Intra-uterine exposure to maternal opiate abuse and HIV: The impact on the developing nervous system

Background: Both intra-uterine exposure to maternal drugs and HIV are known to adversely affect the developing central nervous system. Aims: (1) To describe the quality of GMs in infants who were intra-uterinely exposed to maternal opiate abuse and HIV; and (2) to analyze to what extent (a) perinatal events, (b) status of HIV-infection, and (c) the quality of GMs are associated with the neurodevelopmental outcome at 2 to 3 years of age. Patients and method: Seventy-seven children intra-uterinely exposed to both maternal opiate abuse and HIV in utero (41 boys and 36 girls; 39 born preterm) were videoed twice: first during the first 2 months after term (writhing GMs) and again at 3-5 months (fidgety GMs). Neurodevelopmental outcome was assessed at 2-3 years of age. Results: Thirty-eight infants showed abnormal writhing GMs; 25 infants had abnormal or absent fidgety movements; 22 children had an adverse neurodevelopmental outcome. The association between GM trajectories and outcome revealed a Cramer-V=0.75 (p<0.001). Those infants with active HIV-infection (n=10) did not differ from the 67 infants who were HIV-exposed but uninfected with respect to their GM quality or outcome. Conclusions: Serial assessment of GMs in infants who were intra-uterinely exposed to maternal opiates and to HIV can be utilized for early identification of infants at a higher risk for later deficits and needing early intervention. (C) 2013 Elsevier Ltd. All rights reserved.