Charles M Katherine, Cooper William O, Jansson Lauren M, Dudley Judith, Slaughter James C, Patrick Stephen W
Vanderbilt University School of Medicine, Nashville, Tennessee.
Departments of Pediatrics.
Hosp Pediatr. 2017 Jun;7(6):328-334. doi: 10.1542/hpeds.2016-0218. Epub 2017 May 2.
Neonatal abstinence syndrome (NAS) is a postnatal opioid withdrawal syndrome. Factors associated with development of the syndrome are poorly understood; however, infant sex may influence the risk of NAS. Our objective was to determine if infant sex was associated with the development or severity of the syndrome in a large population-based cohort.
This retrospective cohort study used vital statistics and prescription, outpatient, and inpatient administrative data for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. Multivariable logistic regression models were used to evaluate the association between male sex and diagnosis of NAS, accounting for potential demographic and clinical confounders. NAS severity, as evidenced by hospital length of stay, was modeled by using negative binomial regression.
Of 102 695 infants, 927 infants were diagnosed with NAS (484 male subjects and 443 female subjects). Adjustments were made for the following: maternal age, race, and education; maternal hepatitis C infection, anxiety, or depression; in utero exposure to selective serotonin reuptake inhibitors and cigarettes; infant birth weight, small for gestational age, and year; and the interaction between opioid type and opioid amount. Male infants were more likely than female infants to be diagnosed with NAS (adjusted odds ratio, 1.18 [95% confidence interval, 1.05-1.33]) and NAS requiring treatment (adjusted odds ratio, 1.24 [95% confidence interval, 1.04-1.47]). However, there was no sex-based difference in severity for those diagnosed with NAS.
Treatment of NAS should be tailored to an infant's individual risk for the syndrome. Clinicians should be mindful that male sex is an important risk factor in the diagnosis of NAS.
新生儿戒断综合征（NAS）是一种出生后的阿片类药物戒断综合征。与该综合征发生相关的因素尚不清楚；然而，婴儿性别可能会影响NAS的风险。我们的目的是确定在一个大型的基于人群的队列中，婴儿性别是否与该综合征的发生或严重程度相关。
这项回顾性队列研究使用了2009年至2011年期间参加田纳西医疗补助计划的母亲和婴儿的生命统计数据以及处方、门诊和住院管理数据。多变量逻辑回归模型用于评估男性性别与NAS诊断之间的关联，同时考虑潜在的人口统计学和临床混杂因素。以住院时间为证据的NAS严重程度采用负二项回归进行建模。
在102695名婴儿中，927名婴儿被诊断为NAS（484名男性和443名女性）。对以下因素进行了调整：母亲年龄、种族和教育程度；母亲丙型肝炎感染、焦虑或抑郁；子宫内接触选择性5-羟色胺再摄取抑制剂和香烟；婴儿出生体重、小于胎龄和年份；以及阿片类药物类型与阿片类药物剂量之间的相互作用。男婴比女婴更有可能被诊断为NAS（调整后的优势比，1.18[95%置信区间，1.05-1.33]）以及需要治疗的NAS（调整后的优势比，1.24[95%置信区间，1.04-1.47]）。然而，对于被诊断为NAS的患者，严重程度没有基于性别的差异。
NAS的治疗应根据婴儿患该综合征的个体风险进行调整。临床医生应注意，男性性别是NAS诊断中的一个重要风险因素。
