Department of Pediatrics.
Mildred Stahlman Division of Neonatology, Vanderbilt University.
Curr Opin Pediatr. 2018 Apr;30(2):182-186. doi: 10.1097/MOP.0000000000000589.
The current review provides an update focused on the evolving epidemiology of neonatal abstinence syndrome (NAS), factors influencing disease expression, advances in clinical assessment of withdrawal, novel approaches to NAS treatment, and the emerging role of quality improvement in assessment and management of NAS.
The rise in the incidence of NAS disproportionately occurred in rural and suburban areas. Polysubstance exposure and genetic polymorphisms have been shown to modify NAS expression and severity. New bedside assessments using a limited number of factors to identify infants with NAS result in fewer infants receiving pharmacotherapy. In addition, buprenorphine may be a promising therapeutic alternative to morphine to treat NAS. Lastly, local, state, and national quality improvement initiatives have emerged as an effective mechanism to advance the care of infants with NAS.
NAS remains a critical public health issue associated with significant medical, economic, and personal burdens. Emerging data on associated risk factors, assessment of and treatment for NAS provide clinicians and hospitals with new knowledge and an urgency to promote standardization of care for infants with NAS.
本综述聚焦于新生儿戒断综合征（NAS）的不断演变的流行病学、影响疾病表现的因素、撤药的临床评估进展、NAS 治疗的新方法，以及质量改进在 NAS 评估和管理中的新兴作用。
NAS 的发病率上升不成比例地发生在农村和郊区地区。多物质暴露和遗传多态性已被证明可改变 NAS 的表达和严重程度。使用少数几个因素进行床边评估以识别患有 NAS 的婴儿，从而减少了接受药物治疗的婴儿数量。此外，丁丙诺啡可能是治疗 NAS 的一种有前途的吗啡替代治疗方法。最后，地方、州和国家质量改进举措已成为推进 NAS 患儿护理的有效机制。
NAS 仍然是一个重大的公共卫生问题，与重大的医疗、经济和个人负担相关。与相关风险因素、NAS 的评估和治疗相关的新数据为临床医生和医院提供了新知识，并迫切需要促进 NAS 患儿护理的标准化。
