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Biomedical subjects

N S Woods

Publications and source records attributed to N S Woods.

11 recordsLinked to original sources
PubMed1999

Cranial ultrasound abnormalities identified at birth: their relationship to perinatal risk and neurobehavioral outcome.

OBJECTIVES: Minor cranial ultrasound abnormalities, such as mild ventricular enlargement, choroid plexus cysts, and subependymal cysts, have been identified in 3% to 5% of the newborn population. Although clinicians generally consider these abnormalities to be insignificant for the outcome of the newborn, few convincing data have been published to support this optimism. The objectives of this study were to identify potential risk factors associated with the identification of cranial ultrasound abnormalities at birth and to determine if the abnormalities were related to neurobehavioral sequelae in the newborn. METHODS: Three hundred eight women were enrolled in this prospective, longitudinal maternal-infant health and development study either at the time they entered the public health care system for prenatal care or at delivery if they had no prenatal care. Each woman participated in an in-depth psychosocial interview at the end of each trimester of pregnancy. Retrospective chart review by experienced medical personnel was used to compile data for the Hobel perinatal risk score for each study participant after delivery. Offspring underwent cranial ultrasound evaluation, the Amiel-Tison Neurologic Assessment, and the Brazelton Neonatal Behavioral Assessment Scale within 96 hours of birth by experienced examiners blinded to any maternal-infant history. RESULTS: Of the 308 women originally enrolled in the study, 301 delivered living infants. Of these, 266 infants (88%) underwent a cranial ultrasound evaluation and are the subject of this article. For the purposes of the current study, infants were divided into those with normal (n = 239) and those with abnormal (n = 27) ultrasound results. Abnormal ultrasound results included the following lesions: subependymal cyst (n = 13); mild ventricular enlargement (n = 6); choroid plexus cysts (n = 3); a combination of cysts and increased ventricular size (n = 2); a 7-mm midline cyst in the superior posterior portion of the third ventricle (n = 1); subependymal hemorrhage and ventricular enlargement (n = 1); and increased ventricular size, subependymal hemorrhage and cysts, and two small, right thalamic calcifications (n = 1). There were no significant differences between those with an abnormal ultrasound and those with a normal ultrasound for birth weight, length, gestational age, rate of prematurity, frequency of nulliparity, or frequency of small for gestational age infants. However, infants with an abnormal ultrasound had a significantly smaller mean head circumference than those with a normal ultrasound (34.5 +/- 1.9 cm vs 33.7 +/- 1.9 cm). The infants with an abnormal ultrasound had a higher median prenatal (50 vs 45), neonatal (14 vs 8), and total (94 vs 77) Hobel risk score but not a higher labor-delivery score. There were no significant differences when these groups were compared on additional risk factors not included in the Hobel scoring system such as race and socioeconomic status. In addition, mothers who used a greater number of drugs during the first trimester of pregnancy were more likely to have an infant with an abnormal ultrasound at birth such that the probability of having an abnormal ultrasound rose to 22% by the time the pregnant women were using four drugs. Neurologic examinations revealed no differences between the infants with normal and abnormal ultrasounds. There were also no group differences for five of the seven Brazelton cluster scores, the excitable or depressed clusters, or eight of the nine qualifier scores. However, infants with abnormal ultrasounds performed significantly better on the habituation (7.3 +/- 0.8 vs 6.6 +/- 1.5) and autonomic regulation (6.5 +/- 0.8 vs 6.0 +/- 1.0) clusters but more poorly on the cost of attention qualifier score (4.9 +/- 1.2 vs 5.5 +/- 1.2) on the Brazelton Neonatal Behavioral Assessment Scale. CONCLUSION: Infants with an abnormal cranial ultrasound at birth had higher perinatal risk scores. (ABSTRACT TRUNCATED)

Brain Diseases↗
PubMed1998

Pygmalion in the cradle: observer bias against cocaine-exposed infants.

This study examined whether the widely disseminated negative image of the "cocaine baby" would lead adults to perceive a videotaped unexposed infant more negatively simply because they had been told the infant was prenatally cocaine-exposed. Two hundred and forty-nine students from three state universities used a seven-point Likert scale to rate either an African-American or a white female infant on 20 bipolar adjective-pairs. As predicted, participants who observed a labeled infant rated her more negatively than did those for whom the infant had not been labeled as cocaine-exposed. The potentially negative consequences of this documented bias toward cocaine-exposed infants should both alert and concern professionals and researchers. If adults view the behavior of a nonexposed infant more negatively merely because they believe that the infant has been exposed, then parents (biological and adoptive), professionals, and researchers may view and respond to the behavior of infants who are cocaine-exposed more negatively. Transactional models of development suggest a potential for self-fulfilling prophecy.

Adult↗
PubMed1998

Birth outcome from a prospective, matched study of prenatal crack/cocaine use: I. Interactive and dose effects on health and growth.

