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

Ferguson, Sherry A.; Ward, Wendy L.; Paule, Merle G.; Hall, Richard; Anand, K. J. S.

doi:10.1016/j.ntt.2011.10.008

Cited by 125 publications

(134 citation statements)

References 65 publications

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“…Conversely, other studies showed needless analgesic therapy prolongs need for mechanical ventilation, delays feeding, or leads to other sequelae including impaired brain growth, poor socialization skills, and impaired performance in short-term memory tasks 17,18 . About 460,000 neonates in the US require care in Neonatal ICUs (NICUs) each year and are exposed to acute pain from invasive procedures or prolonged pain from surgery or inflammation 22-24 .…”

Section: Introductionmentioning

confidence: 98%

“…Numerous clinical studies have demonstrated that failure to treat pain leads to short-term complications and long-term physiological, behavioral, cognitive sequelae including altered pain processing, attention deficit disorder, impaired visual-perceptual ability or visual-motor integration 17-19 , and poor executive functions 20,21 . Conversely, other studies showed needless analgesic therapy prolongs need for mechanical ventilation, delays feeding, or leads to other sequelae including impaired brain growth, poor socialization skills, and impaired performance in short-term memory tasks 17,18 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pain Management in Newborns

Hall¹,

Anand

2014

Clinics in Perinatology

213

126

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Effective pain management is a desirable standard of care for preterm and term newborns and may potentially improve their clinical and neurodevelopmental outcomes. Neonatal pain should be assessed routinely using context-specific, validated and objective pain methods, despite the limitations of currently available tools. Reducing invasive procedures, and using pharmacological, behavioral or environmental measures can be used to manage neonatal pain. Non-pharmacologic approaches include kangaroo care, facilitated tucking, non-nutritive sucking, sucrose and other sweeteners, massage and acupuncture therapy. They are used for procedures causing acute, transient, or mild pain, or as adjunctive therapy for moderate or severe pain. Local and topical anesthetics can reduce the acute pain caused by skin-breaking or mucosa-injuring procedures. Opioids form the mainstay for treatment of severe pain; morphine and fentanyl are the most commonly used drugs, although other opioids are also available. Non-opioid drugs include various sedatives and anesthetic agents, mostly used as adjunctive therapy in ventilated neonates. Acetaminophen, ibuprofen and other drugs are used for neonates, although their efficacy and safety remains unproven. Approaches for implementing an effective pain management program in the Neonatal ICU are summarized, together with practical protocols for procedural, postoperative, and mechanical ventilation-associated neonatal pain and stress.

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Pain Management in Newborns

Hall¹,

Anand

2014

Clinics in Perinatology

213

126

View full text Add to dashboard Cite

show abstract

“…Further details, including the background characteristics of the participants, can be found in the original article. 20 Follow-Up Study (8)(9) Years)…”

Section: Original Studymentioning

confidence: 99%

“…14,21,25 In humans, participants of 2 randomized controlled trials (RCTs) on neonatal morphine administration were studied 5 years after the original RCT was conducted. 1,20 The first, a small-scale follow-up of the NEOPAIN (Neurologic Outcomes and Pre-emptive Analgesia in Neonates) trial, 9 showed that children who had received morphine (n = 14) had a smaller head circumference, weighed less, and had more social problems than children who had received placebo (n = 5). The second, performed in our institution, showed that children who had received morphine (n = 49) performed more poorly on 1 subtest of the intelligence scale than did the children who had received placebo (n = 41); other neurobehavioral outcomes and the incidences of chronic pain were comparable between the 2 groups.…”

mentioning

confidence: 99%

Long-Term Effects of Neonatal Morphine Infusion on Pain Sensitivity: Follow-Up of a Randomized Controlled Trial

Valkenburg

Bosch

Graaf

et al. 2015

The Journal of Pain

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“…Based on the existing evidence, 4 studies have analyzed the relationship between exposure to neonatal analgesic/sedative drugs and outcome at schoolgoing age [92,93,94,95]. None of these trials were designed to assess long-term outcomes.…”

Section: Pain Analgesia and Sedationmentioning

confidence: 99%

Impact of Common Treatments Given in the Perinatal Period on the Developing Brain

et al. 2014

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Background: Over the last decades, considerable progress has been made in the perinatal management of high-risk preterm neonates, changing the landscape of pathological conditions associated with neurological impairments. Major focal destructive lesions are now less common, and the predominant neuropathological lesion is diffuse white-matter damage in the most immature infants. Similarly, over the last few years, we have observed a trend towards a decrease in neurological impairment in the absence of treatments specifically aimed at neuroprotection. Objectives: We examined whether recent changes in treatment strategies in perinatal care during the perinatal period could have had an indirect beneficial impact on the occurrence of brain lesions and their consequences. Methods: Thus, we reviewed the effects of the most common treatments administered during the perinatal period to the mother or to very preterm infants on brain damage and neurocognitive follow-up. Results: Antenatal steroids and exogenous surfactant are the two main treatments capable of leading to neuroprotection in very preterm infants. Randomized controlled trials are currently investigating the effects of inhaled nitric oxide and erythropoietin, while antenatal magnesium sulphate and caffeine are also likely to provide some neuroprotection, but this needs to be further investigated. Finally, other common treatments against pain, haemodynamic failure and patent ductus arteriosus have conflicting or no effects on the developing brain. Conclusion: While specific neuroprotective drugs are still awaited, recent advances in perinatal care have been associated with an unexpected but significant decrease in the incidence of both severe brain lesions and neurological impairment.

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

Cited by 125 publications

References 65 publications

Pain Management in Newborns

Pain Management in Newborns

Long-Term Effects of Neonatal Morphine Infusion on Pain Sensitivity: Follow-Up of a Randomized Controlled Trial

Impact of Common Treatments Given in the Perinatal Period on the Developing Brain

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