Physiologic dysregulation in newborns with prenatal opioid exposure: Cardiac, respiratory and movement activity.
Physiologic dysregulation in newborns with prenatal opioid exposure: Cardiac, respiratory and movement activity.
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产前阿片类药物暴露新生儿的生理失调：心脏、呼吸和运动活动。
DOI：
10.1016/j.ntt.2022.107105
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发表时间：
2022-07
影响因子：
2.9
通讯作者：
Goldschmidt L
中科院分区：
文献类型：
--
作者：
Bloch-Salisbury E;Rodriguez N;Bruch T;McKenna L;Goldschmidt L
由于特征性症状和明显行为，产前阿片类药物暴露（POE）的新生儿通常被诊断为新生儿戒断/阿片类药物戒断综合征。然而，对阿片类药物暴露新生儿的潜在生理学知之甚少。心脏，呼吸和运动活动进行了测量，以确定生理失调和量化病理生理不稳定性的中枢和自主神经系统的POE新生儿。在这项初步研究中，30名住院的POE新生儿（>35周胎龄）参加了两个研究阶段之一，其中测量了8-10小时的生理活动。在第1阶段，17名婴儿接受常规治疗，以提供生理活动的一般评估。在第2阶段，13名婴儿参与了一项干预性研究（NCT 02768844），该研究使用了可提供随机振动刺激（SVS）的原型床垫。比较了三个互喂期（FNF或NFN）器械开启（N）和关闭（F）时生理活动的变化。第1阶段显示，尽管婴儿的心率平均在正常新生儿范围内（平均137 bpm，SD 7），但研究期间16%的婴儿心动过速，62%的婴儿呼吸急促（平均74次/min，SD 13）。婴儿在这段时间内移动了33%; 17%的持续时间>30 s。在第2阶段，与FNF方案中的SVS F相比，SVS N的心率、呼吸频率、运动持续时间和频率均降低（P < 0.05）。研究结果支持，生理措施可以识别失调没有捕获与目前的戒断评分评估。需要进行更大规模的研究，以评估床垫SVS是否有助于调节POE婴儿的病理生理不稳定性。
Newborns with prenatal opioid exposure (POE) are commonly diagnosed with neonatal abstinence/opioid-withdrawal syndromes due to characteristic symptoms and overt behaviors. However, little is known about the underlying physiology of opioid-exposed newborns. Cardiac, respiratory and movement activity were measured to identify physiologic dysregulation and quantify pathophysiologic instabilities of the central and autonomic nervous systems in POE newborns. In this pilot study, 30 hospitalized POE newborns (>35 wks gestational age) participated in one of two study phases wherein physiologic activity was measured for an 8-10 h session. In Phase 1, 17 infants received usual treatment to provide a general assessment of physiologic activity. In Phase 2, 13 infants participated in an interventional study (NCT02768844) using a prototype mattress that delivered stochastic vibratory stimulation (SVS). Changes in physiologic activity were compared for device on (N) and off (F) for three interfeed periods (FNF or NFN). Phase 1 showed that although infants’ heart rate was on average within normal newborn range (mean 137 bpm, SD 7), infants were tachycardic 16% of the study period and tachypneic (mean 74 breaths/min, SD 13) 62% of the period. Infants moved 33% of the period; 17% were durations >30 s. In Phase 2, heart rate, respiratory rate, movement duration and frequency were each reduced for SVS N compared to SVS F in the FNF protocol (P < 0.05). Findings support that physiologic measures can identify dysregulation not captured with current withdrawal scoring assessments. Larger studies are warranted to assess if mattress SVS helps regulate pathophysiologic instabilities in infants with POE.
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