BOSTON — When Joshua arrived at New England Medical Center, senior nurse Sharon Hill could have held him in her hand. He was three months premature and weighed 2 pounds. And because of cocaine, he was suffering.
The cocaine addiction was his mother's, but Joshua still pays for it after three months in the hospital.
Cocaine pushed him into the world so early and ill-equipped that he was immediately hooked up to a ventilator and feeding tubes and had four cardiac-monitor electrodes taped to his chest.
Although babies with breathing tubes can't make any noise when they cry, Hill said: "Sometimes you can see an expression that they are crying."
Last year, about 10% of the cocaine babies born in Massachusetts died. Some who survived suffered strokes or intestinal failure when cocaine constricted their tiny arteries, but most of their problems result from premature birth.
Experts now are investigating the possibility that problems among "cocaine-exposed" babies might not show up until years later.
Cocaine might damage the infants' central nervous systems, but it is difficult to study their long-term prospects because researchers find it hard to separate the effects of cocaine exposure in the womb from poor parenting, said Barry Zuckerman, director of development and behavioral pediatrics at Boston City Hospital.
"We don't know what effect it has on the developing brain or how it may later affect behavior," Zuckerman said.
A study by the National Assn. for Perinatal Addiction Research and Education has shown that it takes three months before cocaine babies weigh as much as drug-free infants and two years for head circumference, a measure of brain development, to match that of babies not exposed to cocaine.
"The most important thing . . . is extreme prematurity, 10 weeks, 12 weeks, 15 weeks," said Benjamin Sachs, chairman of obstetrics and gynecology at Boston's Beth Israel Hospital. "A baby that's 12 weeks premature may remain in (the) hospital three months and cost $100,000. That's a serious public health problem."
Babies born with cocaine in their systems may alternately be lethargic and overstimulated or given to inconsolable crying, Sachs said.
The study showed that infants remained irritable for six to eight weeks, placing a heavy burden on drug-addicted mothers.
"We're concerned that the mothers may get turned off by their babies," Zuckerman said.
The critical question might be "to whom is this child born and what kind of mothering is going on in that environment" said Sachs, who argues that it illustrates the need for more treatment for female addicts.
"There are very few places in Massachusetts where women who are addicted can get help, and there are long waiting lists," he said.
Zuckerman described it as a pay now or pay later situation.
"We're impressed by how hard the mothers work to stop taking drugs and be a good mother," he said. "We don't have enough drug-treatment programs for women. If you pay later, you spend the money and have a damaged baby."