Ineffective morphine treatment regimen for the control of Neonatal Abstinence Syndrome in buprenorphine- and methadone-exposed infants
Ineffective morphine treatment regimen for the control of Neonatal Abstinence Syndrome in buprenorphine- and methadone-exposed infants
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DOI：
10.1017/s2040174412000190
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发表时间：
2012-08-01
影响因子：
1.7
通讯作者：
White, J. M.
中科院分区：
文献类型：
--
作者：
Gordon, A. L.;Lopatko, O. V.;White, J. M.
本研究旨在确定吗啡是否能有效改善美沙酮和丁丙诺啡暴露婴儿的新生儿戒断综合征（NAS）症状至非阿片类药物暴露对照水平。在澳大利亚的一家大型教学妇产医院进行了一项前瞻性、非随机、灵活给药的比较研究。比较了丁丙诺啡、美沙酮和对照非阿片类药物暴露婴儿组中的25名婴儿（总计n = 75名婴儿）。每4小时对暴露于阿片类兴奋剂的婴儿给予口服硫酸吗啡（1 mg/ml）。确定给药的改良Finnegan戒断量表（MFWS）评分：8-10分：0.5 mg/kg/天，11-13分：0.7 mg/kg/天，14+分：0.9 mg/kg/天。在4周的随访期内，使用戒断评分、吗啡用量和住院时间来评估NAS。没有对照组的MFWS评分高于7分。美沙酮（60%）和丁丙诺啡（48%）婴儿之间需要治疗的婴儿百分比没有显著差异。对于接受治疗的婴儿，与丁丙诺啡婴儿（22.77 +/- 4.29 mg）相比，美沙酮（40.07 +/- 3.95 mg）给予更多的吗啡（P < 0.01）以试图控制NAS。治疗开始后，美沙酮组婴儿（87%）比丁丙诺啡组婴儿（42%）显著（P < 0.01）继续超过吗啡治疗要求的评分阈值和非阿片类药物暴露的对照婴儿评分。对于接受治疗的婴儿，美沙酮和丁丙诺啡婴儿之间的住院时间没有显着差异。吗啡治疗在改善美沙酮或丁丙诺啡婴儿NAS至非阿片类药物暴露对照症状水平方面并不完全有效。与丁丙诺啡婴儿相比，该方案对美沙酮的有效性可能较低。
This study aimed to determine if morphine is effective in ameliorating Neonatal Abstinence Syndrome (NAS) symptoms to non-opioid-exposed control levels in methadone-and buprenorphine-exposed infants. A prospective, non-randomized comparison study with flexible dosing was undertaken in a large teaching maternity hospital in Australia. Twenty-five infants in the groups of buprenorphine-, methadone- and control non-opioid-exposed infants were compared (total n = 75 infants). Oral morphine sulphate (1 mg/ml) was administered every 4 h to opioid agonist-exposed infants. Modified Finnegan Withdrawal Scale (MFWS) scores determined dosing: score of 8-10: 0.5 mg/kg/day, 11-13: 0.7 mg/kg/day and 14+: 0.9 mg/kg/day. Withdrawal score, amount of morphine administered and length of hospital stay, were used to assess NAS over a 4-week follow-up period. No controls achieved a score higher than 7 on the MFWS. There was no significant difference in the percentage of infants requiring treatment between methadone (60%) and buprenorphine (48%) infants. For treated infants, significantly (P < 0.01) more morphine was administered to methadone (40.07 +/- 3.95 mg) compared with buprenorphine infants (22.77 +/- 4.29 mg) to attempt to control NAS. Following treatment initiation, significantly more (P < 0.01) methadone (87%) compared with buprenorphine infants (42%) continued to exceed scoring thresholds for morphine treatment requirement, and non-opioid-exposed control infant scores. For treated infants, there was no significant difference in length of hospital stay between methadone and buprenorphine infants. Morphine treatment was not entirely effective in ameliorating NAS to non-opioid-exposed control symptom levels in methadone or buprenorphine infants. The regimen may be less effective in methadone compared with buprenorphine infants.