Velez Martha L, McConnell Krystle, Spencer Nancy, Montoya Lina M, Jansson Lauren M
Johns Hopkins University School of Medicine, Department of Pediatrics, USA.
Johns Hopkins University School of Medicine, Department of Pediatrics, USA.
Neurotoxicol Teratol. 2024 Nov-Dec;106:107400. doi: 10.1016/j.ntt.2024.107400. Epub 2024 Oct 28.
Although prescription of buprenorphine/naloxone during pregnancy is gaining acceptance, buprenorphine monotherapy is more often used due to the scarce knowledge of the effects of the combined medications on the fetus and neonate. Evaluation of neurobehavioral functioning of neonates prenatally exposed to buprenorphine/naloxone is lacking. The NICU Network Neurobehavioral Scale (NNNS) has been used to evaluate neurobehavioral functioning, stress responses, and regulatory capacities of neonates at risk for altered development due to prenatal stressors. This pilot study presents a descriptive analysis of the neurobehavioral functioning among neonates exposed in utero to buprenorphine/naloxone, as well as maternal characteristics and factors present during their pregnancy.
Participants were pregnant parents receiving comprehensive treatment for opioid use disorder (OUD) and obstetric care, choosing buprenorphine/naloxone treatment with singleton, uncomplicated pregnancies. Participants provided confidential urine specimens for legal and illegal psychoactive substances according to protocol. Maternal psychiatric disorders and psychiatric medications as well as weekly dosing records were obtained for the duration of study participation. The NNNS was administered to 16 full-term neonates on days 3,14 and 30 of life.
Mean summary scores for 12 neurobehavioral domains (attention, arousal, self-regulation, handling, quality of movement, excitability, lethargy, non-optimal reflexes, asymmetrical reflexes, hypertonia, hypotonia and stress/abstinence syndrome) are presented for neonates prenatally exposed to buprenorphine/naloxone at three time points during the first month of life. Several maternal factors that can influence the functioning of the neonate were presented in this sample including smoking cigarettes (94 %), a psychiatric diagnosis (87.5 %), positive urinalysis for legal or illegal substances during treatment (56.2 %).
This report provides preliminary information regarding the neurobehavioral functioning of neonates exposed to buprenorphine/naloxone over the first month of life, including consideration of maternal factors. However, future research with a larger sample and controlling for different neonate and maternal factors is necessary to confirm these preliminary findings.
尽管孕期使用丁丙诺啡/纳洛酮的处方越来越被认可，但由于对联合用药对胎儿和新生儿影响的了解有限，丁丙诺啡单一疗法更为常用。目前缺乏对产前暴露于丁丙诺啡/纳洛酮的新生儿神经行为功能的评估。新生儿重症监护病房网络神经行为量表（NNNS）已被用于评估因产前应激源而有发育改变风险的新生儿的神经行为功能、应激反应和调节能力。这项初步研究对子宫内暴露于丁丙诺啡/纳洛酮的新生儿的神经行为功能，以及母亲的特征和孕期存在的因素进行了描述性分析。
参与者为接受阿片类物质使用障碍（OUD）综合治疗和产科护理的怀孕父母，选择丁丙诺啡/纳洛酮治疗且单胎、无并发症妊娠。参与者按照方案提供了用于检测合法和非法精神活性物质的保密尿液样本。在研究参与期间获取母亲的精神疾病和精神药物以及每周给药记录。在出生第3天、14天和30天对16名足月新生儿进行NNNS评估。
给出了出生后第一个月内三个时间点产前暴露于丁丙诺啡/纳洛酮的新生儿12个神经行为领域（注意力、觉醒、自我调节、处理能力、运动质量、兴奋性、嗜睡、非最佳反射、不对称反射、张力亢进、张力减退和应激/戒断综合征）的平均总分。该样本中呈现了几个可能影响新生儿功能的母亲因素，包括吸烟（94%）、精神疾病诊断（87.5%）、治疗期间合法或非法物质尿检呈阳性（56.2%）。
本报告提供了关于出生后第一个月内暴露于丁丙诺啡/纳洛酮的新生儿神经行为功能的初步信息，包括对母亲因素的考虑。然而，需要未来进行更大样本量的研究并控制不同的新生儿和母亲因素，以证实这些初步发现。
