Divisions of General Academic Pediatrics.
Department of Pediatrics, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
Pediatrics. 2024 Jan 1;153(2). doi: 10.1542/peds.2023-062871.
A significant number of advances have been made in the last 5 years with respect to the identification, diagnosis, assessment, and management of infants with prenatal opioid exposure and neonatal opioid withdrawal syndrome (NOWS) from birth to early childhood. The primary objective of this review is to summarize major advances that will inform the clinical management of opioid-exposed newborns and provide an overview of NOWS care to promote the implementation of best practices. First, advances with respect to standardizing the clinical diagnosis of NOWS will be reviewed. Second, the most commonly used assessment strategies are discussed, with a focus on presenting new quality improvement and clinical trial data surrounding the use of the new function-based assessment Eat, Sleep, and Console approach. Third, both nonpharmacologic and pharmacologic treatment modalities are reviewed, highlighting clinical trials that have compared the use of higher calorie and low lactose formula, vibrating crib mattresses, morphine compared with methadone, buprenorphine compared with morphine or methadone, the use of ondansetron as a medication to prevent the need for NOWS opioid pharmacologic treatment, and the introduction of symptom-triggered dosing compared with scheduled dosing. Fourth, maternal, infant, environmental, and genetic factors that have been found to be associated with NOWS severity are highlighted. Finally, emerging recommendations on postdelivery hospitalization follow-up and developmental surveillance are presented, along with highlighting ongoing and needed areas of research to promote infant and family well-being for families impacted by opioid use.
在过去的 5 年中，在识别、诊断、评估和管理产前阿片类药物暴露和新生儿阿片类戒断综合征（NOWS）方面取得了重大进展，这些婴儿从出生到幼儿期。本次综述的主要目的是总结主要进展，为阿片类药物暴露新生儿的临床管理提供信息，并概述 NOWS 护理，以促进最佳实践的实施。首先，将回顾关于规范化 NOWS 临床诊断的进展。其次，讨论了最常用的评估策略，重点介绍了围绕新的基于功能的评估方法（Eat，Sleep，和 Console approach）的新质量改进和临床试验数据。第三，综述了非药物和药物治疗方式，强调了比较高卡路里和低乳糖配方、振动婴儿床床垫、吗啡与美沙酮、丁丙诺啡与吗啡或美沙酮、昂丹司琼预防需要 NOWS 阿片类药物治疗的药物使用，以及与定时给药相比，症状触发给药的临床试验。第四，强调了与 NOWS 严重程度相关的母体、婴儿、环境和遗传因素。最后，提出了分娩后住院随访和发育监测的新建议，并强调了正在进行和需要的研究领域，以促进受阿片类药物使用影响的家庭中婴儿和家庭的健康。
