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

Öz

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.

Anahtar Kelimeler

• Yoksunluk
• Yenidoğan
• Fenobarbital
• Gebelik
• Madde kullanımı

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

Öz

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.

Anahtar Kelimeler

• Abstinence
• Newborn
• Phenobarbital
• Pregnancy
• Substance use

Kaynakça

1. Forray A. Substance use during pregnancy. F1000 Res 2016;5:F1000 Faculty Rev-887.
2. Shankaran S, Lester BM, Das A, Bauer CR, Bada HS, Lagasse L, et al. Impact of maternal substance use during pregnancy on childhood outcome. Semin Fetal Neonatal Med 2007;12:143-50.
3. NIDA. References. National Institute on Drug Abuse website. https://nida.nih.gov/publications/research-reports/substance-use-in-women/references. October 14, 2022 Accessed December 9, 2022
4. Forray A, Foster D. Substance Use in the Perinatal Period. Curr Psychiatry Rep 2015;17:91.
5. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics 2014;134: e547–61.
6. Hudak ML, Tan RC; Commıttee On Drugs; Commıttee On Fetus And Newborn; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012;129:e540-60.
7. Unodc - Unıted Natıons Offıce On Drugs And Crıme. 2019. World drug report 2019. Nova York: United Nations. Available from: https://www.unodc.org/wdr2019/index. html. Assesed 06 March 2023.
8. Wouldes TA, Lester BM. Stimulants: How big is the problem and what are the effects of prenatal exposure? Semin Fetal Neonatal Med 2019;24:155-60.

9. Warner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980–2008. NCHS Data Brief 2011:1–8.
10. Smid MC, Metz TD, Gordon AJ. Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women. Clin Obstet Gynecol 2019;62:168-84.
11. United Nations Office on drug and crime. Methamphetamine use on rise in east and SoutheastAsia.Availablefrom: https://www.unodc.org/unodc/en/frontpage/2012/December/methamphetamine-use-on-the-rise-in-east-and-south-east-asia.html. Assesed 06 March 2023.
12. Wells C, Loshak H. Treatment of Neonatal Abstinence Syndrome due to Crystal Methamphetamine: A Review of Clinical Effectiveness and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; June 7, 2019.
13. Logan BA, Brown MS, Hayes MJ. Neonatal abstinence syndrome: treatment and pediatric outcomes. Clin Obstet Gynecol 2013;56:186-92.
14. Jansson LM, Patrick SW. Neonatal Abstinence Syndrome. Pediatr Clin North Am 2019;66:353-67.
15. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012;307:1934-40.
16. Grim K, Harrison TE, Wilder RT. Management of neonatal abstinence syndrome from opioids. Clin Perinatol 2013;40:509-24.
17. Jones HE, Finnegan LP, Kaltenbach K. Methadone and buprenorphine for the management of opioid dependence in pregnancy. Drugs 2012;72:747-57.
18. Bakstad B, Sarfi M, Welle-Strand GK, Ravndal E. Opioid maintenance treatment during pregnancy: occurrence and severity of neonatal abstinence syndrome. A national prospective study. Eur Addict Res 2009;15:128-34.
19. Lejeune C, Simmat-Durand L, Gourarier L, Aubisson S, Groupe d'Etudes Grossesse et Addictions (GEGA). Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenophine substitution. Drug Alcohol Depend 2006;82:250-7.
20. Debelak K, Morrone WR, O'Grady KE, Jones HE. Buprenorphine + naloxone in the treatment of opioid dependence during pregnancy-initial patient care and outcome data. Am J Addict 2013;22:252-4.
21. Tran EL, Kim SY, England LJ, Green C, Dang EP, Broussard CS, et al. The MATernaL and Infant NetworK to Understand Outcomes Associated with Treatment of Opioid Use Disorder During Pregnancy (MAT-LINK): Surveillance Opportunity. J Womens Health (Larchmt) 2020;29:1491-9.
22. Kandall SR, Gartner LM. Late presentation of drug withdrawal symptoms in newborns. Am J Dis Child 1974;127:58-61.
23. Selma Aktaş, Leman Tuba Karakurt, Seda Geylani Güleç. In Utero Synthetic Cannabinoid Exposure. JAREM 2017; 7: 42-4.
24. Özel Ş, Tayman C, Üstün Y, Korkut S, Yorgancı A, Parpucu H, et al. Evaluation of neonatal abstinence syndrome (Nas) frequency and systemic inflammatory response in Nas. Turkish J Pediatr Dis 2019; 13: 171-6.
25. Motlagh AJ, Davoodvandi A, Saeieh SE. Association between vitamin D level in mother's serum and the level of vitamin D in the serum of pre-term infants. BMC Pediatr 2023;23:97.
26. The American College of Obstetricians and Gynecologists. Routine tests during pregnancy. ACOG https://www.acog.org/Patients/FAQs/ Routine- Tests-During- Pregnancy (2017) https://www.acog.org/womens-health/faqs/routine-tests-during-pregnancy
27. Patrick SW, Bauer AM, Warren MD, Jones TF, Wester C. Hepatitis C Virus Infection Among Women Giving Birth- Tennessee and United States, 2009-2014. MMWR Morb Mortal Wkly Rep 2017;66:470-3.