Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

Abstract

Premature infants are at risk for adverse motor outcomes, including cerebral palsy and developmental coordination disorder. The purpose of this study was to examine the relationship of ante-, peri-, and postnatal risk factors for abnormal development of the corticospinal tract, the major voluntary motor pathway, during the neonatal period. In a prospective cohort study, 126 premature neonates (24-32 weeks gestational age) underwent serial brain imaging near birth and at term-equivalent age. Using diffusion tensor tractography, mean diffusivity and fractional anisotropy of the corticospinal tract were measured to reflect microstructural development. Generalized estimating equation models examined associations of risk factors on corticospinal tract development.The perinatal risk factor of greater early illness severity [as measured by the Score for Neonatal Acute Physiology-II (SNAP-II)] was associated with a slower rise in fractional anisotropy of the corticospinal tract (p=0.02), even after correcting for gestational age at birth and postnatal risk factors (p=0.009). Consistent with previous findings, neonatal pain adjusted for morphine and postnatal infection were also associated with a slower rise in fractional anisotropy of the corticospinal tract (p=0.03 and 0.02 respectively). Lessening illness severity in the first hours of life might offer potential to improve motor pathway development in premature newborns.

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

“…1,2 Recurring pain in neonates leads to poor cognition 3 and motor function, 4 impaired brain development, 5,6 and altered pain responses. 7 Since care in the neonatal intensive care unit (NICU) involves invasive and noninvasive procedures, mechanical ventilation, and medical or surgical disorders that can cause pain or stress, widespread practices include the administration of sedation and analgesia to patients in the NICU.…”

Invasive Procedures in Preterm Children: Brain and Cognitive Development at School Age

“…Previously, it has been demonstrated that a higher number of invasive and stressful procedures was associated with delayed WM maturation in infants born very preterm both during NICU care and at term-equivalent age. 7,8,25 Higher numbers of invasive procedures are associated with lower stress hormone cortisol responses at 32 weeks' postmenstrual age and higher levels at 8 and 18 months' corrected age. 26,27 Brain regions rich in glucocorticoid receptors (eg, prefrontal cortex) are particularly vulnerable to the effects of ongoing stress.…”

“…[4][5][6] Infants born very preterm undergo frequentinvasive procedures duringneonatal care. Greater numbers of invasive procedures, adjusted for clinical confounders, are associated with abnormal brain development up until term-equivalent age 7,8 and altered functional cortical activity at school age. 9 Moreover, higher numbers of invasive procedures have been found to be associated with poorer cognitive outcome at 18 months' corrected age in children born very preterm.…”

Impact of Recurring Technical Pain-Associated Stress in Preterm Infants

“…Significantly, correlations among infant pain-associated stress and brain maturity also seems to expand further than the affiliations examined in early existence (Brummelte S et al 2012, Zwicker JG 2013. Elevated figures of skinflouting procedures were linked with leaner cortical gray substance in 21 beyond 66 cerebral areas evaluated at 7 years of age, mostly involving the frontal and parietal lobes (Duhrsen L, Simons SH, Dzietko M 2013).…”