儿童在产前接触美沙酮会导致视力受损：一项观察性队列研究。
Impaired vision in children prenatally exposed to methadone: an observational cohort study.
机构信息
Royal Hospital for Children, NHS Greater Glasgow & Clyde and the University of Glasgow, Glasgow, G51 4TF, UK.
Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, EH3 9HA, UK.
出版信息
Eye (Lond). 2024 Jan;38(1):118-126. doi: 10.1038/s41433-023-02644-3. Epub 2023 Jul 4.
BACKGROUND/OBJECTIVES: To examine prevalence of failed visual assessment at 8-10 years in children born to methadone-maintained opioid dependent (MMOD) mothers and relate this to known in utero substance exposure.
SUBJECTS/METHODS: Follow up of observational cohort study of methadone-exposed and comparison children matched for birthweight, gestation and postcode of residence at birth. Participants were 144 children (98 exposed, 46 comparison). Prenatal drug exposure was previously established via comprehensive maternal and neonatal toxicology. Children were invited to attend for visual assessment and casenotes were reviewed. Presence of acuity poorer than 0.2 logMAR, strabismus, nystagmus and/or impaired stereovision constituted a 'fail'. Fail rates were compared between methadone-exposed and comparison children after adjusting for known confounding variables.
RESULTS
33 children attended in person: data were also derived from casenote review for all children. After controlling for maternal reported tobacco use, methadone-exposed children were more likely to have a visual 'fail' outcome, adjusted odds ratio 2.6, 95% CI 1.1-6.2; adjusted relative risk 1.8 (95% CI 1.1-3.4). Visual 'fail' outcome rates did not differ between methadone-exposed children who had (n = 47) or had not (n = 51) received pharmacological treatment for neonatal abstinence/opioid withdrawal syndrome (NAS/NOWS); fail rate 62% vs 53% (95% CI of difference-11-27%).
CONCLUSIONS
Children born to MMOD mothers are almost twice as likely as unexposed peers to have significant visual abnormalities at primary school age. Prenatal methadone exposure should be considered in the differential diagnosis of nystagmus. Findings support visual assessment prior to school entry for children with any history of prenatal opioid exposure.
TRIAL REGISTRATION
The study was prospectively registered on ClinicalTrials.gov (NCT03603301), https://clinicaltrials.gov/ct2/show/NCT03603301 .
背景/目的：检查在 8-10 岁时，接受美沙酮维持治疗的阿片类药物依赖（MMOD）母亲所生儿童的视觉评估失败率，并将其与已知的宫内物质暴露相关联。
研究对象/方法：对美沙酮暴露儿童和按出生体重、胎龄和出生时居住地邮政编码匹配的对照组儿童进行观察性队列研究的随访。参与者为 144 名儿童（98 名暴露组，46 名对照组）。通过全面的母婴毒理学检测，先前确定了产前药物暴露情况。邀请儿童接受视觉评估，并查阅病历记录。视力低于 0.2 logMAR、斜视、眼球震颤和/或立体视觉受损被定义为“失败”。在调整已知混杂变量后，比较美沙酮暴露组和对照组儿童的失败率。
结果
33 名儿童亲自出席：所有儿童的资料也从病历记录中得出。在控制了母亲报告的吸烟情况后，美沙酮暴露的儿童更有可能出现视觉“失败”的结果，调整后的优势比为 2.6，95%可信区间为 1.1-6.2；调整后的相对风险为 1.8（95%可信区间为 1.1-3.4）。接受过新生儿戒断/阿片类药物戒断综合征（NAS/NOWS）药物治疗（n=47）和美沙酮暴露儿童（n=51）的视觉“失败”发生率无差异；失败率分别为 62%和 53%（95%可信区间差值为-11-27%）。
结论
在小学年龄时，接受美沙酮维持治疗的母亲所生的儿童发生显著视觉异常的可能性几乎是未暴露同龄人的两倍。产前美沙酮暴露应作为眼球震颤的鉴别诊断因素。对于有任何产前阿片类药物暴露史的儿童，应在入学前进行视觉评估。
试验注册
该研究在 ClinicalTrials.gov（NCT03603301）上进行了前瞻性注册，网址为：https://clinicaltrials.gov/ct2/show/NCT03603301。
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