Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
Curr Opin Pediatr. 2012 Apr;24(2):252-8. doi: 10.1097/MOP.0b013e32834fdc3a.
This review will discuss the complex nature of maternal and other factors that can affect the infant's display of neonatal abstinence syndrome (NAS), clinical presentation and treatment of NAS, and the impact of recent findings on future directions for research.
NAS has traditionally been described as a constellation of signs/symptoms displayed by the neonate upon withdrawal of gestational opioid exposure; however, recent research has advanced our understanding of this disorder. Other psychoactive substances, such as increasingly prescribed serotonin reuptake inhibitors, may produce an independent or synergistic discontinuation syndrome. The wide variability in NAS presentation has generated interest in the interplay of prenatal and postnatal environmental and genetic factors that may moderate or mediate its expression. Finally, recent advances in the treatment of opioid-dependent pregnant women have suggested buprenorphine as an alternative treatment to methadone during pregnancy, largely due to reduced NAS severity in exposed neonates.
Physicians should be aware of the complexity of the maternal, fetal, and infant factors that combine to create the infant's display of NAS, and incorporate these aspects into comprehensive assessment and care of the dyad. Further research regarding the pathophysiology and treatment of NAS is warranted.
本文将讨论影响婴儿出现新生儿戒断综合征（NAS）、临床特征和治疗的母体和其他因素的复杂性，以及近期研究结果对未来研究方向的影响。
NAS 通常被描述为胎儿在停止接触妊娠期间使用的阿片类药物时表现出的一系列体征/症状；然而，最近的研究加深了我们对这种疾病的理解。其他精神活性物质，如越来越多被开处的 5-羟色胺再摄取抑制剂，可能会产生独立或协同的停药综合征。NAS 表现的巨大差异引起了人们对产前和产后环境和遗传因素相互作用的兴趣，这些因素可能会调节或介导其表达。最后，阿片类药物依赖孕妇治疗方面的最新进展表明，丁丙诺啡可作为怀孕期间替代美沙酮的治疗方法，这主要是因为暴露的新生儿中 NAS 的严重程度降低。
医生应意识到母体、胎儿和婴儿因素的复杂性，这些因素共同导致婴儿出现 NAS，并将这些方面纳入对母婴二人的全面评估和护理中。NAS 的发病机制和治疗仍需要进一步研究。
