Project 4: Neonatal Abstinence Syndrome (NAS): Fetus to First Years

项目总结 阿片类药物使用障碍是一个流行比例的公共卫生问题。我们的项目将做出重大贡献 关于阿片类药物和过量的科布雷中心，因为在怀孕期间滥用阿片类药物会影响婴儿，我们的 最脆弱的人群。该项目的重点是新生儿禁欲综合症(NAS)，即戒断 婴儿在母亲依赖阿片类药物的情况下出生后会遭受痛苦。自那以来，NAS已经增长了五倍 2000年，目前有60%-80%的婴儿在子宫内接触阿片类药物。2012年治疗NAS的成本为15亿美元 大多数婴儿都参加了国家资助的保险计划。NAS通常由 再次注射阿片类药物(吗啡或美沙酮，最近是丁丙诺啡)，然后逐步 断奶，并越来越多地采用非药物干预措施(如寄宿)。不幸的是， 治疗不是以证据为基础的，也没有标准化的方案，导致在 对这些婴儿的管理以及管理不善的可能性。这项提议的总体目标是 开发定义最佳实践所需的基于证据的工具，并开发标准化方法来 加强对NAS患儿的治疗和管理。我们的中心假设是建立一个 母亲阿片类药物依赖的标准化围产期至产后治疗方案和管理 NAS将缩短住院时间和治疗时间，降低医疗成本，并预防或减轻 潜在的不利的长期神经发育结果。在这个项目中，我们建议1)开发一个多 接受阿片类药物治疗的孕妇的纪律、丁丙诺啡产前护理模式 精神障碍，2)进行丁丙诺啡与吗啡治疗NAS的单中心随机对照试验，以及3) 使用分类和回归开发初步风险分层安全评估工具(RSSA) 树(CART)统计决策分析，帮助确定哪些家庭面临最大的用药风险 不合规。通过量身定做产前治疗，消除新干预措施和工作的障碍 通过与这些核心的协同作用，我们将改变我们目前的方法，即NAS的治疗和管理。

PROJECT SUMMARY Opioid use disorders are a public health concern of epidemic proportion. Our project will contribute significantly to this COBRE Center on Opioids and Overdose, as misuse of opioids during pregnancy effects infants, our most vulnerable population. The focus of this project is on Neonatal Abstinence Syndrome (NAS), the withdrawal that infants suffer after being born to a mother who is dependent on opioids. NAS has increased fivefold since 2000, now affecting 60-80% of infants exposed to opioids in utero. The cost to treat NAS in 2012 was $1.5 billion with the majority of infants enrolled in state sponsored insurance programs. NAS is typically treated by the reintroduction of opioids (morphine or methadone and more recently, buprenorphine) followed by gradual weaning and increasingly with non-pharmacological interventions as well (e.g. rooming-in). Unfortunately, treatments are not evidence-based and there are no standardized protocols resulting in a wide variability in the management of these infants and the potential for mismanagement. The overall objective of this proposal is to develop the evidence based tools needed to define best practice and develop a standardized approach to improve the treatment and management of infants with NAS. Our central hypothesis is that establishment of a standardized perinatal to postnatal treatment program for maternal opioid dependency and the management of NAS will shorten length of stay and length of treatment, reduce health care costs, and prevent or mitigate potential adverse long term neurodevelopmental outcomes. In this project we propose to 1) develop a multi- disciplinary, buprenorphine-based prenatal care model for pregnant women being treated for opioid use disorders, 2) conduct a single center randomized control trial of buprenorphine vs. morphine for NAS, and 3) develop a preliminary Risk Stratification Safety Assessment tool (RSSA), using Classification and Regression Tree (CART) statistical decision making analysis to help determine which families are most at risk of medication noncompliance. By tailoring treatment prenatally and removing barriers to novel interventions and working synergistically with the Cores we will transform our current approach the treatment and management of NAS.