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Síndrome de abstinencia neonatal: avances en el diagnóstico y el tratamiento
Elisha M Wachman1,2, Davida M Schiff3, Michael Silverstein1,2
1Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts.
JAMA
|April 4, 2018
Resumen
El diagnóstico y el tratamiento del síndrome de abstinencia neonatal (NAS) carecen de evidencia de alta calidad. Se necesitan más ensayos clínicos para evaluar los resultados de las estrategias de diagnóstico y tratamiento para los lactantes expuestos a opioides in utero.
Área de la Ciencia:
- Cuidado neonatal
- Farmacología
- Salud pública
Sus antecedentes:
- El síndrome de abstinencia neonatal (NAS) afecta a entre 6 y 20 de cada 1000 recién nacidos en los Estados Unidos debido a la exposición in utero a opiáceos.
- Existe una variabilidad significativa en los protocolos de diagnóstico y tratamiento de la NAS.
- La evidencia actual para las estrategias óptimas de NAS es limitada.
Objetivo del estudio:
- Revisar los estudios clave sobre el diagnóstico y el tratamiento de la NAS publicados entre 2007 y 2017.
- Resumir los hallazgos sobre los enfoques farmacológicos y no farmacológicos del tratamiento.
- Identificar las lagunas en la base de pruebas para la atención de la ENS.
Principales métodos:
- Búsqueda sistemática de la literatura de PubMed, Web of Science y CINAHL (julio 2007-diciembre 2017).
- La inclusión de ensayos clínicos, estudios de cohorte y series de casos sobre el diagnóstico o el tratamiento de la NAS.
- Selección de resúmenes para identificar las investigaciones relevantes.
Principales resultados:
- Se revisaron 53 artículos, incluidos 9 ECA y 35 estudios de cohorte, en los que participaron más de 11.905 parejas madre-hijo.
- Los nuevos métodos de diagnóstico son prometedores, pero no se utilizan habitualmente.
- Las intervenciones no farmacológicas como la lactancia materna y el alojamiento en habitación son comunes, pero carecen de apoyo de ensayos de alta calidad.
- Las intervenciones farmacológicas se basan en ensayos pequeños y heterogéneos.
- La evidencia insuficiente vincula los enfoques de diagnóstico o tratamiento con los resultados del desarrollo neurológico.
Conclusiones:
- La evidencia actual para el diagnóstico y el tratamiento de NAS se basa en estudios pequeños y de baja calidad que se centran en resultados intermedios.
- Los ensayos clínicos de alta calidad son esenciales para evaluar los resultados de salud y neurodesarrollo.
- Se necesita más investigación para obtener herramientas de diagnóstico objetivas y modalidades efectivas de tratamiento.
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