Maternal cocaine abuse: the spectrum of radiologic abnormalities in the neonatal CNS.

The purpose of this study was to determine the pattern and frequency of CNS abnormalities in the offspring of cocaine-abusing mothers. The study group consisted of a retrospective review of all neonates born or admitted to our neonatal intensive care unit over a 1-year period who met criteria for maternal cocaine abuse (43 patients). A control group (62 patients) was obtained from patients seen during the same interval and the cases were matched for gestational age and race. The radiologic studies were analyzed by two independent reviewers, and CNS abnormalities were assessed by means of sonography, CT, or MR. By matching the study and control groups for gestational age, we eliminated the higher frequency of prematurity. This allowed us to determine if maternal cocaine use was associated with any intracranial abnormalities other than those seen with prematurity. The frequency of intracranial hemorrhage, ventricular enlargement, and periventricular leukomalacia was not significantly different between the study and control groups. The frequency of cortical infarction was 17% in the study group and 2% in the control group. The frequency of major congenital malformation was 12% in the study group and 0% in the control group. All five of the congenital malformations seen were midline CNS abnormalities, particularly neural tube defects. It is postulated that the higher statistically significant frequency of stroke and congenital malformations in the babies of maternal cocaine abusers is related to vasospasm caused by cocaine when used in the third and first trimesters, respectively.