Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
Division of Alcohol, Drugs and Addiction, Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, USA.
Neurotoxicol Teratol. 2021 Nov-Dec;88:107032. doi: 10.1016/j.ntt.2021.107032. Epub 2021 Sep 29.
There has been increasing emphasis on the importance of the development of self-regulatory capacities of the individual as the cornerstone of development. The caregivers' abilities to manage their own attention, emotions, physiology and behaviors influence the development of the child's self-regulatory and interactive capacities, and thereby their overall development. Newborns prenatally exposed to psychoactive substances and/or to other prenatal stressors such as maternal poor nutrition, increased maternal stress, trauma, difficult and/or impoverished environments, in tandem with genetic predispositions, can result in alterations to their neurodevelopment that predispose them to self-regulatory problems that can be expressed at any stage of life. The care of infants with Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS) and their mother/caregiver is a window of opportunity to assess the regulatory and co-regulatory capacities of both, and to provide holistic interventions with the goal of empowering the mother/caregiver in their own self-knowledge/self-regulation capacities and their crucial role in promoting the healthy development of their children. Non-pharmacologic care for the infant with NAS/NOWS is the first line of treatment and of paramount importance. Yet, current approaches are based on a limited scope of infant functioning, and the scoring systems in current use do not result in individualized and specific non-pharmacologic care of the infant, which can result in excessive or insufficient medication and a lack of caregiver appreciation for the infant's strengths, difficulties and early development. The interventions described here are based on the infant's signs of dysregulation in four neurobehavioral subsystems that can be dysregulated by NAS/NOWS, the infant's adaptive or maladaptive responses to return to a regulated functioning, and the co-regulatory behaviors of the infant and the mother/caregiver. In Part I of this two-part series on re-conceptualizing non-pharmacologic care for NAS/NOWS we laid the foundation for a new treatment approach, one grounded in developmental theory and evidence-based observations of infant and interpersonal neurobiology. Here, in Part II, we outline actionable, individually tailored evaluations and approaches to non-pharmacologic NAS/NOWS treatment based on strategies to support the regulatory capacities and development of 4 key domains: 1) autonomic; 2) motor/tone; 3) sleep/awake state control; and 4) sensory modulation subsystems.
越来越多的人强调，个体自我调节能力的发展是发展的基石。照顾者管理自己的注意力、情绪、生理和行为的能力影响着孩子自我调节和互动能力的发展，进而影响他们的整体发展。在子宫内接触到精神活性物质和/或其他产前应激源（如母亲营养不良、母亲压力增加、创伤、困难和/或贫困环境）的新生儿，加上遗传易感性，可能导致其神经发育发生变化，使其容易出现自我调节问题，这些问题可能在生命的任何阶段表现出来。患有新生儿戒断综合征（NAS）/新生儿阿片类戒断综合征（NOWS）的婴儿及其母亲/照顾者的护理是评估两者调节和共调节能力的机会窗口，并提供整体干预措施，以使母亲/照顾者能够增强自我知识/自我调节能力，并在促进孩子健康发展方面发挥关键作用。针对 NAS/NOWS 婴儿的非药物护理是一线治疗方法，至关重要。然而，目前的方法基于婴儿功能的有限范围，并且当前使用的评分系统不能为婴儿提供个体化和具体的非药物护理，这可能导致药物过量或不足，以及照顾者对婴儿的优势、困难和早期发展缺乏认识。这里描述的干预措施基于婴儿在四个神经行为子系统中出现的失调迹象，这些失调可能是由 NAS/NOWS 引起的，婴儿对恢复调节功能的适应性或不适应性反应，以及婴儿和母亲/照顾者的共调节行为。在关于重新概念化 NAS/NOWS 的非药物护理的两部分系列的第一部分中，我们为一种新的治疗方法奠定了基础，这种方法基于发展理论和对婴儿和人际神经生物学的基于证据的观察。在这里，在第二部分中，我们概述了基于支持 4 个关键领域的调节能力和发展的策略的可操作的、个性化的评估和非药物 NAS/NOWS 治疗方法：1）自主；2）运动/张力；3）睡眠/觉醒状态控制；和 4）感觉调节子系统。
