September 08, 1986 12:00 PM

Zachary was a jittery, difficult baby from the start. “A loud noise would make him jump a mile,” says Pam, his adoptive mother. At 5 weeks, the infant started vomiting and crying almost all the time. “I would swaddle him real tightly in a blanket,” Pam says. “I used a pacifier a lot because sucking helped calm him. About all you could do was walk with him until he fell asleep.”

Pam at least knew what Zachary’s problem was: He had become addicted to cocaine before birth. His natural mother, a 25-year-old jobless woman, had used coke all through her pregnancy. Almost from the moment he was born, Zachary was in the throes of drug withdrawal.

Pam, 37, and her 57-year-old husband (they do not want their surnames used) understood the risks. “We tried for seven years to have a baby,” she says. “We had exhausted all medical possibilities, and because of my husband’s age, the agencies wouldn’t let us adopt unless the child was over 10 years old or severely handicapped. We didn’t have a lot of alternatives.”

The couple consulted Dr. Ira Chasnoff, 39, a Chicago pediatrician whose article last year in the New England Journal of Medicine was the first to be published on the effects of cocaine on pregnancy. “We knew from him,” says Pam, “that babies whose mothers had taken cocaine were susceptible to crib death and seizures. It just scared the hell out of me. I told my husband, ‘I don’t know.’ He said, ‘We’re going to see this thing through.’ ”

Doctors have known for years that the use of alcohol, tobacco or illicit drugs by a pregnant woman can be damaging to her newborn. But it now appears that cocaine may be the worst. Just using coke once can put the unborn child in jeopardy. “Babies whose mothers use this drug are much more shaky and tremulous than even those infants whose mothers used heroin,” says Chasnoff, who also is an assistant professor of pediatrics and psychiatry at Northwestern University Medical School. “Cocaine-exposed babies will be quiet and suddenly start crying and screaming and then drop off again. They’re hard to deal with.

“All drugs cross the placenta, which used to be thought of as a barrier but is really a sieve,” Chasnoff explains. “Illicit drugs have small molecules that are easily absorbed by fat. The developing fetus and the newborn’s central nervous system is almost all fat. Cocaine-addicted babies remain irritable for six to eight weeks after birth and don’t respond well to their environment for two or three months.” The long-term implications are unclear, but Chasnoff warns, “these babies are at very high risk for later problems.”

Chasnoff did not set out to specialize in addicted infants. Born in Houston, he graduated from Trinity University in Texas (where he met his wife) and the University of Texas Medical School in San Antonio. After he joined the Northwestern faculty, he says, “I got tapped to work with drug addicts when no one else wanted to.” Now, he says, “I love it. I feel useful.”

In his 10 years in Northwestern’s addicted mothers program, Chasnoff has watched a changing drug scene careen from heroin through marijuana, PCP and Ts & blues (Talwin and pyribenzamine). “Today 75 percent of the women in our program are cocaine users,” he reports. Only three years ago the program got one or two referrals a month from the national cocaine hotline (1-800-COCAINE). “Now we get four or five calls a week from mothers who’ve heard about the program.” They come from all classes, about half of them are married, and most choose to keep their babies.

“Women using cocaine during pregnancy risk an increased rate of miscarriages and premature deliveries,” Chasnoff warns. “And we have seen two cases of babies of cocaine-using mothers suffering strokes. They survived with brain damage and are doing poorly.” Much as he might want addicted mothers-to-be to quit drugs, Chasnoff acknowledges that many (50 percent of women in Northwestern’s program) cannot or will not. His program seeks to educate these mothers through classes on the special needs of their newborns.

“These babies can’t focus on a human face or respond to a human voice,” he explains. “We encourage the mothers to stimulate the babies’ development by talking to and looking directly at them. Pacifiers calm the babies down, and swaddling works because cocaine-addicted babies need to feel some boundaries to help quiet them.”

In Zachary’s case such techniques have clearly helped. “He is no longer as hyper as he was and not as frantic when uncovered,” Chasnoff notes. At 7 months, the child weighs 14½ lbs., and his pediatrician is confident that he will continue to improve. “He is so responsive now,” says Pam. “He just smiles and giggles. He’s a delight.”

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