The Opioid dependent mother and newborn dyad: non-pharmacologic care.
The Opioid dependent mother and newborn dyad: non-pharmacologic care.
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DOI：
10.1097/adm.0b013e31817e6105
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发表时间：
2008-09
影响因子：
5.5
通讯作者：
Jansson LM
中科院分区：
文献类型：
--
作者：
Velez M;Jansson LM
阿片依赖孕妇和产后妇女及其婴儿是一个复杂和脆弱的群体，需要个体化、全面和多学科的治疗。尽管在孕期提供全面服务时维持美沙酮可显著改善阿片类药物依赖妇女的妊娠结局，但它的使用对婴儿有影响，最明显的是新生儿禁欲综合症(NAS)。NAS是由表明中枢和自主神经系统调节失调的生理迹象和行为组成的，在受影响的婴儿中其表达是不同的。每个受到宫内阿片类药物暴露影响的婴儿表现出的无序行为而不是适应行为可能会损害基本功能，如进食、睡眠以及警觉和向照顾者传达明确提示的能力。了解和应对新生儿神经行为障碍有助于促进婴儿的自组织和自我调节能力。然而，这种滥用母亲身心健康的物质在围产期可能会虚弱，她识别和回应新生儿暗示的能力可能会受到限制。对美沙酮维持的母亲、她的孩子和母婴二元体进行多层次的全面评估和干预可以改善早期母亲养育互动，这是婴儿早期发育的关键组成部分，特别是在这一脆弱人群中。本文的目的是回顾母体阿片类药物依赖对母婴双方及其治疗提供者在产后经历的困难的贡献，以及对婴儿的非药物治疗，并提出实用措施的建议，重点是将母婴作为相互作用的二体进行治疗。
Opioid dependent pregnant and post-partum women and their infants are a complex and vulnerable population requiring individualized, comprehensive and multidisciplinary treatment. Though methadone maintenance in the setting of comprehensive service provision during pregnancy significantly improves pregnancy outcomes for opioid dependent women, its use has implications for the infant, most notably the Neonatal Abstinence Syndrome (NAS). NAS is comprised of physiologic signs and behaviors that indicate a dysfunctional regulation of the central and autonomic nervous systems, and is variable in its expression in affected infants. The disorganized rather than adaptive behaviors displayed by each infant undergoing the effects of in-utero opioid exposure may impair basic functions such as feeding, sleeping, and the ability to be alert and communicate clear cues to caregivers. Understanding and responding to neurobehavioral dysfunction of the newborn may help to promote the infant’s self-organization and self-regulating abilities. However, the substance abusing mother’s physical and psychological wellbeing may be debilitated in the perinatal period, and her ability to recognize and respond to the newborn’s cues may be limited. A multi-tiered comprehensive assessment and intervention of the methadone-maintained mother, her child, and the mother/infant dyad can improve early maternal nurturing interactions, a crucial component of early infant development, particularly in this vulnerable population. The purpose of this article is to review the contribution of maternal opioid dependency to the difficulties experienced by the mother-infant dyad and their treatment providers in the postnatal period, and the non-pharmacological treatment of the infants with suggestions for practical measures with emphasis on the treatment of the mother and baby as an interactional dyad.