Rohrmeister K, Bernert G, Langer M, Fischer G, Weninger M, Pollak A
Universitätsklinik für Kinder- und Jugendheilkunde Wien: Klinische Abteilung für Neonatologie und Intensivmedizin, Germany.
Z Geburtshilfe Neonatol. 2001 Nov-Dec;205(6):224-30. doi: 10.1055/s-2001-19054.
To evaluate the outcome of infants of drug dependent mothers (IDM) after establishing an interdisciplinary attention concept at the University Hospital in Vienna. To compare the influence of different maintenance agents on neonatal morbidity.
All newborns of opiate dependent mothers were prospectively included from III 1995 to IX 1999. The following data were collected: maintenance agent (methadone, slow release morphine, buprenorphine), infectious status, demographic data, congenital malformations, perinatal complications, as well as incidence and duration of the neonatal abstinence syndrome (NAS). Medical treatment with phenobarbital (1995 - 96) or morphine hydrochloride (MoHCl) (1997 - 99), respectively, was indicated when Finnegan score exceeded 10.
88 neonates (38 females/50 males) with a median gestational age of 39 weeks were included, 18 (20.5 %) were born prematurely. The median birthweight was 2905 g, 24 (27.3 %) infants were small for date (< 10th percentile), 15 (17 %) microcephalic. The malformation incidence was 7.4 %. 63 (72 %) of all newborns had to be treated due to abstinence syndrome: in the methadone group 76 %, in the morphine group 93 %, but in the buprenorphine group 19 % only (p < 0.01). Median duration of withdrawal was 15.1 days (d) with significant difference after antenatal buprenorphine exposure compared to methadone and morphine exposure (8.3 d versus 15 d and 16.5 d respectively). In neonates treated with phenobarbital duration of NAS was 17.6 d, whereas NAS in infants with MoHCl therapy lasted 12.8 d (p < 0.05).
Incidence and duration of NAS after buprenorphine exposure was significantly lower than after methadone and morphine exposure. Withdrawal time under morphin-hydrochloride therapy was reduced by one third compared to treatment with phenobarbital.
在维也纳大学医院建立多学科关注概念后，评估药物依赖母亲的婴儿（IDM）的结局。比较不同维持药物对新生儿发病率的影响。
前瞻性纳入1995年3月至1999年9月所有阿片类药物依赖母亲的新生儿。收集以下数据：维持药物（美沙酮、缓释吗啡、丁丙诺啡）、感染状况、人口统计学数据、先天性畸形、围产期并发症以及新生儿戒断综合征（NAS）的发生率和持续时间。当芬尼根评分超过10分时，分别给予苯巴比妥（1995 - 1996年）或盐酸吗啡（MoHCl）（1997 - 1999年）进行药物治疗。
纳入88例新生儿（38例女性/50例男性），中位胎龄为39周，18例（20.5%）早产。中位出生体重为2905g，24例（27.3%）婴儿小于胎龄（<第10百分位数），15例（17%）小头畸形。畸形发生率为7.4%。所有新生儿中有63例（72%）因戒断综合征需要治疗：美沙酮组为76%，吗啡组为93%，但丁丙诺啡组仅为19%（p<0.01）。戒断的中位持续时间为15.1天（d），产前暴露于丁丙诺啡后的持续时间与暴露于美沙酮和吗啡后的相比有显著差异（分别为与15天和16.5天相比为8.3天）。接受苯巴比妥治疗的新生儿NAS持续时间为17.6天，而接受MoHCl治疗的婴儿NAS持续时间为持续12.8天（p<0.05）。
丁丙诺啡暴露后NAS的发生率和持续时间显著低于美沙酮和吗啡暴露后。与苯巴比妥治疗相比，盐酸吗啡治疗下的戒断时间缩短了三分之一。
