Sir.—Dominguez et al1 implicate in utero exposure to cocaine and other vasoactive drugs as the cause of brain and ocular abnormalities. However, their conclusions are drawn from a case study of 10 infants with no comparison group. Since prenatal drug exposure is associated with many potential confounding variables,2 the attribution of their findings to such exposure is unwarranted without further study.
The professional and lay media are saturated with reports of multiple adverse effects ofcocaine and other drugs on the fetus and newborn, mostly based on preliminary data or inadequately performed studies. While there is good reason to suspect adverse effects of such drugs, there is also potential danger in inappropriately expecting damage in these children. The risk of cocaine and other vasoactive drugs to the developingfetus and newborn should be fairly estimated by well-designed studies. Uncontrolled case studies may be valuable to generate hypotheses, not to test them.
DANIEL R. NEUSPIEL. Cocaine-Associated Abnormalities May Not Be Causally Related. Am J Dis Child. 1992;146(3):278. doi:10.1001/archpedi.1992.02160150016007