A pilot study of preemptive morphine analgesia in preterm neonates: Effects on head circumference, social behavior, and response latencies in early childhood

作者：Ferguson Sherry A^*; Ward Wendy L; Paule Merle G; Hall R Whit; Anand K J S

来源：Neurotoxicology and Teratology, 2012, 34(1): 47-55.

DOI：10.1016/j.ntt.2011.10.008

• Prematurity
• Morphine
• Preemptive analgesia
• Neuropsychology
• Cognition
• Delayed matching to sample

Use of preemptive analgesia in Neonatal Intensive Care Units is recommended for severe and/or invasive procedures. However, the potential long-term consequences of such analgesia, which may be prolonged, are only beginning to be studied. In this pilot study, a subset of subjects previously enrolled in the Neurological Outcomes and Preemptive Analgesia in Neonates (NEOPAIN) trial was assessed at early childhood. These expreterm infants (born at 23-32 weeks of gestational age) required intubation within 72 h postpartum and were randomized to receive either preemptive morphine analgesia (maximum of 14 days) or placebo within 8 h post-intubation. At 5-7 years of age, neuropsychological outcomes, morphometrics, adaptive behavior, parent-rated behavior, motivation, and short-term memory were measured. Although overall IQ and academic achievement did not differ between the morphine treated (n=14) and placebo (n=5) groups, preemptive morphine analgesia was associated with distinct differences in other outcome variables. Head circumference of morphine treated children was approximately 7% smaller (Cohen%26apos;s d: 2.83, effect size large) and body weight was approximately 4% less (Cohen%26apos;s d: 0.81, effect size large); however, height did not differ. In the short-term memory task (delayed matching to sample), morphine treated children exhibited significantly longer choice response latencies than placebo children (3.86 +/- 0.33 and 2.71 +/- 0.24 s, respectively) (p%26lt;0.03) and completed approximately 27% less of the task than placebo children (Cohen%26apos;s d: 0.96, effect size large). Parents described morphine treated children as having more social problems, an effect specific to creating and maintaining friendships (Cohen%26apos;s d: -0.83, effect size large). Despite the small sample size and the preliminary nature of this study, these results are strongly suggestive of long-lasting effects of preemptive morphine analgesia. A larger investigation with more comprehensive assessments of some of these key features will enable a more complete understanding of the relationship between preemptive morphine treatment and long-term neurocognitive, behavioral, and adaptive outcomes. Published by Elsevier Inc.

• 出版日期2012-2