Department of Pediatrics, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clin Toxicol (Phila). 2021 Aug;59(8):727-733. doi: 10.1080/15563650.2020.1869755. Epub 2021 Jan 21.
To compare accidental pediatric poisoning from methadone vs. buprenorphine in terms of clinical indicators and in-hospital morbidity.
A matched observational study conducted on children aged ≤12 years admitted to our center between March 2018 and March 2019 with acute poisoning from methadone or buprenorphine. Data were extracted from the electronic patient files of the pediatric methadone poisoning cases, and buprenorphine poisoning cases were followed from ED, during the study period. Cases were compared regarding rates of bradypnea/apnea (primary outcome), the need for antidote therapy and intubation, duration of hospital stay, miosis, loss of consciousness, blood gas analyses, and mortality (secondary outcomes).
A total of 90 methadone- and 30 buprenorphine-poisoned children were evaluated. Methadone cases had significantly higher rates of apnea (20/90 methadone vs. 0/30 buprenorphine; OR = 17.7, 95% CI 1.1, 302.8; = 0.047), but there was no group difference in bradypnea (39/90 methadone vs. 10/30 buprenorphine; = ns). 28 (31%) methadone and 3 buprenorphine (10%) cases had been referred to as fully awake ( = 0.013). Methadone cases required higher median naloxone doses for initial bolus (0.4 vs. 0.02 mg; = 0.014) and maintenance infusion (14.4 vs. 2.4 mg; < 0.001). 20 apnea cases (all from the methadone group) had miotic pupils, and miotic pupils were seen in 44 (90%) cases with bradypnea (OR = 3.2, 95% CI 1.1, 9.3; = 0.026). Intubation was needed in only 5 methadone cases (5.5%; = ns). All patients survived.
Compared to children poisoned with methadone, buprenorphine cases had higher rates of loss of consciousness on admission but subsequently experienced fewer complications during hospital treatment, which is likely due to the buprenorphine partial antagonist effect. Our findings suggest that methadone exposure is more toxic than buprenorphine in pediatric populations.
比较美沙酮和丁丙诺啡致小儿意外中毒的临床指标和院内发病率。
对 2018 年 3 月至 2019 年 3 月期间因急性美沙酮或丁丙诺啡中毒而入住我院的≤12 岁儿童进行了一项匹配的观察性研究。从儿科美沙酮中毒病例的电子病历中提取数据，在研究期间从 ED 随访丁丙诺啡中毒病例。比较两组呼吸频率减慢/呼吸暂停（主要结局）、解毒剂治疗和插管的需要、住院时间、瞳孔缩小、意识丧失、血气分析和死亡率（次要结局）的发生率。
共评估了 90 例美沙酮中毒和 30 例丁丙诺啡中毒的儿童。美沙酮组呼吸暂停发生率明显更高（20/90 例美沙酮 vs. 0/30 例丁丙诺啡；OR=17.7，95%CI 1.1，302.8； = 0.047），但呼吸减慢无组间差异（39/90 例美沙酮 vs. 10/30 例丁丙诺啡； = ns）。28 例（31%）美沙酮和 3 例丁丙诺啡（10%）患儿被认为完全清醒（ = 0.013）。美沙酮组初始推注和维持输注所需的纳洛酮中位数剂量更高（0.4 与 0.02 mg； = 0.014）和（14.4 与 2.4 mg； < 0.001）。20 例呼吸暂停的病例（均来自美沙酮组）均有瞳孔缩小，呼吸减慢的 44 例（90%）均有瞳孔缩小（OR=3.2，95%CI 1.1，9.3； = 0.026）。仅 5 例（5.5%）美沙酮患儿需要插管（ = ns）。所有患者均存活。
与美沙酮中毒患儿相比，丁丙诺啡中毒患儿入院时意识丧失发生率较高，但随后住院治疗期间并发症较少，这可能与丁丙诺啡的部分拮抗作用有关。我们的研究结果表明，美沙酮暴露对儿科人群的毒性大于丁丙诺啡。
