Mücke S, Nagel M, Siedentopf J, Bührer C, Hüseman D
Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
Department of Obstetrics, Charité University Medical Center, Berlin, Germany.
Klin Padiatr. 2017 Jan;229(1):32-39. doi: 10.1055/s-0042-115300. Epub 2016 Oct 10.
Infants exposed to opiates antenatally display withdrawal symptoms after birth referred to as neonatal abstinence syndrome (NAS).A total of 366 newborns (166 females, 10 twins) from 361 mothers were diagnosed with NAS from 2000 to 2011 at a single large metropolitan referral center.Retrospective chart review of all newborn infants exposed to opiates in utero.20% were premature (gestational age<37 weeks), 32% were small-for-gestational-age (<10 percentile). 70% of infants (195/278) antenatally exposed to methadone (racemic methadone or levomethadone) required pharmacological treatment for 11 (1-55) days (median; range); however, 45% of infants (28/62) exposed to buprenorphine required pharmacological treatment for a median of only 5 (1-20) days (p=0.014). Pharmacological treatment of infants with phenobarbital (n=189) took a median of 9 (1-53) days, but treatment with morphine (n=39) took 19 (3-55) days (p<0.001). The median duration of hospitalization increased from 11 days in 2000-2004 to 19 days in 2008-2011 (p<0.001). The increased durations of neonatal hospitalization were associated with similar increases in the average dosages of maternal methadone.Use of buprenorphine, rather than methadone, for treatment of opiate-addicted pregnant women is associated with fewer and shorter neonatal withdrawal symptoms. The duration of hospitalization and treatment for NAS has increased over time.
产前接触阿片类药物的婴儿在出生后会出现戒断症状，称为新生儿戒断综合征（NAS）。2000年至2011年期间，在一个大型都市转诊中心，共361名母亲所生的366名新生儿（166名女性，10对双胞胎）被诊断为NAS。对所有子宫内接触阿片类药物的新生儿进行回顾性病历审查。20%为早产儿（胎龄<37周），32%为小于胎龄儿（<第10百分位数）。70%产前接触美沙酮（消旋美沙酮或左美沙酮）的婴儿（195/278）需要进行11（1 - 55）天（中位数；范围）的药物治疗；然而，45%接触丁丙诺啡的婴儿（28/62）仅需要中位数为5（1 - 20）天的药物治疗（p = 0.014）。用苯巴比妥治疗的婴儿（n = 189）中位数为9（1 - 53）天，但用吗啡治疗的婴儿（n = 39）需要19（3 - 55）天（p<0.001）。住院时间中位数从2000 - 2004年的11天增加到2008 - 2011年的19天（p<0.001）。新生儿住院时间的增加与母亲美沙酮平均剂量的类似增加相关。使用丁丙诺啡而非美沙酮治疗阿片类药物成瘾的孕妇，与新生儿戒断症状更少、持续时间更短相关。随着时间的推移，NAS的住院和治疗时间有所增加。
