Review of the assessment and management of neonatal abstinence syndrome.
Review of the assessment and management of neonatal abstinence syndrome.
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DOI：
10.1186/1940-0640-9-19
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发表时间：
2014-09-09
影响因子：
3.7
通讯作者：
Brogly SB
中科院分区：
文献类型：
--
作者：
Bagley SM;Wachman EM;Holland E;Brogly SB
新生儿戒断综合征（NAS）继发于宫内阿片类药物暴露是一个日益严重的问题。NAS评估和治疗的差异性归因于缺乏高质量的证据来指导暴露新生儿的管理。本系统性综述检查了NAS评估工具、非药物干预和阿片类药物暴露婴儿的药物管理的现有证据。由于缺乏标准化方法，关于NAS评估工具的观察者间可靠性的数据有限。此外，大多数量表是在普遍使用处方的产前合并用药之前开发的，这可能使NAS评估复杂化。非药物干预，特别是母乳喂养，可能会降低NAS的严重程度。阿片类药物如吗啡或美沙酮被推荐作为一线治疗，苯巴比妥或可乐定作为二线治疗。需要进一步的研究来确定评估、非药物干预和药物管理NAS婴儿的最佳实践，以改善预后。
Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes.