Sarkar S, Donn S M
1The Department of Pediatrics, Division of Neonatal-Perinatal Medicine, C.S. Mott, Children's Hospital, University of Michigan Health System, Ann Arbor, MI 48109-0254, USA.
J Perinatol. 2006 Jan 1;26(1):15-7. doi: 10.1038/sj.jp.7211427.
To determine the monitoring and treatment of neonatal abstinence syndrome (NAS) in neonatal intensive care units (NICUs) following opiate or polydrug exposure in utero.
A pretested questionnaire was distributed via email to the chiefs of the neonatology divisions with accredited Fellowship programs in Neonatal-Perinatal Medicine in the United States.
Of the 102 individuals contacted, 75 participated in the survey. In all, 41 of the respondents (54.5%) have a written policy regarding the management of neonatal NAS. The method of Finnegan is the most commonly used abstinence scoring system (49 of 75, 65%), while only three respondents use the Lipsitz tool. Opioids (tincture of opium, or morphine sulfate solution) are used most commonly for management of both opioid (63% of respondents) and polydrug (52% of respondents) withdrawal, followed by phenobarbital (32 % of respondents) for polydrug withdrawal and methadone (20% of respondents) for opioid withdrawal. In all, 53 respondents (70%) use phenobarbital, and 19 (25%) use intravenous morphine to control opioid withdrawal seizures, while 61 (81%) use phenobarbital in cases of polydrug withdrawal seizures. Only 53 respondents (70%) always use an abstinence scoring system to determine when to start, titrate, or terminate pharmacologic treatment of neonatal NAS.
The management of neonatal psychomotor behavior consistent with withdrawal varies widely, with inconsistent policies to determine its presence or treatment. Only about half of NICUs have written guidelines for the management of NAS, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice.
确定新生儿重症监护病房（NICU）中，胎儿在子宫内接触阿片类药物或多种药物后新生儿戒断综合征（NAS）的监测与治疗情况。
通过电子邮件向美国新生儿 - 围产医学认可 fellowship 项目的新生儿科主任发放一份预先测试过的问卷。
在联系的102人中，75人参与了调查。总共有41名受访者（54.5%）制定了关于新生儿NAS管理的书面政策。芬尼根方法是最常用的戒断评分系统（75人中的49人，65%），而只有三名受访者使用利普希茨工具。阿片类药物（鸦片酊或硫酸吗啡溶液）最常用于阿片类药物（63%的受访者）和多种药物（52%的受访者）戒断的管理，其次是苯巴比妥（32%的受访者）用于多种药物戒断，美沙酮（20%的受访者）用于阿片类药物戒断。总共有53名受访者（70%）使用苯巴比妥，19名（25%）使用静脉注射吗啡来控制阿片类药物戒断性癫痫发作，而61名（81%）在多种药物戒断性癫痫发作时使用苯巴比妥。只有53名受访者（70%）始终使用戒断评分系统来确定何时开始、调整或终止新生儿NAS的药物治疗。
与戒断相符的新生儿精神运动行为管理差异很大，确定其存在或治疗的政策不一致。只有约一半的NICU有NAS管理的书面指南，这可能妨碍对这种做法进行有效的审核。可能需要进行教育干预以确保临床实践的改变。
