BACKGROUND Follow up of children born to drug-addicted mothers is difficult because of social context. The aim of this study was to determine the precise outcome in a cohort of infants from two neonatal units. POPULATION AND METHODS; Analysis of perinatal and follow up data of 59 infants born to drug-addicted mothers, admitted from 1988 to 1993 in the neonatal units of Colombes and Neuilly. RESULTS Perinatal data: very poor social context; 100% addiction by opiates and very frequent polyintoxication; 21% HIV + mothers; 54% came later or not at all to prenatal care; 34% prematurity and 46% intrauterine growth retardation; 80% neonatal withdrawal symptoms. Precise follow up data is known for 95% of the infants at the age of 1 to 7 years: 5% died during the first year of life; 51% are living with their family (with or without their mother); 36% are in institutions or foster homes, and 8% are fully adopted; among 41 newborns discharged from neonatal unit to their mother, 34% have been secondarily placed by Child Protection Services. The only severe sequelae were not related to drug direct effect: 5 neurologic or respiratory chronic impairment related to prematurity, and 3 asymptomatic HIV + children; a few moderate behavioral problems appear to be related to social familial context. Among the 51 mothers, 6 died (5 by overdose) 19 are severely addicted, 10 have stopped addiction but 2 are HIV +, and 16 are lost to follow up. CONCLUSIONS Analysis of this cohort and of the literature suggest a need for changing our perinatal strategies to ameliorate medico-psycho-social care of these pregnancies, mothers and infants, with or without methadone maintenance programs; these strategies have been proved to prevent perinatal problems (specially prematurity), and to improve mother-infant attachment.