Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication
Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication
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DOI：
10.1111/j.1360-0443.2012.04038.x
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发表时间：
2012-11-01
期刊：
影响因子：
6
通讯作者：
Jones, Hendree E.
中科院分区：
文献类型：
--
作者：
Kaltenbach, Karol;Holbrook, Amber M.;Jones, Hendree E.
目的探讨宫内接触美沙酮或丁丙诺啡的新生儿戒断综合征（NAS）的预测因素。设计和设置多中心随机临床试验，其中婴儿在出生后观察至少10天，并由受过训练的评分员评估NAS症状。参与者：共有131名阿片类药物依赖母亲所生的婴儿，其中129名可用于NAS评估。使用母体和婴儿特征进行广义线性建模以预测：治疗前的峰值NAS评分，婴儿是否需要NAS治疗，NAS治疗的持续时间和治疗NAS症状所需的吗啡总剂量。结果在样本中，53%（68名婴儿）需要治疗NAS。分娩时母亲体重较低、估计胎龄（EGA）较晚、母亲使用选择性5-羟色胺再摄取抑制剂（SSRIs）、阴道分娩和婴儿出生体重较高预测NAS评分峰值较高。较高的婴儿出生体重和母亲在分娩时使用较多的尼古丁可预测婴儿接受NAS治疗。母亲使用SSRIs、较高的尼古丁使用和接受研究药物的天数较少也可预测治疗NAS症状所需的药物总剂量。没有变量预测NAS的治疗时间。结论母亲分娩时体重、估计胎龄、婴儿出生体重、分娩类型、母亲尼古丁使用情况、母亲接受研究药物的天数以及妊娠期精神药物的使用情况可能在暴露于美沙酮或丁丙诺啡的婴儿中表达新生儿戒断综合征严重程度方面发挥作用。
Aim To identify factors that predict the expression of neonatal abstinence syndrome (NAS) in infants exposed to methadone or buprenorphine in utero. Design and Setting Multi-site randomized clinical trial in which infants were observed for a minimum of 10 days following birth, and assessed for NAS symptoms by trained raters. Participants A total of 131 infants born to opioid dependent mothers, 129 of whom were available for NAS assessment. Measurements Generalized linear modeling was performed using maternal and infant characteristics to predict: peak NAS score prior to treatment, whether an infant required NAS treatment, length of NAS treatment and total dose of morphine required for treatment of NAS symptoms. Findings Of the sample, 53% (68 infants) required treatment for NAS. Lower maternal weight at delivery, later estimated gestational age (EGA), maternal use of selective serotonin re-uptake inhibitors (SSRIs), vaginal delivery and higher infant birthweight predicted higher peak NAS scores. Higher infant birthweight and greater maternal nicotine use at delivery predicted receipt of NAS treatment for infants. Maternal use of SSRIs, higher nicotine use and fewer days of study medication received also predicted total dose of medication required to treat NAS symptoms. No variables predicted length of treatment for NAS. Conclusions Maternal weight at delivery, estimated gestational age, infant birthweight, delivery type, maternal nicotine use and days of maternal study medication received and the use of psychotropic medications in pregnancy may play a role in the expression of neonatal abstinence syndrome severity in infants exposed to either methadone or buprenorphine.