Osborn David A, Jeffery Heather E, Cole Michael J
Department of Mothers and Babies NICU, Royal Prince Alfred Hospital, John Hopkins Drive, Camperdown, NSW, Australia, 2005.
Cochrane Database Syst Rev. 2010 Oct 6(10):CD002059. doi: 10.1002/14651858.CD002059.pub3.
Neonatal abstinence syndrome (NAS) due to opiate withdrawal may result in disruption of the mother-infant relationship, sleep-wake abnormalities, feeding difficulties, weight loss and seizures.
To assess the effectiveness and safety of using an opiate compared to a sedative or non-pharmacological treatment for treatment of NAS due to withdrawal from opiates.
The review was updated in 2010 with additional searches CENTRAL, MEDLINE and EMBASE supplemented by searches of conference abstracts and citation lists of published articles.
Randomized or quasi-randomized controlled trials of opiate treatment in infants with NAS born to mothers with opiate dependence.
Each author assessed study quality and extracted data independently.
Nine studies enrolling 645 infants met inclusion criteria. There were substantial methodological concerns in all studies comparing an opiate with a sedative. Two small studies comparing different opiates were of good methodology.Opiate (morphine) versus supportive care (one study): A reduction in time to regain birth weight and duration of supportive care and a significant increase in hospital stay was noted.Opiate versus phenobarbitone (four studies): Meta-analysis found no significant difference in treatment failure. One study reported opiate treatment resulted in a significant reduction in treatment failure in infants of mothers using only opiates. One study reported a significant reduction in days treatment and admission to the nursery for infants receiving morphine. One study reported a reduction in seizures, of borderline statistical significance, with the use of opiate.Opiate versus diazepam (two studies): Meta-analysis found a significant reduction in treatment failure with the use of opiate.Different opiates (six studies): there is insufficient data to determine safety or efficacy of any specific opiate compared to another opiate.
AUTHORS' CONCLUSIONS: Opiates compared to supportive care may reduce time to regain birth weight and duration of supportive care but increase duration of hospital stay. When compared to phenobarbitone, opiates may reduce the incidence of seizures but there is no evidence of effect on treatment failure. One study reported a reduction in duration of treatment and nursery admission for infants on morphine. Compared to diazepam, opiates reduce the incidence of treatment failure. A post-hoc analysis generates the hypothesis that initial opiate treatment may be restricted to infants of mothers who used opiates only. In view of the methodologic limitations of the included studies the conclusions of this review should be treated with caution.
阿片类药物戒断所致新生儿戒断综合征（NAS）可能导致母婴关系破裂、睡眠 - 觉醒异常、喂养困难、体重减轻和癫痫发作。
评估与镇静剂或非药物治疗相比，使用阿片类药物治疗阿片类药物戒断所致NAS的有效性和安全性。
该综述于2010年更新，额外检索了Cochrane系统评价数据库（CENTRAL）、医学索引数据库（MEDLINE）和荷兰医学文摘数据库（EMBASE），并辅以会议摘要检索和已发表文章的参考文献列表检索。
对母亲有阿片类药物依赖的NAS婴儿进行阿片类药物治疗的随机或半随机对照试验。
每位作者独立评估研究质量并提取数据。
9项纳入645名婴儿的研究符合纳入标准。在所有比较阿片类药物与镇静剂的研究中，均存在重大方法学问题。两项比较不同阿片类药物的小型研究方法学良好。阿片类药物（吗啡）与支持性护理（一项研究）：观察到恢复出生体重的时间和支持性护理的持续时间缩短，住院时间显著延长。阿片类药物与苯巴比妥（四项研究）：荟萃分析发现治疗失败率无显著差异。一项研究报告阿片类药物治疗使仅使用阿片类药物的母亲所生婴儿的治疗失败率显著降低。一项研究报告接受吗啡治疗的婴儿的治疗天数和入住新生儿重症监护室的天数显著减少。一项研究报告使用阿片类药物可使癫痫发作减少，具有临界统计学意义。阿片类药物与地西泮（两项研究）：荟萃分析发现使用阿片类药物可显著降低治疗失败率。不同阿片类药物（六项研究）：与另一种阿片类药物相比，尚无足够数据确定任何特定阿片类药物的安全性或有效性。
与支持性护理相比，阿片类药物可能会缩短恢复出生体重的时间和支持性护理的持续时间，但会延长住院时间。与苯巴比妥相比，阿片类药物可能会降低癫痫发作的发生率，但没有证据表明对治疗失败有影响。一项研究报告使用吗啡的婴儿治疗时间和入住新生儿重症监护室的时间缩短。与地西泮相比，阿片类药物可降低治疗失败的发生率。一项事后分析提出假设，初始阿片类药物治疗可能仅限于母亲仅使用阿片类药物的婴儿。鉴于纳入研究的方法学局限性，本综述的结论应谨慎对待。
