Showing papers by "Julia A. Klein published in 1994"
TL;DR: This is the first biochemical evidence that infants of passive smokers are at risk of measurable exposure to cigarette smoke, and may be well correlated with perinatal risks.
Abstract: Background. —To date, no biological markers have been identified that can predict the extent of fetal exposure to the toxic constituents of cigarette smoke. A variety of xenobiotic agents have been shown to accumulate in growing hair. Patients and Methods. —We measured maternal and neonatal hair concentrations of nicotine and cotinine in 94 mother-infant pairs. Mothers who were active smokers, nonsmokers, and passive smokers and their infants were included. Results. —Mothers who were active smokers (n=36) had mean (SEM) hair concentrations of 19.2 (4.9) ng/mg for nicotine and 6.3 (4.0) ng/mg for cotinine, significantly higher than concentrations in nonsmokers (n=35) (1.2 [0.4] ng/mg for nicotine and 0.3 [0.06] ng/mg for cotinine, P P P P P =.0001). Conclusions. —This is the first biochemical evidence that infants of passive smokers are at risk of measurable exposure to cigarette smoke. Hair accumulation of cigarette smoke constituents reflects long-term systemic exposure to these toxins and therefore may be well correlated with perinatal risks. ( JAMA . 1994;271:621-623)
148 citations
TL;DR: Infants requiring morphine after ECMO may require higher dose rates to maintain adequate sedation, and a prospective, comparative study of morphine pharmacokinetics during and afterECMO was conducted.
Abstract: OBJECTIVES To study the effect of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics of morphine in infants. DESIGN A prospective, comparative study of morphine pharmacokinetics during and after ECMO. SETTING The pediatric intensive care unit at a children's hospital. PATIENTS Seven infants, aged 1 day to 12 months, requiring ECMO. INTERVENTION Infusion of morphine. MEASUREMENT AND MAIN RESULTS Steady-state concentrations of morphine were used to generate a morphine clearance rate. Plasma clearance rate of morphine increased from 0.574 +/- 0.3 L/kg/hr to 1.058 +/- 0.727 L/kg/hr after discontinuation of ECMO (p < .01). Two infants experienced a clinical picture consistent with opioid withdrawal. CONCLUSION Infants requiring morphine after ECMO may require higher dose rates to maintain adequate sedation.
61 citations
TL;DR: This work reports on the first method that allows determination of both cocaine and nicotine as well as their metabolites in the same hair samples, which is an excellent tool in correlating in utero exposure and outcome.
Abstract: Maternal exposure to drugs and chemicals is increasingly being recognized as adversely affecting the developing fetus. To date, a very large number of fetuses have been exposed in utero to cocaine and cigarette smoke. Neonatal hair as a biological marker for fetal exposure in cocaine and nicotine has emerged as an excellent tool in correlating in utero exposure and outcome. However, a limiting factor is the sparsity of neonatal hair. We report on the first method that allows determination of both cocaine and nicotine as well as their metabolites in the same hair samples.
41 citations
Journal Article•
TL;DR: More than 5,000 babies annually in the greater Toronto area who are cared for postnatally by mothers regularly using cocaine are identified because history and urine testing during delivery fail to identify the majority of these cases, most of these children are not likely to receive the appropriate medical and social services and follow-up.
Abstract: There has been an increasing use of cocaine in North America among women of reproductive age. The potential effects of cocaine on the fetus have raised serious concerns about the health of large numbers of children exposed in utero to the drug. Using neonatal hair and urine tests for benzoylegconine (BE), we quantified the incidence of fetal exposure to cocaine among 600 babies born in 3 nurseries in Toronto from 1990-91. A total of 37 babies (6.25%) tested positive for cocaine exposure by either hair test, urine test, or both. The hair test detected 33 cases and failed to identify 4 babies who had low urine concentrations of BE. The urine test failed to identify 76% of the cases. In downtown Toronto, the overall rate of fetal exposure to cocaine was 12.5% (25/200), significantly higher than in the 2 suburban nurseries (3%; 12/400). Babies are born with hair which has grown during the last trimester of pregnancy; hence, our analysis identifies women who have used cocaine long after they became aware of pregnancy. Our figures translate to more than 5,000 babies annually in the greater Toronto area who are cared for postnatally by mothers regularly using cocaine. Because history and urine testing during delivery fail to identify the majority of these cases, most of these children are not likely to receive the appropriate medical and social services and follow-up.
34 citations
TL;DR: The data suggest that the mode of maternal use of cocaine and individual differences in placental handling of the drug may protect some fetuses, and highlight the need to address interpatient variability.
23 citations