Exposition prénatale aux opioïdes: conséquences neurodéveloppementales et priorités de recherche futures

Aperçu: G.M.

La prévalence du syndrome de sevrage néonatal aux opioïdes (NOWS) est passée de 1,2 pour 1 000 naissances en 2000 à 5,8 pour 1 000 en 2012. Les symptômes chez les nouveau-nés peuvent inclure des pleurs aigus, des tremblements, des difficultés d'alimentation, de l'hypertonie, des selles liquides et des problèmes respiratoires. Cependant, les conséquences neurodéveloppementales de l'exposition prénatale aux opioïdes chez le nourrisson, le jeune enfant et le milieu de l'enfance sont mal connues. On en sait encore moins sur les résultats cognitifs, comportementaux et scolaires des enfants qui développent NOWS. 

Nous passons en revue l’état de la littérature sur les conséquences neurodéveloppementales de l’exposition prénatale aux opioïdes, en mettant l’accent sur les études dans lesquelles les résultats de NOWS ont été examinés. Dans le but de réduire l'incidence de l'exposition prénatale aux opioïdes dans un proche avenir, nous soulignons la nécessité de mener de vastes études avec des participants recrutés de manière prospective et des schémas longitudinaux, en tenant compte de facteurs de confusion tels que le statut socio-économique, les variations institutionnelles dans les soins et l'utilisation par la mère d'autres substances , pour évaluer indépendamment l’impact total de NOWS. 

Comme solution plus immédiate, nous fournissons un programme de recherche future qui exploite le programme Influences environnementales des instituts nationaux de la santé sur les résultats pour la santé des enfants afin de remédier à de nombreuses lacunes méthodologiques graves dans la littérature, et nous répondons aux questions clés concernant les perspectives à court et à long terme. neurodéveloppemental à long terme des enfants exposés aux opioïdes avant la naissance.

Pediatrics. 2019 Aug 28. pii: e20190128. doi: 10.1542/peds.2019-0128.

Prenatal Opioid Exposure: Neurodevelopmental Consequences and Future Research Priorities

Conradt E¹, Flannery T², Aschner JL^3,4, Annett RD⁵, Croen LA⁶, Duarte CS^7,8, Friedman AM⁹, Guille C¹⁰, Hedderson MM⁶, Hofheimer JA¹¹, Jones MR¹², Ladd-Acosta C^12,13, McGrath M¹², Moreland A¹⁴, Neiderhiser JM¹⁵, Nguyen RHN¹⁶, Posner J⁸, Ross JL¹⁷, Savitz DA¹⁸, Ondersma SJ¹⁹, Lester BM^20,21.

Author information

1

Departments of Psychology, Pediatrics, and Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; elisabeth.conradt@psych.utah.edu.

2

School of Public Health, and.

3

Department of Pediatrics, Albert Einstein College of Medicine, New York, New York.

4

Department of Pediatrics, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, New Jersey.

5

Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi.

6

Division of Research, Kaiser Permanente, Oakland, California.

7

New York State Psychiatric Institute.

8

Department of Psychiatry, Columbia University, New York, New York.

9

Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York.

10

Department of Psychiatry and Behavioral Sciences and.

11

Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

12

Department of Epidemiology and.

13

Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

14

National Crime Victims Research and Treatment Center, Medical University of South Carolina, Columbia, South Carolina.

15

Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania.

16

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.

17

Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and.

18

Department of Epidemiology.

19

Merrill Palmer Skillman Institute and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan.

20

Brown Center for the Study of Children at Risk and Departments of Psychiatry and Human Behavior and Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island.

21

Women and Infants Hospital in Rhode Island, Providence, Rhode Island.

Abstract

Neonatal opioid withdrawal syndrome (NOWS) has risen in prevalence from 1.2 per 1000 births in 2000 to 5.8 per 1000 births in 2012. Symptoms in neonates may include high-pitched cry, tremors, feeding difficulty, hypertonia, watery stools, and breathing problems. However, little is known about the neurodevelopmental consequences of prenatal opioid exposure in infancy, early childhood, and middle childhood. Even less is known about the cognitive, behavioral, and academic outcomes of children who develop NOWS. We review the state of the literature on the neurodevelopmental consequences of prenatal opioid exposure with a particular focus on studies in which NOWS outcomes were examined. Aiming to reduce the incidence of prenatal opioid exposure in the near future, we highlight the need for large studies with prospectively recruited participants and longitudinal designs, taking into account confounding factors such as socioeconomic status, institutional variations in care, and maternal use of other substances, to independently assess the full impact of NOWS. As a more immediate solution, we provide an agenda for future research that leverages the National Institutes of Health Environmental Influences on Child Health Outcomes program to address many of the serious methodologic gaps in the literature, and we answer key questions regarding the short- and long-term neurodevelopmental health of children with prenatal opioid exposure.

Copyright © 2019 by the American Academy of Pediatrics.

PMID:31462446

DOI:10.1542/peds.2019-0128