Seiler Berenike, Deindl Philipp, Somville Thierry, Ebenebe Chinedu Ulrich, Hecher Kurt, Singer Dominique
Sektion Neonatologie und Pädiatrische Intensivmedizin, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Deutschland.
Klinik und Poliklinik für Geburtshilfe und Pränatalmedizin, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Deutschland.
Z Geburtshilfe Neonatol. 2021 Dec;225(6):473-483. doi: 10.1055/a-1392-1773. Epub 2021 Mar 22.
Three-quarters of all women receive analgesia during labor. There are regional and systemic analgesia procedures available. In this review, we investigate the impact of obstetric analgesia using systemic opioids on neonatal outcomes.
We searched the PubMed and Cochrane Library databases using the following search terms: "meptazinol", "meptide", "analgesia", "painkiller", "pain reliever", "obstetrics", "labor", "labour", "delivery", "neonate", "newborn", "child", "baby", "infant", "fetus", "fetal", "opioid" and "opiate" as well as performed an additional MeSH Terms search in PubMed.
Of 355 potentially relevant studies, we included 23 studies in this review. The studies varied widely in quality, sample size, and outcome criteria. Neonatal outcome was often only a secondary endpoint. Rarely were significant differences related to neonatal outcome reported between the different systemic opioids or compared with control groups. Twelve studies compared neonatal APGAR scores between treatment groups, with ten (83%) of these studies showing no differences.
DISCUSSION/OUTLOOK: In summary, we assess the evidence as limited and ambiguous as to whether systemic obstetric opioid therapy negatively affects the newborn. Studies regarding the long-term outcome of the newborns are lacking. A statement regarding the necessity of postnatal monitoring of newborns after maternal obstetric opioid therapy cannot be concluded. Further studies, ideally with a prospective study design and control group, should be considered.
四分之三的女性在分娩期间接受镇痛治疗。有区域镇痛和全身镇痛方法可供选择。在本综述中，我们研究了使用全身性阿片类药物进行产科镇痛对新生儿结局的影响。
我们使用以下检索词在PubMed和Cochrane图书馆数据库中进行检索：“美普他酚”、“肽”、“镇痛”、“止痛药”、“镇痛剂”、“产科”、“分娩”、“产程”、“新生儿”、“新生儿”、“儿童”、“婴儿”、“胎儿”、“胎儿的”、“阿片类药物”和“阿片样物质”，并在PubMed中进行了额外的医学主题词检索。
在355项可能相关的研究中，我们纳入了本综述中的23项研究。这些研究在质量、样本量和结局标准方面差异很大。新生儿结局通常只是次要终点。不同全身性阿片类药物之间或与对照组相比，很少报告与新生儿结局相关的显著差异。12项研究比较了治疗组之间的新生儿阿氏评分，其中10项（83%）研究显示无差异。
讨论/展望：总之，关于全身性产科阿片类药物治疗是否会对新生儿产生负面影响，我们评估证据有限且不明确。缺乏关于新生儿长期结局的研究。无法得出关于产妇产科阿片类药物治疗后对新生儿进行产后监测必要性的结论。应考虑进一步的研究，理想情况下采用前瞻性研究设计并设立对照组。
