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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Published on: August 25, 2014

Does neonatal morphine use affect neuropsychological outcomes at 8 to 9 years of age?

Joke de Graaf1, Richard A van Lingen, Abraham J Valkenburg

  • 1Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands Princess Amalia Department of Pediatrics, Department of Neonatology, Isala Clinics, Zwolle, The Netherlands Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands Department of Medical Psychology, Isala Clinics, Zwolle, The Netherlands Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.

Pain
|January 29, 2013
PubMed

Insights

Neonatal morphine treatment did not harm general functioning in children. Follow-up at 8-9 years suggests potential benefits for executive functions, including inhibition and organization, in children who received morphine as newborns.

Area of Science:

  • Neonatal care
  • Pediatric neurology
  • Pharmacology

Background:

  • Morphine is used for severe pain in neonatal intensive care units.
  • Animal studies suggest potential long-term adverse effects of neonatal morphine.
  • Previous follow-up at age 5 found no general functioning deficits but suggested impacts on executive functions.

Purpose of the Study:

  • To assess long-term effects of neonatal morphine on general functioning and executive functions at 8-9 years.
  • To investigate intelligence quotient (IQ), visual motor integration, behavior, and executive functions.
  • To determine if neonatal morphine influences response inhibition and organizational skills.

Main Methods:

  • Second follow-up of children from a neonatal morphine-placebo controlled trial.
  • Assessment of general functioning (IQ, behavior) and executive functions (inhibition, organization, planning).
  • Statistical adjustments for IQ, propensity scores, and open-label morphine use.

Main Results:

  • Morphine-treated children showed fewer externalizing problems (parents) but more internalizing behavior (teachers) after adjustments.
  • Significantly fewer executive function problems in daily life (inhibition, organization, planning) were reported by parents and teachers.
  • Executive functioning, as rated by parents, remained significantly better in the morphine-treated group after adjustments.

Conclusions:

  • Continuous neonatal morphine infusion (10 μg/kg/h) does not impair general functioning at 8-9 years.
  • Neonatal morphine may positively influence executive functions, specifically inhibition and organization.
  • No significant influence of additional open-label morphine was observed on outcome variables.

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