D'Abaco Elise
Paediatric Medicine, Western Health, Joan Kirmer Women's and Children's Hospital, Melbourne, Victoria, Australia.
The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2021 Jan;57(1):155-159. doi: 10.1111/jpc.15265.
To undertake a literature search and critical appraisal of best available evidence to answer the clinical question: Does the addition of clonidine (I) to standard treatment with an opioid (C) improve outcomes (O) in infants with Neonatal Abstinence Syndrome? A search of both comprehensive (MedLine and Embase) and pre-filtered databases (Dynamed, UpToDate and TRIP), utilising Boolean Operators to combine search terms appropriately. Three relevant studies were identified. One paper describing the outcomes of a randomised controlled trial by Agthe et al. (2009) most accurately answered the clinical question posed. This paper was critically appraised, and evidence applied to the clinical scenario. The use of clonidine as an adjunct to opioid in the management of infants with NAS reduces the total number of treatment days and dose of opioid required to control symptoms. However, there is a higher risk of rebound in symptoms post-cessation of opioid and clinicians need to account for this in their discharge planning. More large scale, multi-centre high-quality research is needed to clarify the role of clonidine in the treatment of NAS: as monotherapy versus adjunct, the optimal dose and longer-term impact on neurodevelopment.
进行文献检索并对现有最佳证据进行批判性评价，以回答临床问题：在新生儿戒断综合征婴儿中，在阿片类药物标准治疗（C）基础上加用可乐定（I）是否能改善结局（O）？检索综合数据库（MedLine和Embase）以及预筛选数据库（Dynamed、UpToDate和TRIP），并使用布尔运算符适当组合检索词。共识别出三项相关研究。Agthe等人（2009年）描述的一项随机对照试验结果的论文最准确地回答了所提出的临床问题。对该论文进行了批判性评价，并将证据应用于临床情况。在新生儿戒断综合征婴儿管理中，使用可乐定作为阿片类药物的辅助药物可减少控制症状所需的总治疗天数和阿片类药物剂量。然而，阿片类药物停用后症状反弹的风险较高，临床医生在出院计划中需要考虑到这一点。需要更多大规模、多中心的高质量研究来阐明可乐定在新生儿戒断综合征治疗中的作用：作为单一疗法与辅助疗法、最佳剂量以及对神经发育的长期影响。
