A pilot study of preemptive morphine analgesia in preterm neonates: effects on head circumference, social behavior, and response latencies in early childhood |
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Authors: | Ferguson Sherry A Ward Wendy L Paule Merle G Hall R Whit Anand K J S |
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Affiliation: | a Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, United Statesb Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR, United Statesc Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, AR, United Statesd Department of Pediatrics, Division of Critical Care Medicine, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, United States |
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Abstract: | 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 ex-preterm 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's d: 2.83, effect size large) and body weight was approximately 4% less (Cohen'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 < 0.03) and completed approximately 27% less of the task than placebo children (Cohen'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'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. |
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Keywords: | Prematurity Morphine Preemptive analgesia Neuropsychology Cognition Delayed matching to sample |
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