Cocaine babies: the scourge of the '90s (1991)

FRANÇAIS :
Description détaillée des aspects pathologiques, toxicologiques et sociaux de 6 cas de mortalité infantile liés à la cocaïne. Diversité des causes : abus de cocaïne par la mère pendant la grossesse ou l'accouchement, négligence des parents toxicomanes ou ingestion accidentelle. Afin de prévenir ce type de cas devenus fréquents et très préoccupants ces dernières années, les auteurs suggèrent la mise en place d'une politique intégrant approches médicales, répressives et éducatives. Quelques propositions concrètes sont faites p.e. l'instauration de l'obligation d'aviser les autorités sanitaires, amélioration du suivi de la grossese des mères à risque, autopsie et analyse toxicologique systématiques.
ENGLISH :
Six cases of cocaine-related deaths of infants have covered the spectrum of potentially devastating effects. They include an intrauterine death of a 35-week-old fetus following acute maternal cocaine abuse; anoxic encephalopathy at birth with 3 months' vegetative survival from a similar episode; traumatic compression asphyxia in a 4-month-old; infectious cardiomyopathy with heart failure in a twin at age 21 months following maternal cocaine abuse at birth; malnutrition and dehydration in a 7-week-old during continuing cocaine abuse by the parents; and a teenage sibling's cocaine lacing of a baby milk bottle ingested by his 6-week-old brother. All the cases had positive toxicological screening for cocaine or metabolites or both in the mother at delivery or in the infant at birth, or both. There were no instances of sudden infant death syndrome (SIDS, or "crib death"). Pathologic and toxicologic, as well as birth, developmental, and social data are presented. An integrated medical, public health, law enforcement, and educational policy to prevent or at least ameliorate these tragic cases, now approaching epidemic proportions, has yet to be developed. A careful obstetrical history and examination of the mother, indication on the birth certificate of maternal drug abuse, and notification of health authorities (by birth certificate checking, among other ways) may send an early warning message to providers for intercession. Active ingestion/injection and passive inhalation by older children and teenagers require more intensive monitoring and aggressive interaction by pediatricians, social workers, school authorities, and employers.(ABSTRACT TRUNCATED AT 250 WORDS)