Cocaine effects are subtle and can be detected when studied in the context of polydrug use and level of cocaine exposure. Effects of other drugs even at low thresholds can also be observed in the context of a polydrug model. The ability to detect these drug effects requires a large sample and neurobehavioral tests that are differentially sensitive to drug effects. Long-term follow-up is necessary to determine whether these differences develop into clinically significant deficits.

Objective-This study examined the NICU Network Neurobehavioral Scale (NNNS) as a predictor of negative medical and behavioral findings one month to 4½ years of age.Methods-. The sample included 1248 mother-infant dyads (42% born <37 weeks' gestational age) participating in a longitudinal study of the effects of prenatal substance exposure on child development. Mothers were recruited at 4 urban university-based centers and were mostly AfricanAmerican and on public assistance. At 1 month of age, infants were tested with the NICU Network Neurobehavioral Scale (NNNS). Latent Profile Analysis (LPA) was carried out on NNNS summary scales to identify discrete behavioral profiles. The validity of the NNNS was examined using logistic regression to predict prenatal drug exposure, medical and developmental outcomes through 4½ years of age including adjustment for gestational age and socioeconomic status (SES). Results-.Five discrete behavioral profiles were reliably identified with the most extreme negative profile found in 5.8% of the infants. The profiles showed statistically significant associations with prenatal drug exposure, gestational age and birthweight, head ultrasound, neurological and brain disease findings and abnormal scores on measures of behavior problems, school readiness and IQ through 4½ years of age.Conclusions-The NNNS may be useful to identify infant behavioral needs to be targeted in wellbaby pediatric care, as well as for referrals to community based early intervention services. In this study we describe a method to classify infants into discrete risk categories or "profiles" based on previously established NNNS summary scores. 4,21 We then examined the ability of the profiles to predict problematic medical and behavioral findings in infancy and early childhood. Keywords MethodsSubjects were enrolled in the Maternal Lifestyle Study (MLS), a multisite longitudinal study of children at risk due to factors such as prenatal exposure to cocaine and other substances and prematurity. 5 Details of enrollment and exclusion criteria are described elsewhere. [22][23][24][25] The study was approved by the institutional review board at each study site and written informed consent was obtained. The exposed group (n=658) was based on mother report of cocaine use during pregnancy and/or a positive meconium assay for cocaine. 22 The comparison group (n=730) included children born to mothers who denied cocaine use confirmed by negative meconium results, group matched to the exposed group by gestational age categories (<32 weeks, 33-36 weeks and >36 weeks), child gender, race, and ethnicity within study site. Background substances associated with cocaine use, alcohol, tobacco, and marijuana, were included in both groups. Children were seen at 10 visits from 1 month to 4½ years with an average retention rate of 78%. Measures NNNSThe NNNS was administered by certified, blinded psychometrists at the hospital clinic 1-month visit to 1248 (90%) of the original 1388 infants. Items from the NNNS were scored using pre...

Prenatal cocaine exposure has a negative impact on the trajectories of childhood behavior outcomes. When they co-occur with prenatal cocaine exposure, prenatal and postnatal tobacco and alcohol exposures have added negative effects on behavior outcomes.

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Disease burden for each outcome increases with each added drug exposure; however, etiologic fraction attributable to tobacco is greater than for cocaine.

Prenatal cocaine and opiate exposure are thought to subtly compromise social and emotional development. The authors observed a large sample of 236 cocaine-exposed and 459 nonexposed infants (49 were opiate exposed and 646 nonexposed) with their mothers in the face-to-face still-face paradigm. Infant and maternal behaviors were microanalytically coded. No opiate-exposure effects were detected. However, mothers of cocaine-exposed infants showed more negative engagement than other mothers. The cocaine-exposed dyads also showed higher overall levels of mismatched engagement states than other dyads, including more negative engagement when the infants were in states of neutral engagement. Infants exposed to heavier levels of cocaine showed more passive-withdrawn negative engagement and engaged in more negative affective matching with their mothers than other infants. Although effect sizes were small, cocaine exposure, especially heavy cocaine exposure, was associated with subtly negative interchanges, which may have a cumulative impact on infants' later development and their relationships with their mothers.

In the largest at-risk sample observed longitudinally to date, infant prenatal exposure to cocaine and to opiates was not associated with mental, motor, or behavioral deficits after controlling for birth weight and environmental risks.

Central and autonomic nervous system symptoms were more frequent in the exposed cohort and persisted in an adjusted analysis. They were usually transient and may be a true cocaine effect. Abnormal anatomic outcomes previously reported were not confirmed. Increased infections, particularly sexually transmitted diseases, pose a serious public health challenge. Exposure increased involvement of child protective services and out-of-home placement.