Barr Gordon A, McPhie-Lalmansingh Anika, Perez Jessica, Riley Michelle
ILAR J. 2011;52(3):329-41. doi: 10.1093/ilar.52.3.329.
Human infants may be exposed to opiates through placental transfer from an opiate-using mother or through the direct administration of such drugs to relieve pain (e.g., due to illness or neonatal surgery). Infants of many species show physical dependence and tolerance to opiates. The magnitude of tolerance and the nature of withdrawal differ from those of the adult. Moreover, the mechanisms that contribute to the chronic effects of opiates are not well understood in the infant but include biological processes that are both common to and distinct from those of the adult. We review the animal research literature on the effects of chronic and acute opiate exposure in infants and identify mechanisms of withdrawal and tolerance that are similar to and different from those understood in adults. These mechanisms include opioid pharmacology, underlying neural substrates, and the involvement of other neurotransmitter systems. It appears that brain circuitry and opioid receptor types are similar but that NMDA receptor function is immature in the infant. Intracellular signaling cascades may differ but data are complicated by differences between the effects of chronic versus acute morphine treatment. Given the limited treatment options for the dependent infant patient, further study of the biological functions that are altered by chronic opiate treatment is necessary to guide evidenced-based treatment modalities.
人类婴儿可能通过使用阿片类药物的母亲的胎盘转运接触阿片类药物，或者通过直接使用此类药物来缓解疼痛（例如，由于疾病或新生儿手术）。许多物种的婴儿对阿片类药物表现出身体依赖性和耐受性。耐受性的程度和戒断的性质与成年人不同。此外，导致阿片类药物慢性影响的机制在婴儿中尚未得到很好的理解，但包括与成年人共有的和不同的生物学过程。我们回顾了关于婴儿慢性和急性阿片类药物暴露影响的动物研究文献，并确定了与成年人理解的相似和不同的戒断和耐受机制。这些机制包括阿片类药物药理学、潜在的神经底物以及其他神经递质系统的参与。似乎脑回路和阿片受体类型相似，但婴儿中的NMDA受体功能不成熟。细胞内信号级联可能不同，但慢性与急性吗啡治疗效果之间的差异使数据变得复杂。鉴于依赖阿片类药物的婴儿患者的治疗选择有限，有必要进一步研究慢性阿片类药物治疗改变的生物学功能，以指导循证治疗模式。