OBJECTIVE: This prospective, longitudinal project was designed to determine the effects of prenatal cocaine use on the pregnancy outcomes of women from a historically understudied rural public health population. METHODOLOGY: We interviewed over 2500 women prenatally, identified 154 cocaine users, and matched 154 controls on race, parity, socioeconomic status, and location of prenatal care (that related to level of pregnancy risk). Drug testing was required at enrollment and at delivery; detailed demographic, psychosocial, and drug histories were taken at each available trimester and follow-up visit. After birth, neonatal nurse practitioners, blinded to maternal history of drug use, examined infants to assess gestational age and take growth measurements. Medical charts were reviewed and the Hobel Risk Scale was completed. RESULTS: Compared with controls, the cocaine users had significantly higher Hobel Prenatal and Total Risk Scores and more preterm infants (28 vs 14), but not a significantly greater number of fetal deaths (3 vs 1). After controlling for the effects of marijuana, alcohol, and tobacco use, the following results remained. There was no difference in gestational age, Ponderal Index, birth weight, or length between infants born to cocaine users and controls. There was a significant interaction effect such that infant head and chest circumference were smaller in cocaine users who also smoked tobacco. Significant correlation coefficients demonstrated the effects of the amount of drug usage on fetal growth during each trimester of pregnancy. The average cocaine use per day for trimesters one and three and for the entire pregnancy was negatively related to birth length. The mean amounts used in trimesters two and three were negatively related to head circumference. Amounts of tobacco and alcohol use in pregnancy were also inversely related to fetal growth measures. When the effects of marijuana, alcohol, and tobacco were partialed out, there continued to be a negative relationship between the amount of cocaine used in the third trimester and infant length and head circumference. CONCLUSIONS: The observed decrement in fetal growth, especially head circumference, among cocaine-exposed neonates raises concerns about later growth and development. Follow-up of these infants will reveal if these disadvantages continue. These early results also emphasize the importance of considering amount and time of drug exposure as well as the interactive effects of drug exposure and other risk variables.

Adult↗
PubMed1998

Birth outcome from a prospective, matched study of prenatal crack/cocaine use: II. Interactive and dose effects on neurobehavioral assessment.

OBJECTIVE: This prospective, longitudinal project was designed to determine the effects of prenatal cocaine use on the neurodevelopmental outcomes of infants from a historically understudied rural public health population. METHODOLOGY: We interviewed > 2500 women prenatally, identified 154 cocaine users, and matched 154 controls on race, parity, socioeconomic status, and location of prenatal care (that related to level of pregnancy risk). Drug testing was required at enrollment and at delivery; detailed demographic, psychosocial, and drug histories were taken at each available trimester and follow-up visit. After birth, certified evaluators, blinded to maternal history of drug use, administered the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) under controlled conditions. Evaluation time for preterm infants was adjusted for gestational age. RESULTS: After controlling for the effects of marijuana (users of other illicit drugs were excluded), alcohol, and tobacco use, the following results remained. There were significant drug group interactions on the BNBAS Qualifier Score of Alert Responsiveness that demonstrated lower scores among infants who were exposed to both cocaine and tobacco and among those exposed to both marijuana and tobacco. There were also significant correlations between the amount of cigarette, alcohol, marijuana, and cocaine exposure and several BNBAS scores. The reported amount of cocaine use in the third trimester was negatively related to scores of Orientation, Cost of Attention, and Alert Responsiveness (that was also related to amount of cocaine used over the entire pregnancy). When the effects of marijuana, alcohol, and tobacco were partialled out, the amount of cocaine use in the third trimester was negatively related to Regulation of State, a precursor of alertness, and the infant's ability to orient to the environment. CONCLUSIONS: The observed decrement in state regulation, attention, and responsiveness among cocaine-exposed neonates raises concerns about later developmental abilities as well as the effect these infants may have on caregivers (who themselves may be compromised in their parenting abilities by their drug use). Follow-up of these infants will reveal if these disadvantages continue. These early results also emphasize the importance of considering amount and time of drug exposure as well as the interactive effects of drug exposure and other risk variables.

Adult↗
PubMed1997

How fetal cocaine exposure increases neonatal hospital costs.

OBJECTIVE: Our goals were to document hospital costs associated with prenatal cocaine exposure in an understudied population-women using rural county public health units who had minimal access to drug rehabilitation and whose cocaine of choice was crack with little other illicit drug use- and to explore why increased costs occur in an effort to identify cost-reduction strategies. METHODS: We identified a sample of cocaine-exposed infants who were computer-matched to a control group with no history or evidence of cocaine exposure. Matching was performed one-to-one on the variables of maternal race, age, parity, time of entry into prenatal care, and alcohol and nicotine use. There were 327 live births, for whom 311 were correctly classified as to their prenatal cocaine use and had billing and medical records available for review (156 exposed, 155 nonexposed). RESULTS: Hospital charges were positively correlated with length of stay. Cocaine-exposed infants had an across-the-board increase in utilization of hospital resources as well as higher hospital charges and longer lengths of stay. Cocaine-exposed infants were significantly younger in gestational age and lower in birth weight. Significantly more cocaine-exposed infants were admitted to the neonatal intensive care unit, had more social and family problems delaying discharge, and received more septic work-ups. In addition, of those infants urine-screened for cocaine at delivery, 92% were screened secondary to a maternal history of prenatal use. CONCLUSIONS: Cost-reduction strategies should be aimed at measures that reduce length of stay by addressing problems identified prenatally as an outpatient before delivery and by influencing objective decision-making regarding the need for medical interventions with the infant after birth.

