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Antenatal substance misuse and smoking and newborn hypoxic challenge response
  1. Kamal Ali1,
  2. Thomas Rossor1,
  3. Ravindra Bhat1,
  4. Kim Wolff2,
  5. Simon Hannam1,
  6. Gerrard F Rafferty1,
  7. Janet L Peacock3,4,
  8. Anne Greenough1,3
  1. 1Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
  2. 2Addiction Sciences Unit, King's College London, London, UK
  3. 3National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas’ NHS Foundation Trust and King's College London, London, UK
  4. 4Division of Health and Social Care Research, King's College London, London, UK
  1. Correspondence to Professor Anne Greenough, NICU, 4th Floor Golden Jubilee Wing, King's College Hospital, Denmark Hill, London, SE5 9RS, UK; anne.greenough{at}


Objectives Infants of smoking (S) and substance misusing (SM) mothers have an increased risk of sudden infant death syndrome. The aim of this study was to test the hypothesis that infants of SM or S mothers compared with infants of non-SM, non-smoking mothers (controls) would have a poorer ventilatory response to hypoxia, which was particularly marked in the SM infants.

Design Physiological study.

Setting Tertiary perinatal centre.

Patients 21 SM; 21 S and 19 control infants. Infants were assessed before maternity/neonatal unit discharge.

Interventions Maternal and infant urine samples were tested for cotinine, cannabinoids, opiates, amphetamines, methadone, cocaine and benzodiazepines.

Main outcome measures During quiet sleep, the infants were switched from breathing room air to 15% oxygen and changes in minute volume were assessed.

Results The SM infants had a greater mean increase (p=0.028, p=0.034, respectively) and a greater magnitude of decline (p<0.001, p=0.018, respectively) in minute volume than the S infants and the controls. The rate of decline in minute volume was greater in the SM infants (p=0.008) and the S infants (p=0.011) compared with the controls.

Conclusions Antenatal substance misuse and smoking affect the infant's ventilatory response to a hypoxic challenge.

  • Sudden infant death syndrome
  • in utero nicotine exposure
  • minute volume

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