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Comparative Study
. 2013 Oct;163(4):989-94.e1.
doi: 10.1016/j.jpeds.2013.04.033. Epub 2013 Jun 4.

Prenatal substance exposure: neurobiologic organization at 1 month

Elisabeth Conradt  1 , Stephen J Sheinkopf, Barry M Lester, Ed Tronick, Linda L LaGasse, Seetha Shankaran, Henrietta Bada, Charles R Bauer, Toni M Whitaker, Jane A Hammond; Maternal Lifestyle Study
Collaborators, Affiliations
Comparative Study

Prenatal substance exposure: neurobiologic organization at 1 month

Elisabeth Conradt et al. J Pediatr. 2013 Oct.

Abstract

Objective: To examine the autonomic nervous system and neurobehavioral response to a sustained visual attention challenge in 1-month-old infants with prenatal substance exposure.

Study design: We measured heart rate, respiratory sinus arrhythmia, and neurobehavior during sustained visual orientation tasks included in the Neonatal Intensive Care Unit Network Neurobehavioral Scale in 1129 1-month-old infants with prenatal substance exposure. Four groups were compared: infants with prenatal cocaine and opiate exposure, infants with cocaine exposure, infants with opiate exposure, and infants with exposure to other substances (ie, alcohol, marijuana, and tobacco).

Results: The infants with prenatal exposure to both cocaine and opiates had the highest heart rates and lowest levels of respiratory sinus arrhythmia during a sustained visual attention challenge compared with the other 3 groups. Infants with prenatal cocaine and opiate exposure had poorer quality of movement and more hypertonicity during the Neonatal Intensive Care Unit Network Neurobehavioral Scale examination. They also had more nonoptimal reflexes and stress/abstinence signs compared with infants with prenatal exposure to cocaine only and those with prenatal exposure to alcohol, tobacco, and marijuana.

Conclusion: Problems with arousal regulation were identified in infants with prenatal substance exposure. Autonomic dysregulation has been implicated as a mechanism by which these difficulties occur. Our results suggest that infants with prenatal exposure to both cocaine and opiates have the greatest autonomic response to the challenge of a sustained visual attention task, possibly putting these infants at risk for problems associated with physiologic and behavioral regulation, a necessary prerequisite for early learning.

Keywords: ECG; Electrocardiography; HR; Heart rate; NNNS; Neonatal Intensive Care Unit Network Neurobehavioral Scale; PMA; Postmenstrual age; RSA; Respiratory sinus arrhythmia.

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Conflict of interest statement

Funding and conflict of interest information is available at www.jpeds.com (Appendix 2).

Figures

Figure 1
Figure 1
HR (top panel) and RSA (bottom panel) during NNNS visual orientation procedure by exposure classification.
See this image and copyright information in PMC

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