Lewis Tamorah, Erfe Betty Luan, Ezell Tarrah, Gauda Estelle
Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
J Opioid Manag. 2015 Jul-Aug;11(4):305-12. doi: 10.5055/jom.2015.0279.
Neonatal intensive care unit (ICU) care involves use of opiates to treat postoperative, ventilated, or chronically ill infants. Opiates provide necessary analgesia and sedation, but the morbidities include prolonged neonatal abstinence syndrome (NAS) and extended length of stay for dose tapering. Our objective was to quantify trends in opiate exposure in a tertiary care NICU. The authors hypothesize that medical opiate exposure and resultant ICU-acquired NAS would increase over time.
Retrospective cross-sectional cohort study.
Tertiary care NICU.
High-risk inborn infants admitted in fiscal years 2003-2004, 2007-2008, and 2010-2011.
Average cumulative morphine exposure (all opiate doses converted to morphine equivalents) per time epoch was compared in cohorts of clinically similar infants. Linear regression was used to assess the primary outcome, assessing changes in opiate exposure over time.
Sixty-three infants were included in the final analysis. The primary analysis assessing cumulative opiate exposure per infant showed an increase of 134 mg per time epoch (95% CI-12, 279 mg, p-value 0.071). There was a statistically significant increase in the percent of infants with a diagnosis of iatrogenic NAS, increasing from 9 to 35 to 50 percent (p-value 0.012).
新生儿重症监护病房（ICU）护理涉及使用阿片类药物治疗术后、使用呼吸机或患有慢性病的婴儿。阿片类药物可提供必要的镇痛和镇静作用，但会导致诸如新生儿戒断综合征（NAS）持续时间延长以及因逐渐减少剂量而导致住院时间延长等不良后果。我们的目的是量化三级护理新生儿重症监护病房中阿片类药物暴露的趋势。作者推测，随着时间的推移，医疗用阿片类药物暴露及由此导致的ICU获得性NAS将会增加。
回顾性横断面队列研究。
三级护理新生儿重症监护病房。
2003 - 2004财年、2007 - 2008财年和2010 - 2011财年收治的高危先天性婴儿。
比较临床相似婴儿队列中每个时间段的平均累积吗啡暴露量（所有阿片类药物剂量均换算为吗啡当量）。采用线性回归评估主要观察指标，即评估阿片类药物暴露随时间的变化。
最终分析纳入了63名婴儿。评估每名婴儿累积阿片类药物暴露的主要分析显示，每个时间段增加134毫克（95%可信区间为 - 12至279毫克，p值为0.071）。诊断为医源性NAS的婴儿百分比有统计学显著增加，从9%增至35%，再增至50%（p值为0.012）。