Birth Weight↗
PubMedDate not supplied

Prenatal cocaine use: a comparison of neonates matched on maternal risk factors.

This study was designed to overcome some of the methodological limitations of previous work and investigate the impact of prenatal cocaine use in an understudied population: women using rural county public health units who had minimal access to drug rehabilitation. Through maternal history, interviews, and urine screens, 172 cocaine users were identified. Using an independently collected perinatal data base, 168 nonusers were matched for six variables known to affect pregnancy outcome and chosen a priori: race, age, parity, prenatal care, alcohol, and nicotine use. To avoid chance findings, 10 adverse perinatal outcome variables were identified prospectively. Cocaine-exposed neonates experienced significantly more of the adverse events than the matched controls and were more likely to be preterm, low birthweight, resuscitated at birth, and to remain in the hospital after their mothers were discharged. We conclude that prenatal cocaine use can be a contributor to adverse perinatal outcome in this population. An understanding of the effects of prenatal cocaine use and the needs of these women and infants is important for designing appropriate prenatal care, treatment, and follow-up programs.

Adolescent↗
PubMedDate not supplied

Multiple risk factors do not identify cocaine use in rural obstetrical patients.

This nonconcurrent, cohort study of consecutive admissions to one of three hospital units: labor and delivery (n = 474), well-born nursery (n = 100), and the neonatal intensive care unit (n = 100), was designed to determine the prevalence of cocaine exposure in a rural obstetrical sample and to determine the relationship between exposure and perinatal variables. Urines were analyzed for benzoylecgonine, and the Obstetrical Complications Scale was completed for each mother-infant pair. Elementary comparisons were made using chi 2 analyses and Student's t test. Stepwise discriminant and discriminant function analyses were performed. The prevalence of exposure in the three groups of subjects ranged from 5%-7%. No significant differences in perinatal variables were found between users and nonusers in either of the newborn samples. In the maternal sample the groups differed on twelve mother or infant factors. However, no single variable or set of variables predicted use versus nonuse in any of the groups.

Cocaine↗
PubMedDate not supplied

Newborn evaluations of toxicity and withdrawal related to prenatal cocaine exposure.

The literature on prenatal cocaine exposure is unclear whether immediate postpartum effects on the infant are transient, related to either acute toxicity of cocaine, or to a withdrawal effect as cocaine is metabolized, or whether they might persist. This prospective, longitudinal study was designed to test the hypotheses that newborns urine-positive for cocaine metabolites, compared to those exposed but urine-negative, and to nonexposed controls would (1) have poorer neurobehavioral scores (toxicity effect) and (2) worsen or demonstrate less improvement over the first week (withdrawal effect). We approached over 2500 pregnant women designated to deliver at our referral hospital from public health clinics; 85% consented to participate in a longitudinal study. We excluded women <18 years old with major chronic illness and prenatal drug use except cocaine, marijuana, alcohol and tobacco. From positive urine toxicologies or admissions in private, thorough interviews, 154 were identified as prenatal cocaine users; 154 were selected from noncocaine users matched on socioeconomic status (SES), race, parity and location of prenatal care (that related to perinatal risk), for a total sample size of 308. Included in this article are the 155 surviving infants who were full-term, delivered vaginally and were well and available for testing over the first week postpartum. Infant urine specimens were collected, and neurobehavorial testing was performed by certified, blinded examiners using the Neonatal Behavioral Assessment Scale on days 1, 2-4 and 5-7 postpartum. In toxicity analyses, controlling for amount of prenatal drug exposures, only autonomic regulation demonstrated significant overall and cocaine drug group effects. Urine-positive newborns had the poorest scores (i.e., more startles, tremors). However, given that planned comparisons were not significant, these data provided little support for acute toxicity effects. In withdrawal analyses, only one significant change over time varied among exposure groups. Those infants exposed and positive for cocaine metabolites increased their scores on regulation of state on days 2-4 and decreased them on days 5-7 (when withdrawal might be evident). However, their scores on days 5-7 were not significantly lower than their initial scores, nor different from the days 5-7 scores of the exposed negatives or control infants, lending little support for withdrawal effects. Our data support those of other controlled studies in failing to demonstrate devastating early effects of prenatal cocaine exposure. They add to our understanding that effects observed do not appear to be related to acute toxicity nor to cocaine withdrawal. The uncertainty of persistent effects of cocaine exposure warrants long-term follow-up.

Cocaine↗