Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis.
Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis.
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DOI：
10.1186/1471-244x-14-104
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发表时间：
2014-04-08
期刊：
影响因子：
4.4
通讯作者：
McCowan C
中科院分区：
文献类型：
--
作者：
Baldacchino A;Arbuckle K;Petrie DJ;McCowan C
在积累的文献中，假设阿片类药物依赖孕妇所生的孩子由于长期宫内使用阿片类药物而导致神经行为功能受损。采用流行病学观察性研究荟萃分析（MOOSE）和系统评价和荟萃分析首选报告项目（PRISMA）指南，对怀孕期间母亲慢性使用阿片类药物对儿童神经行为功能影响的文献进行了定量和系统评价。我们检索了1995年1月至2012年1月期间的Cinahl、EMBASE、PsychINFO和MEDLINE。在已确定的200项研究中，只有5项研究定量报告了母亲在怀孕期间使用阿片类药物后儿童的神经行为功能。所有5项研究均为病例对照研究，研究中的暴露受试者人数为33-143人，对照组为45-85人。该荟萃分析显示，与未暴露的婴儿和儿童相比，慢性子宫内暴露的婴儿和学龄前儿童在认知、精神运动或观察行为结果方面没有显著损伤，非保守显著性水平p < 0.05。然而，所有领域都表明，使用阿片类药物的母亲的婴儿/儿童结局不佳的趋势。根据科恩的基准标准，所有可能影响的幅度都很小。慢性子宫内阿片类药物暴露的婴儿和学龄前儿童与未暴露的同龄人相比，在神经行为结果方面没有明显的损害，尽管在所有领域都有较差结果的趋势。本综述的结果受到分析的研究数量少、异质性人群和单个研究数量少的限制。需要进行纵向研究，以确定5岁以后是否出现任何神经心理障碍，并帮助进一步调查环境风险因素对“核心”表型影响的作用。
It is assumed within the accumulated literature that children born of pregnant opioid dependent mothers have impaired neurobehavioral function as a consequence of chronic intrauterine opioid use. Quantitative and systematic review of the literature on the consequences of chronic maternal opioid use during pregnancy on neurobehavioral function of children was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Cinahl, EMBASE, PsychINFO and MEDLINE between the periods of January 1995 to January 2012. There were only 5 studies out of the 200 identified that quantitatively reported on neurobehavioral function of children after maternal opioid use during pregnancy. All 5 were case control studies with the number of exposed subjects within the studies ranging from 33–143 and 45–85 for the controls. This meta-analysis showed no significant impairments, at a non-conservative significance level of p < 0.05, for cognitive, psychomotor or observed behavioural outcomes for chronic intra-uterine exposed infants and pre-school children compared to non-exposed infants and children. However, all domains suggested a trend to poor outcomes in infants/children of opioid using mothers. The magnitude of all possible effects was small according to Cohen’s benchmark criteria. Chronic intra-uterine opioid exposed infants and pre-school children experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers, although in all domains there was a trend to poorer outcomes. The findings of this review are limited by the small number of studies analysed, the heterogenous populations and small numbers within the individual studies. Longitudinal studies are needed to determine if any neuropsychological impairments appear after the age of 5 years and to help investigate further the role of environmental risk factors on the effect of ‘core’ phenotypes.