M Ranger1, A R Synnes, J Vinall, R E Grunau. 1. Department of Paediatrics, University of British Columbia, Vancouver, Canada; Developmental Neurosciences & Child Health, Child & Family Research Institute, Vancouver, BC, Canada.
Abstract
BACKGROUND: Greater neonatal pain is associated with higher internalizing behaviours in very preterm infants at 18 months corrected age, but it is unknown whether this relationship persists to school age. Moreover, it is unclear whether morphine ameliorates or exacerbates the potential influence of neonatal pain/stress on internalizing behaviours. We examined whether neonatal pain-related stress is associated with internalizing behaviours at age 7 years in children born very preterm, and whether morphine affects this relationship. METHODS: One hundred one children born very preterm (≤32 weeks gestation) were seen at mean age 7.7 years. A parent completed the Parenting Stress Index and Child Behavior Checklist questionnaires. Neonatal pain-related stress (the number of skin-breaking procedures adjusted for clinical factors associated with prematurity) was examined in relation to internalizing behaviour, separately in subjects mechanically ventilated and exposed to both pain and morphine (n = 57) and those never mechanically ventilated, exposed to pain but not morphine (n = 44). RESULTS: In the non-ventilated group, higher skin-breaking procedures (p = 0.037) and parenting stress (p = 0.004) were related to greater internalizing behaviours. In the ventilated group, greater morphine exposure (p = 0.004) was associated with higher child internalizing scores. CONCLUSIONS: In very preterm children who undergo mechanical ventilation, judicious use of morphine is important, since morphine may mitigate the negative effects of neonatal pain on nociception but adversely affect internalizing behaviours at school age. Management of procedural pain needs to be addressed in very preterm infants in the neonatal intensive care unit, to prevent long-term effects on child behaviour.
BACKGROUND: Greater neonatal pain is associated with higher internalizing behaviours in very preterm infants at 18 months corrected age, but it is unknown whether this relationship persists to school age. Moreover, it is unclear whether morphine ameliorates or exacerbates the potential influence of neonatal pain/stress on internalizing behaviours. We examined whether neonatal pain-related stress is associated with internalizing behaviours at age 7 years in children born very preterm, and whether morphine affects this relationship. METHODS: One hundred one children born very preterm (≤32 weeks gestation) were seen at mean age 7.7 years. A parent completed the Parenting Stress Index and Child Behavior Checklist questionnaires. Neonatal pain-related stress (the number of skin-breaking procedures adjusted for clinical factors associated with prematurity) was examined in relation to internalizing behaviour, separately in subjects mechanically ventilated and exposed to both pain and morphine (n = 57) and those never mechanically ventilated, exposed to pain but not morphine (n = 44). RESULTS: In the non-ventilated group, higher skin-breaking procedures (p = 0.037) and parenting stress (p = 0.004) were related to greater internalizing behaviours. In the ventilated group, greater morphine exposure (p = 0.004) was associated with higher child internalizing scores. CONCLUSIONS: In very preterm children who undergo mechanical ventilation, judicious use of morphine is important, since morphine may mitigate the negative effects of neonatal pain on nociception but adversely affect internalizing behaviours at school age. Management of procedural pain needs to be addressed in very preterm infants in the neonatal intensive care unit, to prevent long-term effects on child behaviour.
Authors: Mai Thanh Tu; Ruth E Grunau; Julie Petrie-Thomas; David W Haley; Joanne Weinberg; Michael F Whitfield Journal: Dev Psychobiol Date: 2007-03 Impact factor: 3.038
Authors: Diane Holditch-Davis; Margaret Shandor Miles; Mark A Weaver; Beth Black; Linda Beeber; Suzanne Thoyre; Stephen Engelke Journal: J Dev Behav Pediatr Date: 2009-06 Impact factor: 2.225
Authors: Ruth E Grunau; Michael F Whitfield; Julianne Petrie-Thomas; Anne R Synnes; Ivan L Cepeda; Adi Keidar; Marilyn Rogers; Margot Mackay; Philippa Hubber-Richard; Debra Johannesen Journal: Pain Date: 2009-05 Impact factor: 6.961
Authors: Beatriz O Valeri; Manon Ranger; Cecil M Y Chau; Ivan L Cepeda; Anne Synnes; Maria Beatriz M Linhares; Ruth E Grunau Journal: Clin J Pain Date: 2016-12 Impact factor: 3.442
Authors: M M Sperry; B M Kandel; S Wehrli; K N Bass; S R Das; P S Dhillon; J C Gee; G A Barr Journal: Neuroscience Date: 2017-04-06 Impact factor: 3.590