Brown Center for the Study of Children at Risk and Women and Infants Hospital, Providence, RI.
Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Boston, MA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
J Pediatr. 2020 Dec;227:101-107.e1. doi: 10.1016/j.jpeds.2020.08.034. Epub 2020 Aug 14.
To develop an index to determine which opioid-exposed neonates have the most severe neonatal abstinence syndrome (NAS).
Full-term neonates with NAS (n = 116) from mothers maintained on methadone or buprenorphine were enrolled from 8 sites into a randomized clinical trial of morphine vs methadone. Ninety-nine (85%) were evaluated at hospital discharge using the NICU Network Neurobehavioral Scale (NNNS). At 18 months, 83 of 99 (83.8%) were evaluated with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), and 77 of 99 (77.7%) were evaluated with the Child Behavior Checklist (CBCL).
Cluster analysis was used to define high (n = 21) and low (n = 77) NAS severity. Compared with infants in the low NAS severity cluster, infants in the high NAS severity cluster had a longer length of stay (P < .001), longer length of stay due to NAS (P < .001), longer duration of treatment due to NAS (P < .001), and higher total dose of the study drug (P < .001) and were more likely to have received phenobarbital (P < .001), to have been treated with morphine (P = .020), and to have an atypical NNNS profile (P = .005). The 2 groups did not differ in terms of maximum Finnegan score. At 18 months, in unadjusted analyses, compared with the high-severity cluster, the low-severity cluster had higher scores on the Bayley-III Cognitive (P = .013), Language (P < .001), and Motor (P = .041) composites and less total behavior problems on the CBCL (P = .028). In adjusted analyses, the difference in the Bayley-III Language composite remained (P = .013).
Presumptive measures of NAS severity can be aggregated to develop an index that predicts developmental outcomes at age 18 months.
制定一个指数，以确定哪些阿片类药物暴露的新生儿患有最严重的新生儿戒断综合征（NAS）。
从 8 个地点招募了接受美沙酮或丁丙诺啡维持治疗的母亲所生的患有 NAS 的足月新生儿（n=116），并将其纳入一项吗啡与美沙酮随机临床试验。99 例（85%）在出院时使用新生儿重症监护病房网络神经行为量表（NNNS）进行评估。在 18 个月时，对 99 例中的 83 例（83.8%）进行贝利婴幼儿发展量表第三版（Bayley-III）评估，对 99 例中的 77 例（77.7%）进行儿童行为检查表（CBCL）评估。
使用聚类分析定义高（n=21）和低（n=77）NAS 严重程度。与低 NAS 严重程度组的婴儿相比，高 NAS 严重程度组的婴儿住院时间更长（P<0.001）、因 NAS 住院时间更长（P<0.001）、因 NAS 接受治疗的时间更长（P<0.001）、接受研究药物的总剂量更高（P<0.001），且更有可能接受苯巴比妥（P<0.001）、接受吗啡治疗（P=0.020）和出现非典型 NNNS 特征（P=0.005）。两组在最大芬内根评分方面无差异。在未经调整的分析中，与高严重程度组相比，低严重程度组在贝利-III 认知（P=0.013）、语言（P<0.001）和运动（P=0.041）综合评分上得分更高，在 CBCL 上总行为问题得分更低（P=0.028）。在调整分析中，贝利-III 语言综合评分的差异仍然存在（P=0.013）。
NAS 严重程度的推测性指标可以汇总为一个指数，以预测 18 个月时的发育结果。
