Anderson Victoria A, Anbalagan Saminathan, Favara Michael T, Stark Daniela, Carola David, Solarin Kolawole O, Adeniyi-Jones Susan, Aghai Zubair H
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania.
Am J Perinatol. 2025 Feb;42(3):363-368. doi: 10.1055/s-0044-1788717. Epub 2024 Jul 29.
Factors associated with the development and expression of Neonatal Opioid Withdrawal Syndrome (NOWS) are poorly understood. There are conflicting data on the role of infant sex in NOWS. Some studies have suggested that infant sex predicts NOWS severity and adverse outcomes, with male infants being more vulnerable. This study aimed to analyze if infant sex is associated with the severity of NOWS among those who require pharmacologic treatment.
This is a retrospective cohort study of term and late-preterm infants (≥35 weeks gestation) exposed to in utero opioids, born between September 2006 and August 2022, and required pharmacologic treatment for NOWS. Maternal and infant demographics were collected. Indicators of the severity of NOWS (duration of medical treatment (DOT), duration of hospitalization, maximum dose of opioid treatment, and use of secondary medications) were compared between male and female infants. Standard statistical tests and regression analysis were used to establish the differences in outcomes after accounting for confounders and baseline differences.
Out of the 1,074 infants included in the study, 47.9% were female, and 52.1% were male. There was no significant difference in demographic and baseline clinical characteristics between groups except for anthropometry (birth weight, head circumference, and length) and Apgar score at 5 minutes. The median DOT (25 days [14, 39] vs. 23 days [13, 39], = 0.57), length of hospital stay (31.5 days [20, 44] vs. 28 days [20, 44], = 0.35), treatment with phenobarbital (24.7 vs. 26.3%, = 0.56), and clonidine (3.9 vs. 3.8%, = 0.9) were similar in both groups. The differences remained nonsignificant after adjusting for birth anthropometric measurements, gestational age, 5-minute Apgar score, small for gestational age status, and maternal exposure to benzodiazepines.
In this cohort of neonates, sex-related differences were not identified to influence the severity of NOWS among those who required pharmacological treatment.
· Vulnerability to NOWS is multifactorial.. · The role of infant sex in the severity of NOWS is not concrete.. · We noted that sex did not impact NOWS severity in those treated..
新生儿阿片类药物戒断综合征（NOWS）的发生和表现相关因素尚不清楚。关于婴儿性别在NOWS中的作用存在相互矛盾的数据。一些研究表明，婴儿性别可预测NOWS的严重程度和不良结局，男婴更易受影响。本研究旨在分析在需要药物治疗的人群中，婴儿性别是否与NOWS的严重程度相关。
这是一项回顾性队列研究，研究对象为2006年9月至2022年8月出生、孕期暴露于子宫内阿片类药物且需要对NOWS进行药物治疗的足月儿和晚期早产儿（孕周≥35周）。收集了母婴人口统计学数据。比较了男婴和女婴NOWS严重程度的指标（药物治疗持续时间（DOT）、住院时间、阿片类药物治疗的最大剂量以及二线药物的使用情况）。使用标准统计检验和回归分析来确定在考虑混杂因素和基线差异后结局的差异。
在纳入研究的1074名婴儿中，47.9%为女性，52.1%为男性。除人体测量指标（出生体重、头围和身长）以及5分钟时的阿氏评分外，两组间人口统计学和基线临床特征无显著差异。两组的中位DOT（25天[14, 39]对23天[13, 39]，P = 0.57）、住院时间（31.5天[20, 44]对28天[20, 44]，P = 0.35）、苯巴比妥治疗（24.7%对26.3%，P = 0.56）和可乐定治疗（3.9%对3.8%，P = 0.9）相似。在对出生人体测量指标、孕周、5分钟阿氏评分、小于胎龄状态以及母亲暴露于苯二氮䓬类药物进行校正后，差异仍无统计学意义。
在这一队列新生儿中，未发现性别差异会影响需要药物治疗的人群中NOWS的严重程度。
· 对NOWS的易感性是多因素的。· 婴儿性别在NOWS严重程度中的作用不明确。· 我们注意到性别对接受治疗者的NOWS严重程度没有影响。
