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    • Cerebral Perfusion and Neurological Examination Characterise Neonatal Opioid Withdrawal Syndrome: a Prospective Cohort Study

    Kristen L. Benninger,Jin Peng,Mai-Lan Ho,Julia Newton,Danny J. J. Wang,Houchun H. Hu,Ann R. Stark,Jerome A. Rusin,Nathalie L. Maitre

    Archives of Disease in Childhood-Fetal and Neonatal Edition（2022）SCI 1区

    Nationwide Childrens Hosp | Univ Southern Calif | Beth Israel Deaconess Med Ctr | Emory Univ

    Cited 2|Views36
    Abstract
    Objective To test the hypothesis that cerebral blood flow (CBF) assessed with arterial spin labelling (ASL) MRI is increased and standardised neurological examination is altered in infants with neonatal opioid withdrawal syndrome (NOWS) compared with those without. Design Prospective cohort study. Setting Level IV neonatal intensive care unit and outpatient primary care centre. Participants Infants with NOWS receiving pharmacological treatment and unexposed controls matched for gestational age at birth and post-menstrual age at MRI. Main outcomes CBF assessed by ASL on non-sedated 3-Tesla MRI and standardised Hammersmith Neonatal Neurological Examination (HNNE) within 14 days of birth. Results Thirty infants with NOWS and 31 control infants were enrolled and included in the final analysis. Global CBF across the brain was higher in the NOWS group compared with controls (14.2 mL/100 g/min +/- 5.5 vs 10.7 mL/100 g/min +/- 4.3, mean +/- SD, Cohen's d=0.72). HNNE total optimality score was lower in the NOWS group compared with controls (25.9 +/- 3.6 vs 28.4 +/- 2.4, mean +/- SD, Cohen's d=0.81). A penalised logistic regression model including both CBF and HNNE items discriminated best between the two groups. Conclusions Increased cerebral perfusion and neurological examination abnormalities characterise infants with NOWS compared with those without intrauterine drug exposure and suggest prenatal substance exposure affects fetal brain development. Identifying neurological and neuroimaging characteristics of infants with NOWS can contribute to understanding mechanisms underlying later outcomes and to designing potential new treatments. This prospective cohort study found that 30 infants with neonatal opioid withdrawal syndrome had higher global cerebral blood flow and more neurological exam abnormalities than 31 unexposed controls. Follow-up to determine these infants' neurodevelopmental courses is required.
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    neonatology,neurology,toxicology
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    【要点】：该论文通过前瞻性队列研究测试了 neonatal opioid withdrawal syndrome (NOWS) 婴儿的脑血流量 (CBF) 通过动脉自旋标记 (ASL) MRI 评估是否增加以及标准化的神经学检查是否异常，与未暴露于药物的婴儿相比。
    

    【方法】：研究设置在四级新生儿重症监护单元和门诊初级护理中心，入组接受药物治疗的有NOWS婴儿和与出生时妊娠年龄和MRI时月经后年龄相匹配的未暴露对照组，主要结果为非镇静状态下3特斯拉MRI上通过ASL评估的CBF和出生后14天内标准化的Hammersmith新生儿神经学检查(HNNE)。
    

    【实验】：研究最终分析了30名NOWS婴儿和31名对照婴儿的数据。与对照组相比，NOWS组的全球脑血流量更高（14.2 mL/100 g/min ± 5.5 对 10.7 mL/100 g/min ± 4.3，平均 ± 标准差，Cohen's d=0.72）。HNNE总优化分数在NOWS组中较低（25.9 ± 3.6 对 28.4 ± 2.4，平均 ± 标准差，Cohen's d=0.81）。包括CBF和HNNE项目的惩罚逻辑回归模型在两组之间最佳地区分。结论是，与未暴露于子宫内药物的婴儿相比，NOWS婴儿的脑灌注增加和神经学检查异常，这表明宫内物质暴露影响胎儿大脑发育。确定患有NOWS的婴儿的神经学和神经影像学特征可以帮助理解后来结果的机制，并设计潜在的新治疗方法。这项前瞻性队列研究发现，30名患有新生儿阿片类药物戒断综合症的婴儿的全球脑血流量更高，神经学检查异常较31名未暴露对照组婴儿更多。需要随访以确定这些婴儿的神经发育情况。