Neonatal abstinence syndrome

Neonatal abstinence syndrome (NAS) yog ib pawg teeb meem uas tshwm sim hauv tus menyuam mos tshiab uas raug cov tshuaj opioid ntev heev thaum nyob hauv leej niam lub tsev menyuam.

NAS yuav tshwm sim thaum tus poj niam cev xeeb tub noj tshuaj xws li heroin, codeine, oxygencodone (Oxycontin), methadone, lossis buprenorphine.

Cov no thiab lwm yam tshuaj kis tau los ntawm cov me nyuam uas txuas tus menyuam rau hauv leej niam lub tsev menyuam. Tus me nyuam yuav vam khom cov tshuaj nrog tus niam.

Yog tias leej niam tseem siv cov tshuaj nyob hauv ib asthiv lossis li ntawd ua ntej xa menyuam, tus menyuam yuav cia siab rau cov tshuaj thaum yug. Vim tias tus me nyuam tsis tau txais tshuaj ntxiv tom qab yug me nyuam, tshem tawm cov tsos mob yuav tshwm sim vim cov tshuaj maj mam tso tawm hauv tus me nyuam lub system.

Kev tshem tawm cov tsos mob kuj yuav tshwm sim hauv cov menyuam yaus uas raug cawv, benzodiazepines, barbiturates, thiab qee yam tshuaj tiv thaiv kev ntxhov siab (SSRIs) thaum nyob hauv niam plab.

Cov menyuam mos ntawm leej niam uas siv tshuaj opioids thiab lwm yam tshuaj ntxiv (nicotine, amphetamines, cocaine, yeeb tshuaj xas, dej cawv) tej zaum yuav muaj teeb meem mus ntev. Txawm tsis muaj pov thawj tseeb rau NAS rau lwm cov tshuaj, lawv tuaj yeem ua rau kom muaj qhov hnyav ntawm tus me nyuam mos cov tsos mob NAS.

Cov tsos mob ntawm NAS nyob ntawm:

• Cov hom tshuaj uas niam siv
• Yuav ua li cas lub cev txhawm rau thiab rhuav tshem cov tshuaj (cuam tshuam los ntawm caj ces)
• Ntau npaum li cas ntawm cov tshuaj nws tau noj
• Ntev npaum li cas nws siv cov tshuaj
• Txawm tus menyuam yug los puv lub sijhawm lossis thaum ntxov (ntxov ntxov)

Cov tsos mob feem ntau pib li ntawm 1 mus rau 3 hnub tom qab yug, tab sis yuav siv sijhawm ntev txog li ib asthiv. Vim tias qhov no, menyuam mos feem ntau yuav tsum tau nyob hauv tsev kho mob rau kev tshuaj xyuas thiab saib xyuas kom ntev txog li ib asthiv.

Cov tsos mob tuaj yeem suav nrog:

• Blotchy tawv nqaij tawv (mottling)
• Zawv plab
• Quaj ntau dhau los yog qhov siab quaj
• Ntau dhau lawm ntxais
• Ua npaws
• Cov leeg rov zoo
• Muaj zog leeg nqaij
• Vauv
• Pluag mov noj
• Ua pa ceev
• Qaug dab peg
• Teeb meem pw tsaug zog
• Lub cev hnyav hnyav dua
• Tawv qhov ntswg, txham
• Tawm hws
• Ntshai (tshee hnyo)
• Ntuav

Ntau lwm yam mob tuaj yeem ua rau tib cov tsos mob li NAS. Txhawm rau pab ntsuas mob, tus kws saib xyuas kev noj qab haus huv yuav nug cov lus nug txog kev siv tshuaj niam. Tej zaum leej niam yuav raug nug txog qhov tshuaj twg uas nws tau noj thaum cev xeeb tub, thiab thaum twg nws tau noj kawg. Tej zaum cov niam cov zis yuav kuaj rau cov tshuaj ib yam nkaus.

Kev ntsuam xyuas uas yuav ua tau los pab ntsuas qhov tshem tawm hauv ib tus menyuam mos muaj xws li:

• NAS qhov qhab nia, uas muab cov ntsiab lus raws li txhua qhov tsos mob thiab nws qhov mob hnyav. Tus me nyuam cov qhab nia tuaj yeem pab txiav txim kho mob.
• ESC (noj, pw tsaug zog, console) kev ntsuam xyuas
• Tshuaj ntsuam qhov tso zis thiab ntawm thawj qhov quav (meconium). Ib daim me me ntawm txoj hlab ntaws kuj tseem siv tau rau kev soj ntsuam tshuaj.

Kev kho mob nyob ntawm:

• Cov tshuaj cuam tshuam nrog
• Tus menyuam mos cov qhab nia noj qab haus huv tag nrho thiab kev tsis saib xyuas
• Txawm tus menyuam yug los puv lub sijhawm lossis hnub nyoog ntxov ntxov los xij

Pab pawg saib xyuas kev noj qab haus huv yuav saib xyuas tus menyuam mos kom zoo txog li ib lub limtiam (lossis ntau dua nyob ntawm tus menyuam lub cev) ua li cas tomqab yug los rau lub cim ntawm kev tshem tawm, teeb meem noj, thiab lub cev hnyav. Cov menyuam mos ntuav lossis tus uas tsis muaj dej txaus hauv lub cev yuav tsum muaj dej los ntawm cov leeg ntshav (IV).

