Clinically defining the opioid-exposed birthing person and infant as a dyad to support bedside care, surveillance, and research

Introduction An increased incidence of maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) has prompted recommendations supporting a dyadic approach to care for birthing persons and their infants. However, there are no consensus guidelines outlining how the dyad is clinically defined. Methods To examine how the opioid-exposed birthing person-infant dyad has been defined for purposes of data collection and research, a literature review applying the RAND/UCLA Appropriateness Method was conducted. Results The search yielded 320 abstracts, with 110 articles identified as having a dyadic focus. While no articles included a specific definition for the dyad, 33 (30%) contained a descriptive reference to the birthing person-infant dyad. Thematic analysis revealed eight recurring elements characteristic of the dyad: (1) engagement, (2) communication, (3) bonding, (4) attachment, (5) mutual responsiveness, (6) reciprocity, (7) synchrony, and (8) attunement. Integrating these elements revealed the interactional relationship between the opioid-exposed birthing person and infant as the foundational principle that defines the dyad. Discussion This definition shifts the focus of the opioid-exposed dyad from two individual patient populations to an interactional relationship that has broad applicability for clinical use, public health data collection, and research considerations.

### 引言 孕产妇阿片类药物使用障碍（OUD）和新生儿戒断综合征（NAS）的发病率不断上升，这促使人们提出建议，支持对分娩者及其婴儿采取二元护理模式。然而，目前尚无共识性指南来明确这一 “二元体” 在临床上如何定义。 ### 方法 为研究在数据收集和研究中，阿片类药物暴露的分娩者 - 婴儿二元体是如何定义的，我们运用兰德/加州大学洛杉矶分校适宜性方法进行了文献综述。 ### 结果 检索共得到320篇摘要，其中110篇文章聚焦于二元体。虽然没有文章对该二元体给出具体定义，但33篇（30%）文章对分娩者 - 婴儿二元体有描述性提及。主题分析揭示了该二元体反复出现的八个特征要素：（1）参与度，（2）沟通，（3）情感联结，（4）依恋，（5）相互反应性，（6）互惠性，（7）同步性，（8）协调性。整合这些要素后发现，阿片类药物暴露的分娩者与婴儿之间的互动关系是定义该二元体的基本原则。 ### 讨论 这一定义将阿片类药物暴露二元体的关注点从两个独立的患者群体，转移到一种互动关系上，这种关系在临床应用、公共卫生数据收集和研究考量方面具有广泛的适用性。