What is the role of cocaine and amphetamines in the pathogenesis of neonatal abstinence syndrome (NAS)?

Updated: Dec 20, 2017
  • Author: Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP; Chief Editor: Santina A Zanelli, MD  more...
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Cocaine and amphetamines are stimulants with potent vasoconstrictor effects that stimulate the release and block the reuptake of the neurotransmitters dopamine, epinephrine, norepinephrine, and serotonin.

Cocaine, a potent CNS stimulant, alters the major neurotransmitters and rapidly crosses the placenta. Neurobehavioral abnormalities frequently occur in neonates with intrauterine cocaine exposure, most frequently on day 2-3 postnatally. Because cocaine or its metabolites may be detected in neonatal urine up to 7 days after delivery, [18] observed abnormalities in exposed infants may reflect drug effect rather than withdrawal. Early studies suggested neonates exposed to cocaine exhibited a hyperactive Moro reflex, jitteriness, and excessive sucking. More recent studies do not support that neonates exposed to cocaine differ behaviorally from unexposed infants. The unresolved question is whether cocaine acts to limit head growth or disrupt brain development. A synergistic effect between cocaine and other CNS toxins is still possible.

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