Madde Bağımlısı Anne Bebeklerinin Klinik ve Laboratuvar Özellikleri: Tek Merkez Deneyimi

Yıl 2023, Cilt: 24 Sayı: 1, 35 - 42, 31.03.2023

Sarkhan Elbayiyev , Ufuk Çakır

https://doi.org/10.51982/bagimli.1141958

Öz

Amaç: Gebelik döneminde alkol, yasadışı uyuşturucu ve psikoaktif madde kullanımının önemli ölçüde maternal, fetal ve neonatal morbiditelerle ilişkili olduğu bilinmektedir. Yasadışı madde kullanan anneden doğan bebeklerin özelliklerini araştırmayı planladık.
Yöntem: Çalışmaya Eylül 2019 ve Aralık 2021 tarihleri arasında doğan yasadışı uyuşturucu madde kullanan anne bebekleri ve kontrol grubu olarak sağlıklı bebekler dahil edildi. Hastaların demografik, klinik ve laboratuvar verileri ile modifiye Finnegan skorları retrospektif olarak dosya verilerinden kaydedildi.
Bulgular: Çalışmaya uyuşturucu madde kullanan anne bebeği 11 ve kontrol grubuna 13 sağlıklı bebek olmak üzere toplam 24 bebek dahil edildi. Madde kullanan annelerin yaşları, gebelik haftaları, doğum ağırlıkları, 1. ve 5. dakikada APGAR skorları sağlıklı bebeklerden istatistiksel olarak daha düşük bulundu. Modifiye Finnegan skoru ≥8 olup morfin ihtiyacı olan (n:4/11) hastalarda lökopeni ve nötropeni oranı morfin ihtiyacı olmayan (n:7/11) hastalara göre anlamlı olarak yüksek bulundu.
Sonuç: Güncel sağlık problemi olarak yasadışı madde kullanımının önlenmesi, erken tespit ve izlemi konusunda politikaların geliştirilmesi ve neonatal yoksunluk sendromu açısından izlenen bebeklerin erken tespiti için yeni biomarkerların araştırılması konusunda detaylı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Neonatal Yoksunluk Sendromu, Gebelik, Yenidoğan

Clinical and Laboratory Characteristics of Infants Born to Substance Addicted Mothers: A Single Center Experience

Öz

Objective: It is known that the use of alcohol, illicit drugs and psychoactive substances during pregnancy is significantly associated with maternal, fetal and neonatal morbidities. We planned to investigate the characteristics of babies born to mothers who use illicit substances.
Method: Babies born to mothers using illicit drugs and healthy babies born between September 2019 and December 2021 were included in the study. Demographic, clinical and laboratory data of the patients and modified Finnegan scores were recorded retrospectively from the file data.
Results: A total of 24 infants, 11 infants of drug-using mothers and 13 healthy infants in the control group, were included in the study. Ages of mothers, gestational weeks, birth weights, and APGAR scores at 1st and 5th minutes of babies born to mothers who used substance were found to be statistically lower than healthy babies. The rates of leukopenia and neutropenia were found to be significantly higher in patients with a modified Finnegan score ≥8 and in need of morphine (n:4/11) compared to patients without morphine need (n:7/11).
Conclusion: There is a need for detailed studies on the prevention of illicit substance use as a current health problem, the development of policies on early detection and follow-up, and the search for new biomarkers for the early detection of infants followed for neonatal withdrawal syndrome.

