Prenatal Madde Maruziyeti: Tek Merkezli Bir Üçüncü Düzey Yenidoğan Yoğun Bakım Ünitesinde Bir Yıllık Deneyim

Abstract

Amaç: Doğum öncesi yasadışı uyuşturucu maruziyeti olan sekiz yenidoğan, gebelik sırasında kullanılan maddelerin türüne bağlı olarak gelişen neonatal yoksunluk sendromunun klinik seyri açısından değerlendirilmiştir. Gereç ve Yöntemler: Hastanemizin üçüncü basamak Yenidoğan Yoğun Bakım Ünitesine (YYBÜ) Şubat 2022 ile Mart 2023 tarihleri arasında, doğum öncesi yasadışı madde maruziyeti nedeniyle yatırılan yenidoğanlarda retrospektif bir çalışma yürütüldü. Demografik veriler, yoksunluk belirtileri, farmakolojik tedavi ihtiyacı ve hastenede kalış süreleri kaydedildi. Madde maruziyeti olan yenidoğanlar opioid ve opioid-dışı (metamfetamin, Bonsai, esrar) olarak 2 gruba ayrıldı. Bulgular: Çalışmaya toplam sekiz yenidoğan dahil edildi. Vakaların 4’ü (50%) opioide maruz kalan grupta idi. Opioid kullanan gebeler (28±6.73), non-opioid madde kullanan gebelerden daha yaşlıydı (21±4.83). Opioide maruz kalan yenidoğanlarda ortalama doğum tartısı (2541 gr), non-opioid gruptan (3020 gr) daha düşüktü. Ortalama hastane yatış günü opioid grupta (34 gün), non-opioid gruptan daha uzundu (10 gün). Madde maruziyeti olan tüm yenidoğanlar preterm (<37 gestasyon haftası) doğmuştu. Opioid grubundaki tüm vakalar ile non-opiod grubundaki üç vakada çeşitli derecelerde çekilme semptomları gözlendi. Çekilme semptomları gözlenen vakaların 3’ünde medikal tedavi gerekti. Tedavi gerektiren hastaların tamamı opioid grubundaydı. Tüm yenidoğanlar sağlıklı olarak taburcu edildi. Sonuç: Prenatal dönemde yasadışı madde maruziyeti yenidoğanlarda preterm doğumun önemli nedenlerindendir. Bu maddelerin birçoğu yenidoğanlarda çeşitli derecelerde yoksunluk sendromuna neden olmaktadırlar. Gebelikte kullanılan eroin ve nalokson içeren ikame tedavileri, diğer maddelere göre daha şiddetli, uzun seyirli ve tedavi gerektiren neonatal yoksunluk sendromuna neden olabilir. Morfin ve metadonun temin edilemediği durumlarda, yoksunluk sendromu bulguları fenobarbital ile kontrol altına alınabilir, Prenatal dönemde madde maruziyeti olan tüm yenidoğanların doğum sonrası erken izleme alınması, uygun müdahale ve tedaviye olanak sağladığından çok önemlidir.

Keywords

• Yoksunluk
• Yenidoğan
• Fenobarbital
• Gebelik
• Madde kullanımı

Prenatal Substance Abuse: a 1-Year Single-Center Experience at a Tertiary Neonatal Intensive Care Unit

Abstract

Objective: Eight newborns diagnosed with prenatal substance abuse were evaluated for the clinical course of neonatal abstinence syndrome depending on the type of substances used by their mothers during pregnancy. Material and Methods: A retrospective study of neonates with prenatal substance abuse admitted to our tertiary care university hospital’s Neonatal Intensive Care Unit (NICU) was conducted between February 2022 and March 2023. Demographic data, withdrawal symptoms, need for pharmacological treatment, and duration of hospitalization were collected. Newborns exposed to substances were divided into two groups: opioid and non-opioid (methamphetamine, Bonsai, marijuana). Results: Eight infants were included in the study. Four cases (50%) were in the group exposed to opioids. Pregnant users of opioids were older (28±6.73) than non-opioid substance users (21±4.83). The mean birth weight of newborns exposed to opioids (2541 g) was lower than that of the non-opioid group (3020 g). The average length of hospital stay was longer in the opioid group (34 days) compared to the non-opioid group (10 days). All newborns exposed to substances were born preterm (<37 gestational weeks). Withdrawal symptoms were observed in all cases in the opioid group and three cases in the non-opioid group to varying degrees. Medical treatment was required in three out of the seven cases with withdrawal symptoms. All patients requiring treatment were in the opioid group. All infants were discharged in good health. Conclusion: Substance exposure during the prenatal period is a significant cause of preterm birth in neonates. Many of these substances can cause varying degrees of withdrawal syndrome in newborns. Replacement therapies used during pregnancy containing heroin and naloxone can lead to a more severe, prolonged, and treatment-requiring neonatal withdrawal syndrome than other substances. In cases where morphine and methadone are unavailable, the symptoms of withdrawal syndrome can be managed with phenobarbital. It is crucial to monitor all newborns with prenatal exposure to substances early because it allows for appropriate intervention and treatment.

Keywords

• Abstinence
• Newborn
• Phenobarbital
• Pregnancy
• Substance use

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