Taleghani Afshin A, Isemann Barbara T, Rice Ward R, Ward Laura P, Wedig Kathy E, Akinbi Henry T
University of Cincinnati Medical Center Cincinnati Ohio.
James L. Winkle College of Pharmacy University of Cincinnati Cincinnati Ohio.
Paediatr Neonatal Pain. 2019 Nov 1;1(2):33-38. doi: 10.1002/pne2.12008. eCollection 2019 Dec.
We aimed to compare the outcomes of pharmacotherapy with either buprenorphine or methadone in infants treated for neonatal abstinence syndrome (NAS) secondary to intrauterine exposure to methadone. This is a multi-center, retrospective cohort study to assess length of treatment (LOT), hospital length of stay (LOS), and cumulative opioid exposure between infants treated with either methadone or buprenorphine for NAS secondary to in utero exposure to methadone. Infants delivered at a gestational age ≥35 weeks and a maternal history of opioid-use disorder and/or urine drug screen positive for methadone, and postnatal pharmacotherapy for NAS with either buprenorphine or methadone as first-line opioid replacement therapy, were eligible. Median LOT, LOS, and cumulative opioid exposure were compared between buprenorphine- and methadone-treated infants. A total of 156 infants (48 treated with buprenorphine and 108 with methadone) were identified. The median LOT and LOS for buprenorphine-treated infants was 8 and 13 days compared with 15 and 20 days for methadone-treated infants, respectively, < .001 for both outcomes. Median cumulative opioid dose in morphine equivalents was 0.6 mg/kg for buprenorphine-treated infants vs 1.05 mg/kg for methadone-treated infants, < .001. No adverse effects were noted among either group. Of infants treated with buprenorphine, 34 (71%) required the addition of adjunctive pharmacotherapy during the NICU stay, compared with 31 (32%) in the methadone-treated group, = .0008. However, significantly fewer infants treated with buprenorphine required continuation of therapy beyond discharge as compared with those treated with methadone. The difference is most likely a reflection of the protocols used by the sites. In infants that required pharmacotherapy for NAS secondary to intrauterine exposure to methadone, treatment with buprenorphine, compared with methadone therapy, was associated with better outcomes. If confirmed with prospective data, buprenorphine could be considered first-line therapy for the two medication-assisted treatment regimens recommended by the American College of Obstetricians and Gynecologists.
我们旨在比较使用丁丙诺啡或美沙酮对因子宫内暴露于美沙酮而接受新生儿戒断综合征（NAS）治疗的婴儿进行药物治疗的效果。这是一项多中心回顾性队列研究，旨在评估接受美沙酮或丁丙诺啡治疗因子宫内暴露于美沙酮而导致的NAS的婴儿的治疗时长（LOT）、住院时长（LOS）和累积阿片类药物暴露量。符合条件的婴儿为：胎龄≥35周，母亲有阿片类药物使用障碍病史和/或尿液药物筛查美沙酮呈阳性，且产后以丁丙诺啡或美沙酮作为一线阿片类替代疗法对NAS进行药物治疗。比较了丁丙诺啡治疗组和美沙酮治疗组婴儿的中位LOT、LOS和累积阿片类药物暴露量。共确定了156名婴儿（48名接受丁丙诺啡治疗，108名接受美沙酮治疗）。丁丙诺啡治疗组婴儿的中位LOT和LOS分别为8天和13天，而美沙酮治疗组婴儿分别为15天和20天，两种结果均P<0.001。丁丙诺啡治疗组婴儿以吗啡当量计的中位累积阿片类药物剂量为0.6mg/kg，美沙酮治疗组为1.05mg/kg, P<0.001。两组均未观察到不良反应。在接受丁丙诺啡治疗的婴儿中，34名（71%）在新生儿重症监护病房住院期间需要加用辅助药物治疗，而美沙酮治疗组为31名（32%），P=0.0008。然而，与美沙酮治疗的婴儿相比，接受丁丙诺啡治疗的婴儿出院后需要继续治疗的明显较少。这种差异很可能反映了各研究点所采用的方案。在因子宫内暴露于美沙酮而需要对NAS进行药物治疗的婴儿中，与美沙酮治疗相比，丁丙诺啡治疗的效果更好。如果前瞻性数据得到证实，丁丙诺啡可被视为美国妇产科医师学会推荐的两种药物辅助治疗方案的一线治疗药物。