Anahtar Kelimeler

neonatal abstinence syndrome, pregnancy, newborn

Kaynakça

• 1. Hudak ML, Tan RC. Neonatal drug withdrawal. Pediatrics. 2012;129(2):e540-60.
• 2. Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy. Obstet Gynecol. 2017;130(2):e81-e94.
• 3. Finnegan LP, Connaughton JF Jr, Kron RE, Emich JP. Neonatal abstinence syndrome: Assessment and management. Addict Dis 1975;2:141–58.
• 4. Costello EJ, Copeland WE, Shanahan L, Worthman CM, Angold A. C-reactive protein and substance use disorders in adolescence and early adulthood: a prospective analysis. Drug and alcohol dependence. 2013;133(2):712-7.
• 5. Ozkan N, Sonmez MB, Tas Durmus P, Gorgulu Y, Kose Cınar R, Vardar ME. Elevated neutrophil lymphocyte ratio in patients with substance use disorders. European Psychiatry. 2017;41(S1):S872-S3.
• 6. Morcuende A, Navarrete F, Nieto E, Manzanares J, Femenía T. Inflammatory Biomarkers in Addictive Disorders. Biomolecules. 2021;11(12).
• 7. Özel Ş, Tayman C, ÜStÜN Y, et al. Evaluation of Neonatal Abstinence Syndrome (Nas) Frequency and Systemic Inflammatory Response in Nas. Turkish Journal of Pediatric Disease. 2018.
• 8. Huestis MA, Choo RE. Drug abuse's smallest victims: in utero drug exposure. Forensic science international. 2002;128(1-2):20-30.
• 9. WHO. Guidelines for identification and management of substance use and substance use disorders in pregnancy World Health Organization. 2014:224.
• 10. Wong S, Ordean A, Kahan M. Substance use in pregnancy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2011;33(4):367-84.
• 11. Lipsitz PJ. A proposed narcotic withdrawal score for use with newborn infants. A pragmatic evaluation of its efficacy. Clinical pediatrics. 1975;14(6):592-4.
• 12. Jansson LM, Velez M, Harrow C. The opioid-exposed newborn: assessment and pharmacologic management. Journal of opioid management. 2009;5(1):47-55.
• 13. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134(2):e547-61.
• 14. Oji-Mmuo CN, Schaefer EW, Liao L, Kaiser JR, Sekhar DL. The Possibility of Early Discharge for Newborns Being Monitored for Neonatal Abstinence Syndrome Based on Modified Finnegan Score Distributions. Clinical pediatrics. 2019;58(6):641-6.
• 15. Orlando S. An overview of clinical tools used to assess neonatal abstinence syndrome. The Journal of perinatal & neonatal nursing. 2014;28(3):212-9.
• 16. Schiff DM, Grossman MR. Beyond the Finnegan scoring system: Novel assessment and diagnostic techniques for the opioid-exposed infant. Seminars in fetal & neonatal medicine. 2019;24(2):115-20.
• 17. Verklan MT. Time for the Finnegan Neonatal Abstinence Syndrome Scoring Tool to Be Retired? The Journal of perinatal & neonatal nursing. 2019;33(3):276-7.
• 18. Casper T, Arbour M. Evidence-based nurse-driven interventions for the care of newborns with neonatal abstinence syndrome. Advances in neonatal care : official journal of the National Association of Neonatal Nurses. 2014;14(6):376-80.
• 19. Chervoneva I, Adeniyi-Jones SC, Blanco F, Kraft WK. Development of an abbreviated symptom score for the neonatal abstinence syndrome. J Perinatol. 2020;40(7):1031-40.
• 20. Clark AF. Effect of a Neonatal Abstinence Syndrome Training Program on Nurses' Confidence and Ability to Use the Finnegan Scoring Tool. Nursing for women's health. 2019;23(6):485-93.
• 21. Hall ES, Wexelblatt SL, Crowley M, et al. A multicenter cohort study of treatments and hospital outcomes in neonatal abstinence syndrome. Pediatrics. 2014;134(2):e527-34.
• 22. Raffaeli G, Cavallaro G, Allegaert K, et al. Neonatal Abstinence Syndrome: Update on Diagnostic and Therapeutic Strategies. Pharmacotherapy. 2017;37(7):814-23.
• 23. Corr TE, Hollenbeak CS. The economic burden of neonatal abstinence syndrome in the United States. Addiction (Abingdon, England). 2017;112(9):1590-9.
• 24. Huybrechts KF, Bateman BT, Desai RJ, et al. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. BMJ (Clinical research ed). 2017;358:j3326.
• 25. Grim K, Harrison TE, Wilder RT. Management of neonatal abstinence syndrome from opioids. Clin Perinatol. 2013;40(3):509-24.
• 26. Behnke M, Eyler FD. The consequences of prenatal substance use for the developing fetus, newborn, and young child. The International journal of the addictions. 1993;28(13):1341-91.
• 27. Shi X, DeLucia AL, Bao J, Zhang P. Alcohol abuse and disorder of granulopoiesis. Pharmacology & therapeutics. 2019;198:206-19.
• 28. Roy S, Wang J, Kelschenbach J, Koodie L, Martin J. Modulation of immune function by morphine: implications for susceptibility to infection. Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology. 2006;1(1):77-89.
• 29. Romanos-Sirakis E, Zureikat-Obeid R, Chein T, Demissie S. The evaluation of lymphopenia in infants exposed to opioids in-utero. Journal of neonatal-perinatal medicine. 2020;13(1):87-90.