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Controversial Costs of Cocaine

Niel F. Miele, MD
JAMA. 1992;267(4):507. doi:10.1001/jama.1992.03480040055017.
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To the Editor.  —Phibbs et al1 report some extremely important findings regarding increased neonatal costs of maternal cocaine use. Their findings become more substantial when one realizes that they report only the "tip of the iceberg" when reporting neonatal costs. As they allude to in the last paragraph of their article, the costs of care (and the costs to society) for these infants after their neonatal hospitalizations can be substantial. I concur with their opinion that further study on the long-term consequences of maternal cocaine use is needed.As I read through the study, one question came to mind. Were the physicians for the newborn infants blinded (at least initially) to the maternal drug use history? If they were not blinded, could a positive maternal drug use history have influenced the initial decision as to whether to admit an infant to the neonatal intensive care unit? Although there should


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