评估“进食、睡眠、安抚”对物质使用暴露婴儿新生儿戒断综合征治疗的影响
Evaluating the Impact of Eat, Sleep, Console in Neonatal Abstinence Syndrome Treatment for Infants Exposed to Substance Use .
作者信息
McGrath Shannon V, Rivera Allie, Kennie-Richardson Christopher, Ehrmann David, Cline Julie, Gable Kaye, Forrest Victoria
机构信息
Department of Pharmacy (SVM, JC, CK-R, AR, VF), Cone Health Women's and Children's Center, Greensboro, NC.
Department of Neonatology (DE, KG), Cone Health Women's and Children's Center, Greensboro, NC.
出版信息
J Pediatr Pharmacol Ther. 2024 Apr;29(2):151-158. doi: 10.5863/1551-6776-29.2.151. Epub 2024 Apr 8.
OBJECTIVE
An increase in maternal use of licit or illicit substances, alcohol, and tobacco has resulted in an increased incidence of neonatal abstinence syndrome (NAS). In recent years, NAS management has shifted to initiating an Eat, Sleep, Console (ESC) approach prior to pharmacologic treatment. The objective of this study was to evaluate the impact of ESC in combination with pharmacologic treatment in the management of NAS for infants exposed to substance use .
METHODS
This single system, multisite, retrospective cohort study evaluated infants with known exposure to substance or polysubstance use or those who had signs and symptoms of withdrawal with a positive toxicology screen. The primary outcome of rate of pharmacologic therapy initiated was evaluated pre and post implementation of ESC. Secondary outcomes included hospital length of stay, day of life that pharmacologic therapy was initiated, and an evaluation of the ESC guideline. A subgroup analysis with similar outcomes was also performed for patients with maternal polysubstance use.
RESULTS
A total of 2843 patients were screened, and 50 patients were randomly selected for -inclusion in both pre- and post-groups. The rate of pharmacologic therapy initiated post implementation of ESC decreased from 58% to 30% (p < 0.01). In the post-group, there was a decrease in the number of -patients requiring scheduled morphine (33%, p < 0.01) and duration of pharmacologic therapy (14.6 days vs 6.47 days, p < 0.01).
CONCLUSIONS
Implementing an ESC guideline decreased the length of stay and rate of pharmacologic intervention needed for infants with NAS at our institution.
目的
孕产妇使用合法或非法药物、酒精和烟草的情况增加，导致新生儿戒断综合征（NAS）的发病率上升。近年来，NAS的管理已转向在药物治疗之前采用进食、睡眠、安抚（ESC）方法。本研究的目的是评估ESC联合药物治疗对暴露于药物使用的婴儿NAS管理的影响。
方法
这项单系统、多地点的回顾性队列研究评估了已知暴露于药物或多种药物使用的婴儿，或那些有戒断体征和症状且毒理学筛查呈阳性的婴儿。在实施ESC之前和之后评估开始药物治疗的主要结局发生率。次要结局包括住院时间、开始药物治疗的日龄以及对ESC指南的评估。还对母亲使用多种药物的患者进行了具有相似结局的亚组分析。
结果
共筛查了2843例患者，随机选择50例患者纳入前后组。ESC实施后开始药物治疗的发生率从58%降至30%（p<0.01）。在后一组中，需要定期使用吗啡的患者数量减少（33%，p<0.01），药物治疗持续时间缩短（14.6天对6.47天，p<0.01）。
结论
在我们机构实施ESC指南可缩短NAS婴儿的住院时间和所需的药物干预率。
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