Wiegand Samantha L, Stringer Elizabeth M, Stuebe Alison M, Jones Hendree, Seashore Carl, Thorp John
Departments of Obstetrics and Gynecology and Pediatrics, University of North Carolina School of Medicine, and the Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Obstet Gynecol. 2015 Feb;125(2):363-368. doi: 10.1097/AOG.0000000000000640.
To compare neonatal abstinence syndrome prevalence and characteristics among neonates born to women prescribed buprenorphine and naloxone compared with methadone during pregnancy.
Retrospective cohort analysis of mother-neonate dyads treated with either buprenorphine and naloxone or methadone during pregnancy. Primary neonatal outcomes included diagnosis of neonatal abstinence syndrome, neonatal abstinence syndrome peak scores, total amount of morphine used to treat neonatal abstinence syndrome (mg), and duration of treatment for neonatal abstinence syndrome (days). Secondary outcomes included head circumference, birth weight, length, preterm birth, neonatal intensive care unit admission, Apgar scores, and overall length of hospitalization.
From January 1, 2011, to November 30, 2013, we identified 62 mother-neonate dyads, 31 treated with methadone and 31 treated with buprenorphine and naloxone. Sixteen neonates (51.6%) in the methadone group were diagnosed with neonatal abstinence syndrome compared with eight (25.1%) in the buprenorphine and naloxone group (adjusted odds ratio 2.55, 95% confidence interval [CI] 1.31-4.98, P = .01). The buprenorphine and naloxone-exposed neonates had lower peak neonatal abstinence syndrome scores (9.0 ± 4.4 compared with 10.7 ± 3.7, multivariate-adjusted mean difference = -2.77, 95% CI -4.99 to -0.56, P = .02) and shorter overall hospitalization (5.6 ± 5.0 compared with 9.8 ± 7.4 days, multivariate-adjusted mean difference = -3.90, 95% CI, -7.13 to -0.67, P = .02). We found no other differences in primary or secondary outcomes.
In a cohort of pregnant patients treated with either methadone or buprenorphine and naloxone in pregnancy, newborns exposed to maternal buprenorphine and naloxone had less frequent neonatal abstinence syndrome. Additionally, neonates exposed to buprenorphine and naloxone had shorter overall hospitalization lengths.
比较孕期使用丁丙诺啡和纳洛酮的女性所分娩新生儿与使用美沙酮的女性所分娩新生儿的新生儿戒断综合征患病率及特征。
对孕期接受丁丙诺啡和纳洛酮或美沙酮治疗的母婴二元组进行回顾性队列分析。主要新生儿结局包括新生儿戒断综合征的诊断、新生儿戒断综合征峰值评分、用于治疗新生儿戒断综合征的吗啡总量（毫克）以及新生儿戒断综合征的治疗持续时间（天）。次要结局包括头围、出生体重、身长、早产、新生儿重症监护病房入院情况、阿氏评分以及住院总时长。
2011年1月1日至2013年11月30日，我们确定了62对母婴二元组，其中31对接受美沙酮治疗，31对接受丁丙诺啡和纳洛酮治疗。美沙酮组中有16名新生儿（51.6%）被诊断为新生儿戒断综合征，而丁丙诺啡和纳洛酮组为8名（25.1%）（调整后的优势比为2.55，95%置信区间[CI]为1.31 - 4.98，P = 0.01）。暴露于丁丙诺啡和纳洛酮的新生儿的新生儿戒断综合征峰值评分较低（分别为9.0±4.4和10.7±3.7，多变量调整后的平均差异 = -2.77，95% CI为 -4.99至 -0.56，P = 0.02），且住院总时长较短（分别为5.6±5.0天和9.8±7.4天，多变量调整后的平均差异 = -3.90，95% CI为 -7.13至 -0.67，P = 0.02）。我们在主要或次要结局中未发现其他差异。
在一组孕期接受美沙酮或丁丙诺啡和纳洛酮治疗的孕妇中，暴露于母体丁丙诺啡和纳洛酮的新生儿发生新生儿戒断综合征的频率较低。此外，暴露于丁丙诺啡和纳洛酮的新生儿的住院总时长较短。
