The number of in utero cocaine-exposed infants is high and rising; so are their health-related problems. The objective of this study is to determine the impact of this exposure on the renal-genitourinary (GU) system, congenital anomalies and function changes in the newborn, infant, and child. The association between maternal cocaine use and adverse effects on renal-GU morphogenesis and function will be assessed shortly after birth and subsequently in a prospective longitudinal study. The study population (N-500) will include a group of in utero cocaine-exposed term infants (N=250), a control group (N=125) which is unexposed to cocaine but exposed to alcohol/marijuana, and a control group (N=125) which is drug-free. The three groups will be drawn from an initial survey population of 2,250 North American black women delivering at the University of Miami/Jackson Memorial Medical Center (UM/JMMC). A detailed maternal substance abuse history, urine and hair toxicology, and serum testing for HIV-1 will be performed at delivery. Newborn infants meconium toxicology assays will be performed shortly after delivery. Infants whose mothers test positive for HIV-1 antibodies will not be included in the study. Infant kidney growth, anatomy, and glomerular and tubular functions will be assessed. A complete physical examination with emphasis on abdomen, genitalia and blood pressure, and urinalysis, urine culture, serum electrolytes, CO2, BUN, creatinine, urine electrolytes, creatinine, and Beta 2 microglobulin will be performed during the delivery hospitalization and at 12 and 24 months. Infants with abnormal findings, plus a subset of 20 randomly selected cocaine-exposed infants and 20 controls (10 in each of two groups) without abnormal findings, will undergo further evaluation of glomerular filtration rate by cold iothalamate clearance, and tubular function by urine acidification. All enrolled infants will have anatomy evaluation by Doppler ultrasound performed shortly after birth and at 12 and 24 months of age. Infants with abnormal anatomy findings will be tested with Mag 3 diuretic renal scan and manometric nuclear voiding cystogram. Also, Mag 3 diuretic renal scan will be performed during the first month of life and at 12 and 24 months in different subsets of 20 cocaine exposed infants and 10 alcohol-marijuana controls. The individual cocaine-exposed infant's benefit will be early identification of renal-GU malformations and/or functional anomalies, improvement of clinical management possibilities, and minimization of future complications. The overall benefit will be definition of the long-term effect of in utero cocaine exposure on the renal-GU system, increased information about renal-GU response to insult, and perhaps greater understanding of renal-GU growth and development.
