| A. |
Effects on the developing fetus |
|
| 1. |
Chronic cocaine use |
|
| a. |
Increased incidence of preterm birth |
| b. |
Low birthweight |
| c. |
Reduced length |
| d. |
Reduced head circumference |
| e. |
Possible genitourinary malformation |
| f. |
Increased minor congenital anomalies |
| g. |
Possible intrauterine CVA |
|
|
| B. |
Effects on the course of pregnancy |
|
| 1. |
Possible obstetrical complications secondary to
drug induced vasoconstriction |
|
| a. |
Embryopathy |
| b. |
Fetal intracerebral hemorrhages |
| c. |
Maternal CVA |
| d. |
Risk of HIV infection with increased numbers of
sexual partners |
| e. |
Abruptio placentae (most prevalent) |
| f. |
Spontaneous abortion |
| g. |
Fetal hypoxia (oxygen deficiency) |
| h. |
Increased rate of premature rupture of membranes
|
| i. |
Premature labor |
| j. |
Fetal demise |
| k. |
No effect |
|
| 2. |
Improved birth outcomes for women who quit by
end of first trimester |
| 3. |
Appetite-suppressing effects related to poor
maternal nutrition |
|
| C. |
Labor and delivery |
|
| 1. |
Early onset of labor and preterm delivery |
| 2. |
Premature labor most likely if cocaine used
during the third trimester |
| 3. |
Patient may not handle pain well |
|
| D. |
Postpartum |
|
| 1. |
Mother |
|
| a. |
Lactation: Cocaine is found in breast milk of
cocaine-using women |
| b. |
Breast feeding is contraindicated for
cocaine-using women |
| c. |
HIV testing and counseling should be encouraged
for all women and should always be recommended for substance-using mothers (whether
or not they breast feed ) |
| d. |
Consider infectious comorbidities when
counseling about breast feeding (including HIV and TB) |
|
| 2. |
Child |
|
| a. |
Neonate |
|
| • |
Intrauterine growth retardation (IUGR) |
| • |
Reduced head circumference |
| • |
Neurobehavioral abnormalities, CNS irritability,
such as: |
|
| * |
Jitteriness |
| * |
Shrill crying |
| * |
Easily startled |
|
| • |
Slightly increased risk of SIDS |
| • |
Increased congenital anomalies |
| • |
Increased possibility of HIV involvement |
| • |
CNS hemorrhagic ischemic lesions |
| • |
Feeding difficulties |
| • |
Cerebral infarction and seizures |
| • |
Congenital infections |
| • |
Cardiovascular dysfunction/arrhythmias |
| • |
Vascular disruption syndrome |
| • |
Post-excitatory depression, such as: |
|
| * |
Depression of interactive behavior |
| * |
Poor organizational responses to environmental
stimuli |
| * |
Post-reactive lethargy, hyporesponsiveness, and
poor caretaker interaction in cocaine-exposed infants are often ignored because the babies
are noninteractive |
|
| • |
Delayed effects |
| • |
No effect |
|
| b. |
Long term |
|
| • |
The research is too "young" to provide
this information |
| • |
Longitudinal studies are being done |
|
|
|
| E. |
Withdrawal |
|
| 1. |
Characterized by |
|
| a. |
Depression |
| b. |
Anxiety |
| c. |
Lethargy |
| d. |
Paranoid psychosis (less common) |
|
| 2. |
Medication should not be administered except |
|
| a. |
In cases of extreme agitation |
| b. |
By individual order of health care provider |
|
|
| F. |
Treatment for cocaine exposed neonates |
|
| 1. |
Optimal nursery environment |
|
| a. |
Sound primary nursing care |
| b. |
Gentle handling by as few caretakers as possible |
| c. |
Regulation of appropriate stimuli |
|
| 2. |
To facilitate and promote optimal infant growth
and development |
|
| a. |
Monitor feeds |
| b. |
Facilitate intake for infants experiencing
feeding difficulties |
| c. |
Observe for inflammation of the mucous membrane
of the small intestine or colon |
| d. |
Teach the parent(s) methods of appropriate
parent/infant interactions |
|
| 3. |
Evaluate utilizing the Brazelton Neonatal
Behavioral Assessment Scale (or an instrument assessing like characteristics) |
|
| a. |
Behaviors such as |
|
| • |
Habituation/responsivity to stimuli |
|
| * |
Faces, light, voices, bell, rattle, etc. |
|
|
| b. |
State |
|
|
| c. |
Characteristics in changes of state |
|
| • |
Irritability, inconsolability |
|
| d. |
Neurological development |
| e. |
Motor development |
|
| 4. |
Neonatal neurotoxicity assessment |
| 5. |
Pharmacotherapy |
|
| a. |
With persistent irritability, a short course of
phenobarbital is recommended |
|
| 6. |
Cranial sonograms for |
|
| a. |
Preterm infants |
| b. |
Head circumference below the 10th percentile on
standardized fetal growth curves |
| c. |
Abnormal neurologic signs |
| d. |
Neurobehavioral dysfunction |
| e. |
Seizure activity |
|
| 7. |
Assessment for congenital malformations/vascular
disruptions |
|
| a. |
Systems that may be affected |
|
| • |
Genitourinary tract |
| • |
Cardiovascular system (congenital heart
malformations) |
| • |
Gastrointestinal tract |
| • |
Skeletal system |
|
|
|
University of Nevada, Reno
