Raffaeli Genny, Cavallaro Giacomo, Allegaert Karel, Wildschut Enno Diederik, Fumagalli Monica, Agosti Massimo, Tibboel Dick, Mosca Fabio
NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
Pharmacotherapy. 2017 Jul;37(7):814-823. doi: 10.1002/phar.1954. Epub 2017 Jul 2.
Substance use among pregnant women is a major public health issue. Both prescription opioid use and illicit opioid abuse have increased dramatically in recent years. Prolonged in utero drug exposure may result in neonatal abstinence syndrome (NAS), an acute multisystemic clinical entity that occurs in the first days of life. This syndrome is caused by abrupt discontinuation of fetal exposure to licit or illicit drugs chronically consumed by the mother during pregnancy and transmitted to the fetus through the placenta. It usually requires prolonged hospitalization and may have long-term effects. The interplay of many factors contributes to its clinical heterogeneity, and its pathophysiology has not been fully unveiled. The first step in NAS management consists of nonpharmacologic interventions and includes promoting breastfeeding when not contraindicated. If withdrawal signs become severe, pharmacotherapy is needed. The Finnegan scoring system supports care providers across the pharmacotherapy process from initiation through the monitoring phase, until weaning and discontinuation. However, a standardized approach to pharmacotherapy is still lacking. Morphine is usually the first-line agent to treat NAS. Methadone is a valid option, but its safety profile is not completely known. Phenobarbital, despite its lack of effect on gastrointestinal symptoms and unfavorable pharmacologic features, has been identified as a second-line agent to be used in infants unresponsive to opiates. Although buprenorphine and clonidine seem promising, their use requires further validation. Long-term developmental effects of NAS therapy call for more-comprehensive, longitudinal assessments. In this article, key points for use of recommended therapies are outlined, and directions for future research are suggested.
孕妇使用药物是一个重大的公共卫生问题。近年来，处方阿片类药物的使用和非法阿片类药物的滥用都急剧增加。子宫内长期药物暴露可能导致新生儿戒断综合征（NAS），这是一种在生命最初几天出现的急性多系统临床病症。这种综合征是由于胎儿突然停止接触母亲在怀孕期间长期服用并通过胎盘传递给胎儿的合法或非法药物所致。它通常需要长期住院治疗，并且可能产生长期影响。许多因素的相互作用导致了其临床异质性，其病理生理学尚未完全阐明。NAS管理的第一步包括非药物干预，在无禁忌证时促进母乳喂养。如果戒断症状变得严重，则需要药物治疗。芬尼根评分系统在从开始到监测阶段、直至断奶和停药的整个药物治疗过程中为护理人员提供支持。然而，仍然缺乏标准化的药物治疗方法。吗啡通常是治疗NAS的一线药物。美沙酮是一种有效的选择，但其安全性尚未完全明确。苯巴比妥尽管对胃肠道症状无效且药理特性不佳，但已被确定为对阿片类药物无反应的婴儿的二线用药。尽管丁丙诺啡和可乐定似乎很有前景，但它们的使用需要进一步验证。NAS治疗的长期发育影响需要更全面的纵向评估。本文概述了推荐疗法的使用要点，并提出了未来研究的方向。
