Neonatology Unit, Department of Pediatrics, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Department of Psychiatry, Faculty of Medicine, Selcuk University, Konya, Turkey.
J Addict Dis. 2022 Jul-Sep;40(3):432-438. doi: 10.1080/10550887.2021.1987784. Epub 2021 Nov 13.
Neonatal opioid withdrawal syndrome occurs after exposure during pregnancies of mothers with an opioid use disorder. If non-pharmacological treatment is insufficient, pharmacological options are preferred, but a common treatment guideline has not yet been determined. Sublingual buprenorphine tablet is more prominent in the treatment. Since oral alternatives are not available in many clinics, as in our unit, parenteral morphine is still the drug of the first choice. In this paper, we reported that two babies with neonatal opioid withdrawal syndrome were successfully treated with a buprenorphine/naloxone combination, which was not previously shown in the literature.
We followed two babies whose mothers had an opioid use disorder during their pregnancies. The modified Finnegan scoring scale was used for the assessment of the babies. Both infants developed persistent seizures with resistant withdrawal signs. An effective parenteral route could not be provided due to hemodynamic instability. Thus, IV morphine could not be used. Due to the lack of oral treatment alternatives, first, we tried phenobarbital up to 40 mg/kg orally. Afterward, we used buprenorphine/naloxone combined tablet sublingually, which has not been used in children before. Detailed written consent was obtained from the parents for the emergency use of this drug in advance. Shortly after this treatment, the seizures and withdrawal signs were controlled. There were no adverse effects and babies were discharged fully recovered.
Sublingual Buprenorphine 2 mg + Naloxone 0.5 mg (4:1) tablet could be used efficiently and without side effects to treat neonatal opioid withdrawal syndrome.
新生儿阿片类戒断综合征发生于母亲患有阿片类药物使用障碍的妊娠期间暴露之后。如果非药物治疗不足，首选药物治疗，但尚未确定常见的治疗指南。舌下给予丁丙诺啡片在治疗中更为突出。由于在许多诊所，如我们科室，没有口服替代药物，因此仍将注射用吗啡作为一线药物。在本文中，我们报告了两例新生儿阿片类戒断综合征婴儿成功使用丁丙诺啡/纳洛酮合剂治疗，这在文献中尚未显示。
我们随访了两名母亲在妊娠期间患有阿片类药物使用障碍的婴儿。使用改良芬纳根评分量表评估婴儿。两名婴儿均出现持续癫痫发作和难以缓解的戒断症状。由于血流动力学不稳定，无法提供有效的静脉途径。因此，不能使用静脉注射吗啡。由于缺乏口服治疗选择，首先，我们尝试给予 40mg/kg 口服苯巴比妥。之后，我们使用舌下给予丁丙诺啡/纳洛酮合剂，这在儿童中以前没有使用过。事先详细书面征得父母同意，以便在紧急情况下使用这种药物。在此治疗后不久，癫痫发作和戒断症状得到控制。没有不良反应，婴儿完全康复出院。
舌下给予丁丙诺啡 2mg+纳洛酮 0.5mg（4:1）片剂可有效且无副作用地治疗新生儿阿片类戒断综合征。
