Vasan Vikram, Kitase Yuma, Newville Jessie C, Robinson Shenandoah, Gerner Gwendolyn, Burton V Joanna, Jantzie Lauren L
Department of Pediatrics, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Kennedy Krieger Institute, Baltimore, MD; Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM; Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Neural Regen Res. 2021 Mar;16(3):430-432. doi: 10.4103/1673-5374.293136.
Substance use, specifically the use of prescription and non-prescription opioids among pregnant women, is a major public health issue and chief contributor to the opioid crisis. The prevalence of Neonatal Opioid Withdrawal Syndrome has risen 5-fold in the past decade, and is a well-recognized consequence of perinatal opioid exposure. By contrast, the long-term damage to the developing brain from opioid medications is just beginning to be recognized as a serious concern. Published data suggest that opioid exposure commencing in utero negatively affects the maturation of the neural-immune system, and trajectory of central nervous system development. Methadone induces peripheral immune hyper-reactivity, lasting structural and microstructural brain injury, and significant deficits in executive function and cognitive control in adult animals following in utero exposure. Thus, to address the cascading public health crisis stemming from the multitude of infants with in utero opioid exposure who will grow up with altered neurodevelopmental trajectories, rigorous preclinical, mechanistic studies are required. Such studies will define the long-term sequelae of prenatal opioid exposure in an effort to develop appropriate and targeted interventions. Specifically, the development of novel fluid, neuroimaging and biobehavioral biomarkers will be the most useful to aid in early identification and treatment of opioid exposed infants with the greatest risk of poor clinical outcomes. These studies will be essential to understand how in utero insults determine brain structure and function in adulthood, and what targeted interventions will be required to improve long-term outcomes in the countless children being born exposed to opioids each year.
药物使用，特别是孕妇使用处方和非处方阿片类药物，是一个重大的公共卫生问题，也是阿片类药物危机的主要促成因素。在过去十年中，新生儿阿片类药物戒断综合征的患病率上升了5倍，这是围产期阿片类药物暴露的一个公认后果。相比之下，阿片类药物对发育中大脑的长期损害刚刚开始被视为一个严重问题。已发表的数据表明，子宫内开始的阿片类药物暴露会对神经免疫系统的成熟以及中枢神经系统的发育轨迹产生负面影响。美沙酮会导致外周免疫反应过度、持续的结构性和微观结构性脑损伤，以及成年动物在子宫内暴露后执行功能和认知控制方面的显著缺陷。因此，为了解决因大量子宫内阿片类药物暴露的婴儿长大后神经发育轨迹改变而引发的一系列公共卫生危机，需要进行严格的临床前机制研究。此类研究将确定产前阿片类药物暴露的长期后遗症，以便制定适当且有针对性的干预措施。具体而言，开发新型液体、神经影像学和生物行为生物标志物对于帮助早期识别和治疗临床结局最差风险最高的阿片类药物暴露婴儿最为有用。这些研究对于理解子宫内损伤如何决定成年期的脑结构和功能，以及需要采取哪些有针对性的干预措施来改善每年出生时暴露于阿片类药物之下的无数儿童的长期结局至关重要。