Cov menyuam mos nrog NAS feem ntau npau taws thiab nyuaj ua rau siab tus. Cov lus qhia ua kom txias rau lawv suav nrog kev ntsuas feem ntau hu ua "TLC" (kev sib tw hlub zoo):

• Maj mam co ntawm tus me nyuam
• Txo cov suab nrov thiab lub teeb ua ke
• Daim tawv nqaij los saib xyuas daim tawv nqaij nrog leej niam, lossis muab daim pam los pam tus menyuam
• Kev pub niam mis (yog hais tias tus niam nyob rau hauv tshuaj txiav yeeb (Methadone lossis buprenorphine kho mob yam tsis muaj kev siv tshuaj txhaum cai)

Qee tus menyuam mos uas muaj cov tsos mob hnyav yuav tsum tau siv tshuaj xws li tshuaj txiav yeeb (Methadone) lossis morphine los kho tus mob tshem tawm thiab pab lawv muaj peev xwm noj, pw tsaug zog thiab so. Cov menyuam yaus no yuav tsum tau nyob hauv tsev khomob rau ntau lub limtiam lossis ntau hlis tom qab yug. Lub hom phiaj ntawm kev kho mob yog txhawm rau muab tshuaj rau menyuam mos kom zoo ib yam li cov tshuaj leej niam siv thaum cev xeeb tub thiab maj mam txau tshuaj lub sijhawm. Qhov no pab rau kom me nyuam tsis txhob quav yeeb tshuaj thiab pab txo qee cov tsos mob tshem tawm.

Yog tias cov tsos mob ua rau hnyav, xws li yog lwm yam tshuaj siv, ib qho tshuaj thib ob xws li phenobarbital lossis clonidine yuav raug ntxiv.

Cov menyuam mos uas muaj tus mob no feem ntau muaj pob khaus loj heev lossis lwm qhov chaw ntawm daim tawv nqaij tawg. Qhov no yuav tsum tau kho nrog tshuaj pleev tshwj xeeb lossis pleev.

Cov menyuam yaus tseem yuav muaj teeb meem nrog kev pub mis lossis kev loj hlob qeeb. Cov menyuam no yuav tsum muaj:

• Cov pub mis ntau dua uas muab cov khoom noj khoom haus ntau dua
• Cov kab noj haus me dua muab ntau dua

Txoj kev kho yog pab txo cov tsos mob ntawm thim. Txawm tias tom qab kho NAS dhau thiab cov menyuam yaus tawm hauv tsev kho mob, lawv yuav xav tau "TLC" ntxiv rau cov lis piam lossis hli.

Kev siv tshuaj yeeb thiab dej cawv thaum cev xeeb tub tuaj yeem ua rau ntau yam mob hauv tus menyuam dua li NAS. Cov no suav nrog:

• Kev yug los ua neeg tsis huv
• Tus me nyuam yug hnyav
• Yug ntxov ntxov tau
• Kab taub hau me me
• Cov me nyuam mos cia li tuag tam sauv (SIDS)
• Teeb meem kev tsim kho thiab kev coj cwj pwm

Kev kho mob NAS tuaj yeem ntev li 1 lub lis piam txog 6 hli.

Nco ntsoov tias koj tus kws khomob paub txog txhua yam tshuaj thiab tshuaj noj koj siv thaum cev xeeb tub.

Hu rau koj tus kws khomob yog koj tus menyuam muaj mob NAS.

Tham nrog txhua yam tshuaj, siv yeeb siv tshuaj, dej caw thiab luam yeeb nrog koj tus kws kho mob.

Nug koj tus kws kho mob kom pab sai li sai tau yog tias koj:

• Siv cov tshuaj tsis-khomob
• Siv cov tshuaj tsis tau sau tseg rau koj
• Siv cawv lossis luam yeeb

Yog tias koj twb cev xeeb tub lawm thiab noj tshuaj lossis tshuaj uas tsis tau sau tseg rau koj, nrog koj tus kws kho mob tham txog txoj kev zoo tshaj plaws kom koj thiab tus menyuam muaj kev nyab xeeb. Qee cov tshuaj yuav tsum tsis txhob ua haujlwm yog tsis muaj kev saib xyuas mob, lossis cov teeb meem yuav dhau los. Koj qhov chaw muab kev pab yuav paub zoo tshaj los tswj cov kev pheej hmoo.

NAS; Neonatal tsis meej cov tsos mob

• Neonatal abstinence syndrome

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Hudak ML. Cov menyuam mos ntawm kev siv tshuaj khomob leej niam. Hauv: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff thiab Martin's Neonatal-Perinatal TshuajCov. 11th ed. Philadelphia, PA: Elsevier Saunders; 2020: cha 46.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Tsis sib haum syndromes. Hauv Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, .eds. Nelson Phau Ntawv ntawm PediatricsCov. 21st ed. Philadelphia, PA: Elsevier; 2020: chap 126.