Cocaine’s Tiniest Victims: A Struggle From the Start

In a fourth-floor intensive care unit of the Bronx-Lebanon Hospital Center, a dark-haired baby girl born prematurely struggles for her life.

When doctors were forced to deliver the child by Caesarean section, she experienced severe breathing problems and was in very poor condition. Her mother had gone into labor early after suffering bleeding and a ruptured placenta.

Before delivery, physicians asked if the mother used drugs. She admitted taking cocaine every day.

“When was the last time?” a resident asked.

“Last night,” the mother answered.

“I wonder if she can take care of the baby?” a doctor checking the infant’s heart and respiration rate pondered later. “I don’t think so. She doesn’t even ask for the baby. She doesn’t even come to her baby. We have to pull her by the hand to come over to see her baby.”

These babies are the tiniest victims of cocaine, easily held in one hand as they struggle for life under the clear plastic domes of their incubators.

As they toss and turn in their artificial wombs, every heartbeat and breath recorded by sophisticated monitoring equipment, these children often lie abandoned by their parents.

In the war against drugs, scenes of police officers with guns drawn crashing into houses, suspects sprawled against walls and being frisked, bloody bodies and drugs seized from ships and planes have become the grist of news.

But there is another front line in the fight against narcotics--neonatal intensive care units in places like the Bronx-Lebanon Hospital Center in a New York City neighborhood infected by crack, the cheap, rapidly addictive form of cocaine. At Bronx-Lebanon, every social problem imaginable arrives round-the-clock at the emergency room. On a recent day, nine of the 17 babies in Bronx-Lebanon’s intensive care unit were born to cocaine addicts.

In big cities across the nation, including Los Angeles, increasingly disturbing reports are beginning to turn up of cocaine addiction being passed on by mothers to their newborns. Often these are premature babies with cocaine withdrawal symptoms superimposed on the already considerable problems of prematurity. Some New York City physicians grimly estimate that significant numbers of these cocaine infants in hospitals serving poor neighborhoods could also have AIDS.

“Everyone is overwhelmed,” said Dr. Jing Ja Yoon, chief of Bronx-Lebanon’s neonatal unit. “Recently, we see a lot of mothers who do not care. They are on cocaine, but nothing else matters. They do not want to see the baby sometimes. They don’t care about their appearance, their health. They don’t seek prenatal care. They don’t care whether they are going to take back their babies or not.”

‘Our Future’

The physician paused as she spoke in the staff lounge alongside the newborn intensive care unit. “These babies are our future. If your future starts with this, can you imagine?”

At Bronx-Lebanon, mirroring the experience of some other inner-city hospitals, the number of babies born to drug abusers has grown dramatically from 75 in 1982 to more than 260 in 1987. Since 1982, the hospital’s pediatricians have treated almost 800 such infants.

In 1982, approximately a third of the drug-abusing mothers were cocaine addicts. Last year, the rate soared to 90%.

Physicians have found a high incidence among cocaine children of prematurity and low birth weight. Increased numbers of congenital malformations of the central nervous system, kidneys, joints and bones also have been observed. Doctors also are trying to determine whether cocaine may be responsible for some sudden infant deaths, even though the addiction symptoms generally clear rapidly.

Studies in some other hospitals concur with these findings and have shown an increase in stillbirths and spontaneous abortions among cocaine-abusing women.

The problem is being felt from coast to coast. At the Martin Luther King/Charles Drew Medical Center in South-Central Los Angeles, doctors also say there has been a greater incidence of babies born to mothers using cocaine. Some cocaine users have experienced stillbirths. Some of the babies who lived had withdrawal symptoms.

At Lincoln Hospital in the Bronx and at a hospital in Harlem, a joint study of 50 cocaine-using women showed not only a higher rate of congenital malformations and growth retardation among the babies of cocaine abusers: Immediately after using cocaine, several mothers suffered premature separation of the placenta from the uterus, and their babies were born dead. A study at Northwestern Memorial Hospital in Chicago showed that four women experienced the onset of labor immediately after injecting themselves with cocaine.

Cardiac Irregularities

Writing in the Journal of Pediatrics, the team of physicians from Lincoln Hospital and the New York Medical College speculated that pregnant cocaine users may experience constriction of blood vessels, sudden high blood pressure and cardiac irregularities interrupting the blood supply to various fetal tissues--causing abortion or disruption of growth.

The long-term effect of cocaine on infants is only beginning to be understood.

