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NEONATOLOGY: MANAGEMENT, PROCEDURES, ON-CALL PROBLEMS, DISEASES, AND DRUGS - part 7

Gây tranh cãi a. hiệp hội cocaine Ở trẻ sơ sinh, sau đây đã được mô tả: viêm ruột hoại tử, tăng huyết áp thoáng qua, và giảm cung lượng tim (vào ngày đầu tiên của cuộc sống), xuất huyết nội sọ và nhồi máu, co giật, apneic phép thuật, thở định kỳ, bất thường electroencephalogram | described. 2. Controversial cocaine associations a. In the neonate the following have been described Necrotizing enterocolitis transient hypertension and reduced cardiac output on the first day of life intracranial hemorrhages and infarcts seizures apneic spells periodic breathing abnormal electroencephalogram abnormal brainstem auditory evoked potentials abnormal response to hypoxia and carbon dioxide and ileal perforation. These reports were mostly case reports or insufficiently controlled case series with numerous confounding factors notably various other perinatal and gestational risk factors including multiple drug and alcohol usage . There are large case-control studies that have found no association between cocaine exposure and intraventricular hemorrhage. Despite earlier concerns there does not appear to be an increased risk of SIDS. b. Cocaine has been suggested as a teratogen. Its teratogenic potential is presumed to be due to its vascular effects although direct toxicity on various cell lines may also play a role. Numerous CNS anomalies as well as cardiovascular abnormalities limb reduction defects intestinal atresias and other malformations have been attributed to cocaine. However most of these associations were derived from case reports or series or poorly controlled studies and a detailed examination of the data does not substantiate most of these teratogenic associations. An exception appears to be an increased risk of genitourinary tract defects associated with cocaine exposure during gestation. Moreover there does not appear to be a dysmorphism recognizable as a cocaine syndrome. Cocaine is associated with an increased incidence of spontaneous abortion stillbirth abruptio placentae premature labor and IUGR. 3. Prognosis. By 1 year of age most infants will have achieved catch-up growth. At 3-4 years there are problems with expressive and receptive speech and children are reported to be hyperactive distractable and irritable and to have problems .