Cognitive deficits in premature infants

Article Abstract:

Every year thousands of very-low-birth-weight infants are born who develop serious problems such as learning disabilities. In the July 25, 1991 issue of The New England Journal of Medicine, Hack et al. report on findings that may prove valuable in the early identification of infants with very low birth weights who are at high risk for such problems. They found that eight-year-old children with very low birth weights and below normal head sizes at eight months achieved significantly lower scores on a battery of cognitive tests than similar children who had very low birth weights and normal head sizes at eight months. Another finding of the study was that many of the infants suffered from motor deficits such as spastic diplegia, or poor control of leg movement. Other studies have associated this motor deficit with periventricular leukomalacia, or an abnormality of the white matter of the brain, which is probably caused by a lack of oxygen to the brain. It is thought that premature infants often suffer oxygen deficits to the brain. The cause of cognitive deficits later in life is less clear. Recent research suggests that a major disturbance in the development of the brain leads to lasting problems. The study by Hack found that many of the very-low-birth-weight infants who had small heads at eight months had normal head sizes at birth. This suggests that the process that led to the development of small head size occurred following birth. While the prognostic method used by Hack did not detect all the children likely to experience deficits later in life, it did detect the majority of such children. However, this technique may detect children with brain abnormalities at too late a time. A more useful prognostic tool might be ultrasonography, which uses high-frequency sound waves to produce images. Ultrasonography can detect abnormalities in the brain. It could be used on infants who exhibit slow head growth during the first few months of life to examine the brain for abnormalities. This method could potentially detect more infants at risk for cognitive deficits than measuring head size at eight months. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Cases, Infants (Premature), Birth weight, Low, Premature infants, Low birth weight, Child development, editorial

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The management of cocaine-associated myocardial ischemia

Article Abstract:

Cocaine use can cause an insufficient supply of blood to the heart, known as myocardial ischemia. Cocaine causes increased blood pressure and heart rate, constriction of blood vessels, increased clotting action of platelets, atherosclerosis, and overdevelopment of the left ventricle. These various responses may lead to myocardial ischemia. Diagnosis of heart attack in cocaine users with chest pain is difficult but may be tested for with electrocardiograms, measurements of the waste product creatinine kinase, and a test for cardiac troponin I. Initial treatment for ischemia should include oxygen, benzodiazepines, aspirin, and nitroglycerin, followed by calcium antagonists, angioplasty, or thrombolytic therapy. Aspirin should not be used in patients with a risk of brain hemorrhage. A nine- to twelve-hour observation may be recommended in cocaine users with sudden chest pain. Preventative therapy should involve drug rehabilitation, and, if cocaine users are smokers, cessation of tobacco use.

Care and treatment, Coronary heart disease

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Effect of cocaine use on the fetuses

Article Abstract:

Babies whose mothers use cocaine during pregnancy may have a higher risk of brain damage and neurological disorders than other babies. Cocaine is a drug that affects the central and peripheral nervous systems. The number of pregnant women who use cocaine during pregnancy has been increasing since the 1970s. Exposure to cocaine in utero is usually detected by testing the mother's urine for cocaine or by interviewing the mother. Sometimes health care workers test the urine of infants whose mothers are suspected of using cocaine. In the developing fetus, cocaine may interfere with normal development of the brain. It may cause the formation of lesions in the brain that can cause a stroke or cerebral hemorrhage. Some infants exposed to cocaine in utero may suffer from a neurological syndrome that disappears soon after birth, but others may die from sudden infant death syndrome.

Fetus, Children, Drug abusers, Children of drug addicts, Drug abuse in pregnancy

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