A team of UCLA physicians followed the case of a boy who tested positive to cocaine and PCP at birth. At 10 months, this baby continued to have tremors, attention problems and irregular sleeping and eating. He experienced several episodes of total body shaking a day.

In recent years, medicine has made dramatic advances in saving the premature. Improved care coupled with sophisticated technology have allowed many babies with very low birth weights to live. But in places like the Bronx-Lebanon Hospital Center, paradox prevails. Doctors fighting to save infants cannot help but wonder whether their often heroic efforts will result in tragic lives in some cases. Sometimes, infants they save return to the hospital after being abused by their parents.

All visitors are required to scrub their hands with antiseptic soap before entering Bronx-Lebanon’s neonatal intensive care unit. As a visitor washed, Dr. Yoon explained that mothers are routinely tested for syphilis. But sometimes results do not come back before they and their infants are discharged. And too often, when physicians try to trace mothers who test positive, they find the parent has given a phony name and address and a false telephone and Medicaid number.

“A few months later, the patient is admitted somewhere else with full-blown syphilis,” Yoon said.

Inside the room filled with incubators, monitors and busy nurses and physicians, Yoon stopped before an incubator in a corner near the door. This twin was premature at 32 weeks and weighed 2 pounds, 2 ounces at birth. Her mother used cocaine. As another doctor injected nutrition through an intravenous line, the tiny curly-haired girl stirred.

Feeding Problems

“The baby was on a ventilator for a long time, now the baby is improving,” Yoon said. “The baby is much better compared to what she was. Both (twins) were very sick. They had severe respiratory distress syndrome, intra-ventricular hemorrhage. Then the babies got better. We weaned them off the ventilator. This baby is gaining weight, but we have problems feeding her fully.”

She paused before another incubator. This baby girl had developed both fungus and bacterial infections. She also had become jaundiced. “She is getting better. She is off the ventilator,” Yoon said. “The mother was taking cocaine.”

“Did the mother say why she was taking the drug?” the physician asked Dr. Vjera Sutic, a pediatric resident.

“She said: ‘My friend gives it to me,’ ” replied Sutic, who went to medical school in Yugoslavia. “They don’t say most of the time. They sit drinking coffee (and don’t respond). Then I stopped asking them . . . I’ve gotten used to it now.”

In another part of the intensive care unit, a red plastic bag for infectious materials was attached to an incubator. This baby’s mother, a cocaine user, had tested positive for AIDS.

“We have to wait a year or a year-and-a-half to see if the baby is infected,” Yoon explained. “Usually they don’t develop symptoms until later.”

Generally, infants withdraw from cocaine within hours or days. But there are exceptions. In a clear plastic bassinet, an older baby rested on her stomach. Physicians had found it necessary to give her a sedative. She had been suffering withdrawal symptoms for more than two weeks.

“You can see the baby cannot sleep,” Sutic said. “This baby is irritable, has tremors, rigid muscular tone. This baby has been crying and crying.”

Poor Follow-Up

“Eventually withdrawal symptoms can be controlled with medications,” Yoon said. “We don’t have very good follow-up with these babies. The history is short. I can’t tell you what is going to happen. Certainly, this baby needs a lot more tender loving care than other babies.”

As she emerged from the intensive care unit, Yoon met Father Joe Gleeson, the hospital’s Roman Catholic chaplain. They continued to the pediatrician’s office in another part of the hospital.

“So many of our babies are starting off with deficiencies right from practically the time they were conceived,” Gleeson said.

“We have to worry about the next generation,” Yoon said. “This is not the end of it. This is the beginning of our problem . . . the outlook for the future is quite grim for these kids.”

“We don’t have a way of stopping this. It is physically destroying two generations of people,” the chaplain added, settling down in a chair in the office.

“When you ask mothers why they are taking cocaine, their shoulders go up,” Yoon said.

“There is very little else for recreation. Most are not working. They are poorly educated,” said Gleeson.

“They don’t have a home to go to. They don’t have a mother. There is no one to rely on,” continued Yoon.

‘No Role Models’

“There are no role models,” interjected Gleeson. “There is no togetherness. There is no support system. They depend on drugs.”

Yoon said new interns often become angry when they meet mothers who abuse cocaine. “Interns have such difficulty in the beginning. They ask themselves, what kind of people are these? As time goes on, they accept it as it is.”

She said that sometimes watching these mothers, she sees similarities to animal studies where rats were given the opportunity to feed on unlimited amounts of cocaine.

“They are different from previous mothers,” Yoon said. “Mothers using crack seem different. I was so impressed when I read the rat study. The rats ate cocaine until they died.”