Dahlem P, Bucher H U, Cuendet D, Mieth D, Gautschi K
Klinik für Neonatologie, Universitätsspital Zürich.
Monatsschr Kinderheilkd. 1993 Mar;141(3):237-40.
The number of newborn infants with symptoms suggesting drug withdrawal is increasing. As only part of prenatally exposed infants show typical drug withdrawal, and drug-use reported by addicted mothers is often unreliable the prevalence of neonates that were exposed to illicit drugs before birth is unknown. The purpose of this study was to evaluate prospectively the prevalence of drugs in meconium and to define risk factors for intrauterine drug exposure.
During a period of 4 months meconium was collected twice in 420 nonselected newborn infants. Meconium was analysed with a modified test developed for toxicology screening in urine. Information on pre- and postnatal risk factors including drug-use during pregnancy was obtained.
Among 415 mothers four reported illicit drug use and ten licit drug use during late pregnancy. In all these infants meconium drug test was positive. After exclusion of these infants and of five second twins 401 infants with negative drug history remained. 45 of them (11%) had one or two drugs in the meconium: opiate 17x, amphetamine 16x, barbiturate 15x, benzodiazepine 3x, cannabinoid 2x, cocaine 1x (in 9 infants two substances were detected). None was positive for LSD or phencyclidine. The infants with positive drug tests had the following risks compared to those with negative tests: prematurity (odds ratio 2.3, 95% confidence interval 1.3-4.3). Microcephaly or macrocephaly (2.0:1.01-4.1), Apgar-Score below 5 at 1 min (2.4:1.5-5.4), Apgar score below 7 at 10 min (4.0: 1.6-9.9), mother academic (2.8:1.2-6.2).
Newborn infants may have been exposed to illicit drugs in utero even if their mothers deny drug use and even if they do not show withdrawal symptoms. Prematurely born infants and infants with problems in postnatal adaptation have an increased risk of having been exposed to drugs.
有药物戒断症状的新生儿数量正在增加。由于只有部分产前暴露于药物的婴儿表现出典型的药物戒断症状，且成瘾母亲报告的药物使用情况往往不可靠，因此出生前暴露于非法药物的新生儿患病率尚不清楚。本研究的目的是前瞻性评估胎粪中药物的患病率，并确定宫内药物暴露的危险因素。
在4个月的时间里，对420名未经选择的新生儿的胎粪进行了两次采集。采用一种为尿液毒理学筛查开发的改良检测方法对胎粪进行分析。获取了包括孕期药物使用情况在内的产前和产后危险因素信息。
在415名母亲中，有4名报告在妊娠晚期使用非法药物，10名报告使用合法药物。所有这些婴儿的胎粪药物检测均呈阳性。排除这些婴儿和5对双胞胎中的第二个后，剩下401名药物史阴性的婴儿。其中45名（11%）婴儿的胎粪中含有一种或两种药物：阿片类药物17例，苯丙胺16例，巴比妥类药物15例，苯二氮䓬类药物3例，大麻素2例，可卡因1例（9名婴儿检测出两种物质）。无一例LSD或苯环利定检测呈阳性。与药物检测阴性的婴儿相比，药物检测呈阳性的婴儿存在以下风险：早产（比值比2.3，95%置信区间1.3 - 4.3）。小头畸形或大头畸形（2.0:1.01 - 4.1），1分钟时阿氏评分低于5分（2.4:1.5 - 5.4），10分钟时阿氏评分低于7分（4.0:1.6 - 9.9），母亲学历（2.8:1.2 - 6.2）。
即使母亲否认使用药物，且新生儿没有出现戒断症状，新生儿仍可能在子宫内暴露于非法药物。早产婴儿和产后适应有问题的婴儿暴露于药物的风险增加。
