Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Family Birthing Center, Mercy Anderson Hospital, Cincinnati, OH.
Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Family Birthing Center, Mercy Anderson Hospital, Cincinnati, OH.
J Pediatr. 2015 Mar;166(3):582-6. doi: 10.1016/j.jpeds.2014.10.004. Epub 2014 Nov 12.
To evaluate the efficacy of a universal maternal drug testing protocol for all mothers in a community hospital setting that experienced a 3-fold increase in neonatal abstinence syndrome (NAS) over the previous 5 years.
We conducted a retrospective cohort study between May 2012 and November 2013 after the implementation of universal maternal urine drug testing. All subjects with positive urine tests were reviewed to identify a history or suspicion of drug use, insufficient prenatal care, placental abruption, sexually transmitted disease, or admission from a justice center, which would have prompted urine testing using our previous risk-based screening guidelines. We also reviewed the records of infants born to mothers with a positive toxicology for opioids to determine whether admission to the special care nursery was required.
Out of the 2956 maternal specimens, 159 (5.4%) positive results were recorded. Of these, 96 were positive for opioids, representing 3.2% of all maternity admissions. Nineteen of the 96 (20%) opioid-positive urine tests were recorded in mothers without screening risk factors. Seven of these 19 infants (37%) required admission to the special care nursery for worsening signs of NAS, and 1 of these 7 required pharmacologic treatment.
Universal maternal drug testing improves the identification of infants at risk for the development of NAS. Traditional screening methods underestimate in utero opioid exposure.
评估在社区医院环境中对所有产妇进行普遍药物检测方案的效果，该医院在过去 5 年中新生儿戒断综合征（NAS）的发病率增加了 3 倍。
在实施普遍产妇尿液药物检测后，我们于 2012 年 5 月至 2013 年 11 月进行了回顾性队列研究。对所有尿液检测呈阳性的受试者进行了回顾性审查，以确定药物使用史或可疑情况、产前护理不足、胎盘早剥、性传播疾病或从司法中心入院，这将促使我们使用以前的基于风险的筛查指南进行尿液检测。我们还审查了母亲尿液毒物检测呈阳性的婴儿的记录，以确定是否需要入住特殊护理新生儿病房。
在 2956 份产妇标本中，记录了 159 份（5.4%）阳性结果。其中，96 份为阿片类药物阳性，占所有产妇入院人数的 3.2%。19 份阿片类药物阳性尿液检测记录在没有筛查风险因素的母亲中。这 19 名婴儿中有 7 名（37%）因 NAS 恶化迹象需要入住特殊护理新生儿病房，其中 1 名需要药物治疗。
普遍的产妇药物检测可提高对有 NAS 发展风险的婴儿的识别能力。传统的筛查方法低估了胎儿期阿片类药物暴露的情况。
