ABSTRACT:We investigated the effects of prenatal cocaine exposure (PCE) on heart rate (HR) and heart rate variability (HRV) in the presence of orthostatic stress among near-and full-term neonates. PCE infants (n ϭ 21) and controls (n ϭ 23) were enrolled within 120 h of birth. ECG was recorded for an hour during quiet sleep, 30 min in supine position and then 30 min in an inclined position. Linear mixed models were used to analyze HR and HRV in the time domain and wavelet and power spectrum analyses in the frequency domain. PCE infants had tachycardia both before (p ϭ 0.091) and after tilting (p ϭ 0.015), but with a clear interaction between PCE and orthostatic stress (p ϭ 0.049). Compared with controls, PCE infants had a delayed and prolonged reaction to orthostatic stress. There was also a pronounced interaction with regard to log-transformed SDDRR, a measure of HRV (p ϭ 0.049). Controls experienced an instantaneous increase in log (SDDRR) followed by a prompt return to normal levels, while PCE infants had a gradual increase that did not dissipate quickly. Frequency-domain analyses also distinguished between the cocaine-exposed infants and the controls. Results suggest that the effects of PCE on the development of sympathetic and parasympathetic systems could lead to altered cardiovascular function. H eart rate (HR) and heart rate variability (HRV) are increasingly used to detect a variety of pathophysiologic alterations in the autonomic nervous system (ANS) regulation of cardiac control mechanisms (1). Infants who succumb to sudden infant death syndrome have higher HR and reduced HRV compared with other infants; one speculation is that autonomic disturbances may lead to cardiac instability or may indicate ANS alterations with the potential to affect other vital functions (2). Moreover, the circadian range of HR and certain quantities related to blood pressure (BP) are predictors of neonatal cardiovascular events (3). Hence, power spectrum analysis (PSA) of HRV has been used to assess fetal viability and maturity of the ANS (4,5).Cocaine use by pregnant women has continued to be a prevalent public health problem. Prenatal cocaine exposure (PCE) may lead to abruptio placentae, premature delivery, intrauterine growth restriction, congenital malformations, and fetal death (6 -8). However, controversy exists regarding the influences of PCE on the ANS control mechanism and on neonatal cardiovascular function. Some studies (9 -11), have found elevated HR and reduced HRV in infants with PCE. On the other hand, Regalado et al. (12) found reduced HR and increased HRV following PCE, while another study focusing on the nonlinear dynamics of HRV (13) found no significant differences between PCE infants and controls in spectral power distribution, approximate entropy, correlation dimension, or nonlinear predictability. Spectral analyses in particular have not yielded a consensus about the nature of PCEinduced autonomic alterations. Higher HRV was attributed to increased spectral power across all frequency bands in quiet sl...