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co·caine ba·by(kō-kān' bā'bē)
Cocaine is vasoconstrictive and decreases blood flow to the placenta and fetus. Cocaine abuse during pregnancy has been correlated with birth defects, intrauterine growth retardation, and perinatal death related to premature separation of the placenta (abruptio placentae), preterm labor and delivery, low birth weight, and sudden infant death syndrome.
Cocaine use by the father at the time of conception may have a negative effect on sperm quality.
Cocaine-dependent newborns often experience a significant, agonizing withdrawal syndrome that can last 2 to 3 weeks and require continual assessment and evaluation. During the withdrawal period, patient care measures are instituted to effect the following outcomes: that the infant maintain an open airway and breathe easily, with adequate oxygen intake, independent respiratory effort, and adequate tissue perfusion; that the infant relax and sleep; that crying diminish; that the infant be able to remain asleep for 3- to 4-hr periods; that the infant recover from seizures with minimal or no sequelae; that the infant ingest and retain sufficient fluids for hydration and nutrients for growth; and that the infant's skin remain intact and free from infection.
The parents and significant others are an important part of the care plan. The mother requires considerable support because her need for and abuse of drugs result in decreased coping abilities. The newborn's withdrawal symptoms, decreased consolability, and poor interactive behavior put even more stress on the mother's ability to cope. Home health care, treatment for addiction, and education are important considerations. Health care providers explore, with the mother, options for care of herself and her infant and for future fertility management, employing a sensitive approach that communicates respect for the patient and her ability to make responsible decisions. Depending on the scope of the patient's drug abuse problem, total prevention may be unrealistic; however, the parent is referred for education and social supports to provide opportunities for detoxification and abstinence. If the infant is in the mother’s care, inclusion in the support program has been shown to be beneficial to both. Because the newborn's dependence is physiological, not psychological, no predisposition to later dependence is thought to be present. The psychosocial environment in which the infant is raised, however, may predispose the baby to addiction. The infant must be referred for child welfare follow-up assessment, evaluation, and action, which may include removing the infant from the birth mother's care temporarily or permanently. See: infant of substance-abusing mother