Maternal use of cocaine during gestation increases the risk of prematurity and low birth weight but may also have direct effects on fetal development that would contribute additional risk for poor neonatal outcome. Early post-natal life in a Neonatal Intensive Care Unit (NICU) is a stressful and challenging experience that provides an opportunity to observe autonomic functioning and reactivity of both drug-exposed and non-exposed neonates. Cocaine exposed premature infants may be less able to adapt and cope with NICU care due to their exposure to a CNS stimulant that targets the neurological systems necessary for adaptive responsivity to stress. This study will evaluate the abilities of cocaine-exposed, low birth weight, premature, newborns to respond adaptively to care and handling in the NICU. Forty drug exposed neonates admitted to the Johns Hopkins Bayview Medical Center's Neonatal Intensive Care Unit will be recruited for study. Cocaine exposed and polydrug exposed neonates will be included as determined by maternal urine toxicology reports, infant meconium analysis, and maternal self-report. Measures of autonomic and behavioral reactivity to invasive procedures including gavage feeding and heel stick, and a perceptual stressor (auditory stimulus) will be collected at two week intervals once the neonates are medically stable.
