Chi square analysis. The relationship between NEURO and NNNS were assessed by t-tests, ANOVA and linear regression modeling.

RESULTS: On the NEURO exam, 1029 infants (77%) had a normal NEURO finding; 195 had 1 NEURO finding, and 57 had ≥3 findings. EXP and COMP were similar for hypotonia, hyperactivity, high pitched or weak cry, posture, consolability, arousal and lethargy. More EXP infants than COMP were hypertonic (4.2 vs. 0.6%), had jittery tremors (18 vs. 7.5%) and were irritable (15 vs. 9%); all p<.05. On the NNNS, there was no difference in summary scores in EXP and COMP (orientation, stress abstinence, excitability, hypotonia, hypertonia, non-optimal reflexes, handling, movement quality, self regulation, asymmetry, arousal, depression). When NEURO was compared to NNNS on all infants, jittery/tremor and irritability on NEURO was associated with excitability on NNNS and lethargy on NEURO with depression on NNNS; all p<.05. When exposure was added to the model the associations remained with no effect of exposure status. When relationship of any NEURO finding was compared to NNNS on all infants, those with any NEURO were more likely to have hypertonia (p<.05), excitability (p<.001) and stress abstinence (p<.05) on NNNS. When exposure was added to this model, again, the associations remained with no effect of exposure status. To assess the best predictor of NNNS, the relationship between NEURO components, exposure and site and 5 NNNS summary scores (hypotonia, hypertonia, stress abstinence, excitability and arousal) was assessed by linear regression. No effect of exposure was noted but site and hypotonia on NEURO were associated with hypotonia on NNNS; site and jitteriness on NEURO with hypertonia on NNNS; and site, jitteriness, and irritability on NEURO with stress abstinence on NNNS; all p<.05.

CONCLUSION: In this large multi-site study, infants exposed to cocaine-opiates were more hypertonic, irritable and had jittery tremors than COMP group at birth; at 1 mo, neurobehavior was similar between groups. There was a consistent association between components of NEURO and NNNS among all infants. Site, not cocaine-opiate exposure, influenced this relationship.