lunes, 21 de noviembre de 2011

Síndrome de abstinencia en neonatos


Actualización del manejo farmacológico de los neonatos con síndrome de abstinencia.
Update on the pharmacologic management of neonatal abstinence syndrome
L L Bio, A Siu and C Y Poon
Journal of Perinatology (2011) 31, 692-701; doi:10.1038/jp.2011.116; published online 25 August 2011
Although a statement on Neonatal Drug Withdrawal was published in 1998 by the American Academy of Pediatrics, pharmacologic management of neonatal abstinence syndrome (NAS) remains a challenge. Published clinical trials are limited, restricting treatment decision making to practitioner's experience and preference rather than evidence-based medicine. To optimize withdrawal symptom prevention, drug selection is often based on the offending agent (opioids versus polysubstance exposure), clinical presentation, mechanism of action (agonist versus partial agonist/antagonist, receptor effects), pharmacokinetic parameters and available drug formulations. This review addresses risk factors and pathophysiology of NAS, summarizes parameters of common drugs used for the management of NAS, and reviews published literature of standard therapies as well as newer agents. Based on the current literature, paregoric is no longer recommended and oral morphine solutions remain the mainstay of therapy for opiate withdrawal. Other potential therapies include methadone, buprenorphine, phenobarbital and clonidine with the latter two agents as adjunctive therapies.
Keywords: buprenorphine; methadone; morphine; opioids; tincture of opium
http://www.nature.com/jp/journal/v31/n11/pdf/jp2011116a.pdf
 
Manejo ocasional de la exposición de neonatos a narcóticos
The occasional management of narcotic exposure in neonates.
Kelly L, Minty B, Madden S, Dooley J, Antone I.
Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, Ont. lkelly@mcmaster.ca
Can J Rural Med. 2011 Summer;16(3):98-101.
Abuse of long-acting oxycodone is becoming commonplace  in northwestern Ontario. Among the many social and medical problems that arise from this is an increased incidence of use during pregnancy, leading to passive exposure and withdrawal in neonates. There are few Canadian data on the incidence of maternal narcotic abuse or neonatal abstinence syndrome (NAS). Standardization of diagnosis and treatment is still developing in the literature, as are treatment protocols among institutions. This paper will summarize relevant research findings and practical
treatment options for rural clinicians.
http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjrm/vol-16/issue-3/pdf/pg98.pdf  
Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
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