Yuan Q, Rubic M, Seah J, Rae C, Wright I M R, Kaltenbach K, Feller J M, Abdel-Latif M E, Chu C, Oei J L
School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia.
J Perinatol. 2014 Dec;34(12):909-13. doi: 10.1038/jp.2014.111. Epub 2014 Jun 19.
A substantial number of children exposed to gestational opioids have neurodevelopmental, behavioral and cognitive problems. Opioids are not neuroteratogens but whether they affect the developing brain in more subtle ways (for example, volume loss) is unclear. We aimed to determine the feasibility of using magnetic resonance imaging (MRI) to assess volumetric changes in healthy opioid-exposed infants.
Observational pilot cohort study conducted in two maternity hospitals in New South Wales, Australia. Maternal history and neonatal urine and meconium screens were obtained to confirm drug exposure. Volumetric analysis of MRI scans was performed with the ITK-snap program.
Scans for 16 infants (mean (s.d.) gestational age: 40.9 (1.5) weeks, birth weight: 3022.5 (476.6) g, head circumference (HC): 33.7 (1.5 cm)) were analyzed. Six (37.5%) infants had HC <25th percentile. Fourteen mothers used methadone, four used buprenorphine and 11 used more than one opioid (including heroin, seven). All scans were structurally normal whole brain volumes (357.4 (63.8)) and basal ganglia (14.5 (3.5)) ml were significantly smaller than population means (425.4 (4.8), 17.1 (4.4) ml, respectively) but lateral ventricular volumes (3.5 (1.8) ml) were larger than population values (2.1(1.5)) ml.
Our pilot study suggests that brain volumes of opioid-exposed babies may be smaller than population means and that specific regions, for example, basal ganglia, that are involved in neurotransmission, may be particularly affected. Larger studies including correlation with neurodevelopmental outcomes are warranted to substantiate this finding.
大量暴露于孕期阿片类药物的儿童存在神经发育、行为和认知问题。阿片类药物并非神经致畸剂，但它们是否以更微妙的方式影响发育中的大脑（例如，体积减小）尚不清楚。我们旨在确定使用磁共振成像（MRI）评估健康的阿片类药物暴露婴儿体积变化的可行性。
在澳大利亚新南威尔士州的两家妇产医院进行的观察性试点队列研究。获取产妇病史以及新生儿尿液和胎粪筛查结果以确认药物暴露情况。使用ITK-snap程序对MRI扫描进行体积分析。
分析了16名婴儿的扫描结果（平均（标准差）胎龄：40.9（1.5）周，出生体重：3022.5（476.6）克，头围（HC）：33.7（1.5厘米））。6名（37.5%）婴儿的头围低于第25百分位数。14名母亲使用美沙酮，4名使用丁丙诺啡，11名使用不止一种阿片类药物（包括7名使用海洛因的母亲）。所有扫描的全脑结构均正常，但全脑体积（357.4（63.8））和基底神经节体积（14.5（3.5））毫升均显著小于总体均值（分别为425.4（4.8）、17.1（4.4）毫升），而侧脑室体积（3.5（1.8）毫升）大于总体值（2.1（1.5）毫升）。
我们的试点研究表明，暴露于阿片类药物的婴儿脑体积可能小于总体均值，并且参与神经传递的特定区域，例如基底神经节，可能受到特别影响。需要开展更大规模的研究，包括与神经发育结局的相关性研究，以证实这一发现。
