More than one-third of the sickest infants examined recently in an urban hospital emergency department tested positive for cocaine exposure, according to a School of Medicine study. The finding suggests that passive exposure to crack-cocaine smoke may pose a significant health risk for the very young.
The study, which was published in the Journal of the American Academy of Pediatrics, showed that 36.3 percent of infants younger than one year whose urine samples were studied because they were acutely ill tested positive for cocaine. An additional 18.5 percent showed possible traces of cocaine, boosting the total suspected cocaine exposures in the group of 122 children to 54.8 percent.
More respiratory ailments. "We decided to check for cocaine after two children who had died of Sudden Infant Death Syndrome were found to have low levels of cocaine at autopsy," says Dr. Andrew S. Lustbader, a Yale child psychiatrist and a member of the research team. "Not only did we find a surprisingly high incidence of cocaine exposure in our sample of sick infants, we also found a high incidence of upper and lower respiratory symptoms such as runny nose, sore throat and asthma among those with measurable cocaine levels. Those infants also were brought in for medical care more frequently during the first year of life."
Because the researchers used two testing methods that varied in sensitivity to small levels of cocaine and its by-products, they estimated that cocaine exposure occurred in roughly one-sixth to one-third of the infants studied. Overall, about 2 percent to 7 percent of the 2,548 infants treated in the emergency department of Yale-New Haven Hospital between December 1993 and September 1994 may have been exposed to cocaine, probably in the form of crack smoke, according to the report.
Newborns excluded from study. The Yale study focused on only those infants sick enough to require urine tests as part of a routine battery of tests, which was 4.8 percent of all infants examined during the nine-month period. Infants younger than 4 days old were excluded from the study to eliminate the potential for positive urine samples resulting from prenatal cocaine exposure.
Other studies have found cocaine residues in children, but none have looked at exposure in the first year of life, says Lustbader, a postdoctoral fellow at the Yale Child Study Center, who collaborated on the study with Dr. Linda C. Mayes, associate professor at the center; Yale medical student Barbara A. McGee; Dr. Peter Jatlow, psychiatrist and chair of laboratory medicine at Yale; and William L. Roberts, University of Mississippi department of clinical chemistry.
"This is an important finding in a typical urban hospital of a possible health risk to children that must be looked into more deeply," says Lustbader, who suggested that future research focus on the long-term effects of second-hand cocaine exposure and the link between cocaine and respiratory problems in the very young. Because crack abusers generally have a higher incidence of cigarette use, the additional impact of cigarette smoke also should be studied, he notes.
In addition to second-hand crack smoke, infants in the Yale study could also have been exposed to cocaine directly through breast feeding or ingestion, the researchers note. The study was supported by a Yale Children's Clinical Research Center Grant and by the National Institute on Drug Abuse as part of a longitudinal study led by Mayes.
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