Vital Signs In Opioid-Exposed Neonates

项目摘要 怀孕期间使用阿片类药物的比例达到流行病的比例。婴儿暴露于阿片类药物之前 新生儿经常出现阿片类药物戒断综合征（NOWS）， 婴儿猝死综合症（SIDS）。一个主要的知识差距是，目前无法确定 暴露于阿片类药物的婴儿中NOWS或SIDS风险的大小。大多数产前暴露于阿片类药物的婴儿 出生后在医院观察几天，以确定婴儿是否发展为NOWS。的婴儿 开发NOWS经常使用复杂和主观的Finnegan评分系统进行管理。 因此，需要对类阿片戒断症状进行快速、客观和定量的测量。 目前迫切需要确定NOWS的住院过程或呼吸控制异常是否可以 出生后不久就可以预测，以便早期监测或治疗。此外，必须 能够以更加循证的方式调整治疗。 阿片类药物暴露新生儿生命体征（Vision）项目的总体目标是使用 心肺动力学（心率、呼吸率和氧饱和度的特征和模式） 出生后不久，从现有的阿片类药物暴露的新生儿（>140/年）的大学 在伯明翰的亚拉巴马开发和验证数学模型，以预测（a）NOWS的发生，（B） 通过Finnegan评分估计的NOWS幅度变化，以及（c）异常多导睡眠图 （睡眠）研究在三个月大。这项拟议研究的中心假设是， 动态改善NOWS发作和严重程度的检测，并可预测婴儿睡眠障碍 出院前呼吸具体目标是： 具体目标1：检验出生后不久的心肺动力学识别阿片类药物暴露的假设 新生儿阿片类药物戒断综合征的风险较高。这一假设将在一个 200名阿片类药物暴露的新生儿和100名健康对照婴儿的前瞻性队列。 具体目标2：检验诊断为新生儿心脏病的婴儿的心肺动力学 阿片类戒断综合征与Finnegan评分的临床评估进行时间跟踪。这 将在100名诊断为新生儿阿片类药物的新生儿的前瞻性队列中检验这一假设 戒断综合征 具体目标3：检验出生后不久发生的间歇性低氧血症和心动过缓事件是 与三个月龄时多导睡眠图研究的呼吸暂停低通气指数相关。这一假设 将在60名诊断为NOWS的新生儿、60名阿片类药物暴露婴儿的前瞻性队列中进行测试。 无NOWS组和60名健康对照组婴儿。

Project Summary Rates of opioid use during pregnancy are at epidemic proportions. Infants exposed to opioids before birth frequently develop neonatal opioid withdrawal syndrome (NOWS) and are at a much higher risk of sudden infant death syndrome (SIDS). A major knowledge gap is that it not currently possible to determine the magnitude of NOWS or SIDS risk in opioid-exposed infants. Most infants with antenatal opioid exposure are observed for several days after birth in the hospital to determine if the infant develops NOWS. Infants who develop NOWS are frequently managed using the Finnegan scoring system which is complex and subjective. There is therefore a need for rapid objective and quantitative measurement of signs of opioid withdrawal. There is a critical need to determine if the hospital course of NOWS or abnormalities in respiratory control can be predicted soon after birth, in order to initiate earlier monitoring or therapy. Furthermore, it is essential to be able to adjust therapy in a more evidence-based manner. The overall objective of the Vital Signs In Opioid-exposed Neonates (ViSION) project is to use cardiorespiratory dynamics (characteristics and patterns of heart rate, respiratory rate, and oxygen saturations) soon after birth from the existing large cohort of opioid-exposed newborns (>140/yr) at the University of Alabama at Birmingham to develop and validate mathematical models to predict (a) onset of NOWS, (b) changes in magnitude of NOWS as estimated by Finnegan scoring, and (c) abnormal polysomnographic (sleep) study at three months of age. The central hypothesis of this proposed study is that cardiorespiratory dynamics improve detection of NOWS onset and severity, and can predict infants with sleep disordered breathing before discharge. The Specific Aims are: Specific Aim 1: Test the hypothesis that cardiorespiratory dynamics soon after birth identify opioid-exposed neonates at higher risk of neonatal opioid withdrawal syndrome. This hypothesis will be tested in a prospective cohort of 200 opioid-exposed newborn infants and 100 healthy control infants. Specific Aim 2: Test the hypothesis that cardiorespiratory dynamics of infants diagnosed with neonatal opioid withdrawal syndrome track temporally with clinical assessment by the Finnegan scoring. This hypothesis will be tested in a prospective cohort of 100 newborn infants diagnosed with neonatal opioid withdrawal syndrome. Specific Aim 3: Test the hypothesis that intermittent hypoxemia and bradycardia events soon after birth are associated with apnea-hypopnea index on polysomnographic studies at three months of age. This hypothesis will be tested in a prospective cohort of 60 newborn infants diagnosed with NOWS, 60 opioid-exposed infants without NOWS, and 60 healthy control infants.