Maternal use of a combination of recreational and antiretroviral drugs (nyaope/whoonga): Case reports of their effects on the respiratory system in infants

Nyaope/whoonga is an indigenous street drug in South Africa (SA). It is made from a combination of neuro-stimulatory illicit drugs such as antiretroviral drugs, heroin, cannabis, opioids, cocaine as well as common household powders such as flat-screen television glass powder. It is a very addictive substance and is used even during pregnancy. Its effects on the developing fetus have been described as causing neonatal abstinence syndrome (NAS), intrauterine growth restriction (IUGR) and neurological complications. There are no data in the literature that report its effect on the respiratory system (RS) of the fetus or neonates. We describe two children who were prenatally exposed to nyaope and presented with upper and lower respiratory tract obstructions associated with recurrent pneumonias. Further studies are required to describe the adverse effects of whoonga on the developing RS of prenatally exposed fetuses.