Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA 19104, USA.
J Perinatol. 2011 Nov;31(11):692-701. doi: 10.1038/jp.2011.116. Epub 2011 Aug 25.
Although a statement on Neonatal Drug Withdrawal was published in 1998 by the American Academy of Pediatrics, pharmacologic management of neonatal abstinence syndrome (NAS) remains a challenge. Published clinical trials are limited, restricting treatment decision making to practitioner's experience and preference rather than evidence-based medicine. To optimize withdrawal symptom prevention, drug selection is often based on the offending agent (opioids versus polysubstance exposure), clinical presentation, mechanism of action (agonist versus partial agonist/antagonist, receptor effects), pharmacokinetic parameters and available drug formulations. This review addresses risk factors and pathophysiology of NAS, summarizes parameters of common drugs used for the management of NAS, and reviews published literature of standard therapies as well as newer agents. Based on the current literature, paregoric is no longer recommended and oral morphine solutions remain the mainstay of therapy for opiate withdrawal. Other potential therapies include methadone, buprenorphine, phenobarbital and clonidine with the latter two agents as adjunctive therapies.
虽然美国儿科学会在 1998 年发表了一篇关于新生儿戒断药物的声明，但新生儿戒断综合征（NAS）的药物治疗仍然是一个挑战。已发表的临床试验有限，这使得治疗决策只能基于医生的经验和偏好，而不是基于循证医学。为了优化戒断症状的预防，药物选择通常基于引起戒断的药物（阿片类药物与多药物暴露）、临床表现、作用机制（激动剂与部分激动剂/拮抗剂、受体效应）、药代动力学参数和可用的药物制剂。本综述介绍了 NAS 的风险因素和病理生理学，总结了用于 NAS 管理的常见药物的参数，并回顾了标准治疗方法和新药物的已发表文献。基于目前的文献，不再推荐使用颠茄酊，口服吗啡溶液仍然是阿片类药物戒断的主要治疗方法。其他潜在的治疗方法包括美沙酮、丁丙诺啡、苯巴比妥和可乐定，后两种药物作为辅助治疗。
