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新生児 禁酒 症候群: 診断 と 治療 の 進歩
Elisha M Wachman1,2, Davida M Schiff3, Michael Silverstein1,2
1Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts.
JAMA
|April 4, 2018
まとめ
新生児禁酒症候群 (NAS) の診断と管理には高品質の証拠が欠けている. 子宮内でオピオイドに曝された乳児の診断と治療戦略の成果を評価するために,より多くの臨床試験が必要である.
科学分野:
- 新生児のケア
- 薬理学について
- 公衆衛生
背景:
- 新生児禁酒症候群 (NAS) は,胎内オピオイド暴露による米国新生児1000人に6~20人に及ぶ.
- NASの診断と管理プロトコルには大きな違いがある.
- 最適なNAS戦略の現在の証拠は限られている.
研究 の 目的:
- 2007年から2017年の間に発表されたNADの診断と管理に関する主要な研究をレビューする.
- 薬理学的および非薬理学的治療方法に関する発見を要約する.
- NASの医療に関する証拠の欠陥を特定する.
主な方法:
- PubMed,Web of Science,およびCINAHLの体系的な文献検索 (2017年7月 - 12月)
- NASの診断や管理に関する臨床試験,コホート研究,症例シリーズを含む.
- 関連する研究を特定するために要約をスクリーニングします.
主要な成果:
- 9つのRCTと35のコホート研究を含む53件の論文がレビューされ,11,905件以上の母と乳児の二重関係が調査されました.
- 新しい診断方法は有望ですが,日常的に使用されていません.
- 授乳やルームインのような 非薬学的な介入は一般的ですが 高品質の治験の支持は得られません
- 薬理学的介入は,小規模で異質な試験に基づいています.
- 診断方法や治療方法と神経発達の結果を 関連付ける証拠は不足しています
結論:
- NASの診断と治療に関する現在の証拠は,中途半端な結果に焦点を当てた小規模で低品質な研究に基づいています.
- 健康と神経発達の結果を評価するには 高品質の臨床試験が不可欠です
- 客観的な診断ツールや 効果的な治療方法については さらに研究が必要です
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