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. 2009 May;143(1-2):138-46.
doi: 10.1016/j.pain.2009.02.014.

Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants

Ruth E Grunau  1 , Michael F Whitfield, Julianne Petrie-Thomas, Anne R Synnes, Ivan L Cepeda, Adi Keidar, Marilyn Rogers, Margot Mackay, Philippa Hubber-Richard, Debra Johannesen
Affiliations

Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants

Ruth E Grunau et al. Pain. 2009 May.

Abstract

Procedural pain in the neonatal intensive care unit triggers a cascade of physiological, behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm, who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development. The aim of this study was to examine relationships between cumulative procedural pain (number of skin-breaking procedures from birth to term, adjusted for early illness severity and overall intravenous morphine exposure), and later cognitive, motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age (CCA), and further, to evaluate the extent to which parenting factors modulate these relationships over time. Participants were N=211 infants (n=137 born preterm 32 weeks gestational age [GA] and n=74 full-term controls) followed prospectively since birth. Infants with significant neonatal brain injury (periventricular leucomalacia, grade 3 or 4 intraventricular hemorrhage) and/or major sensori-neural impairments, were excluded. Poorer cognition and motor function were associated with higher number of skin-breaking procedures, independent of early illness severity, overall intravenous morphine, and exposure to postnatal steroids. The number of skin-breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation. In general, greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months, but not at 18 months CCA, however, specific protocols for morphine administration were not evaluated. Lower parenting stress modulated effects of neonatal pain, only on cognitive outcome at 18 months.

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Conflict of interest statement

Conflict of interest

None of the authors had any financial or other relationship that might lead to a conflict of interest.

Figures

Fig. 1
Fig. 1
Residual regression scores of neonatal predictors (cumulative pain from birth to term, adjusted for early illness severity, intravenous morphine exposure and days on postnatal dexamethasone) in relation to MDI at 8 months CCA.
Fig. 2
Fig. 2
Residual regression scores of neonatal predictors (cumulative pain from birth to term, adjusted for early illness severity, intravenous morphine exposure and days on postnatal dexamethasone) in relation to MDI at 18 months CCA.
Fig. 3
Fig. 3
Residual regression scores of neonatal predictors (cumulative pain from birth to term, adjusted for early illness severity, intravenous morphine exposure and days on postnatal dexamethasone) in relation to PDI at 8 months CCA.
Fig. 4
Fig. 4
Residual regression scores of neonatal predictors (cumulative pain from birth to term, adjusted for early illness severity, intravenous morphine exposure and days on postnatal dexamethasone) in relation to PDI at 18 months CCA.
See this image and copyright information in PMC

References

    1. Abidin RR. Parenting stress index. 3. Odessa (FL): Psychological Assessment Resources, Inc; 1995.
    1. Anand KJ. Effects of perinatal pain and stress. Prog Brain Res. 2000;122:117–29. - PubMed
    1. Anand KJS, Garg S, Rovnaghi CR, Narsinghani U, Bhutta AT, Hall RW. Ketamine reduces the cell death following inflammatory pain in newborn rat brain. Pediatr Res. 2007;62:283–90. - PubMed
    1. Anand KJ, Hall RW, Desai N, Shephard B, Bergqvist LL, Young TE, Boyle EM, Carbajal R, Bhutani VK, Moore MB, Kronsberg SS, Barton BA NEOPAIN Trial Investigators Group. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet. 2004;363:1673–82. - PubMed
    1. Anderson PJ, Doyle LW. Cognitive and educational deficits in children born extremely preterm. Semin Perinatol. 2008;32:51–8. - PubMed

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