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Cumulative pain-related stress and developmental outcomes among low-risk preterm infants at one year corrected age
Iris Morag1, Ifat Rotem2, Mor Frisch2
1Department of Neonatology, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
Insights
Pain-related stress (PRS) in preterm infants, especially those needing mechanical ventilation, is linked to lower developmental scores at 12 months. This highlights the impact of early life stress on infant neurodevelopment.
Area of Science:
- Neonatal research
- Developmental neuroscience
- Pediatric critical care
Background:
- Preterm infants experience significant pain-related stress (PRS) during critical brain development.
- Early life stress may negatively impact neurodevelopmental trajectories.
Purpose of the Study:
- To investigate the association between early PRS and neurodevelopmental outcomes in very preterm infants.
- To assess outcomes at one year corrected age (CA) in a low-risk cohort.
Main Methods:
- 107 infants born <32 weeks gestational age (GA) were prospectively monitored.
- Pain-related stress (PRS) was quantified using skin-breaking procedures and the Neonatal Infant Stressor Scale (NISS).
- Infants with severe neonatal morbidities were excluded; adjustments were made for early neonatal morbidities.
Main Results:
- Overall developmental outcomes were within the normal range (mean 100±11.03).
- Infants requiring invasive mechanical ventilation (IMV) experienced significantly higher PRS.
- Among IMV infants, greater PRS exposure correlated with lower developmental scores, independent of other factors.
Conclusions:
- Increased PRS in low-risk preterm infants undergoing IMV is associated with diminished developmental scores at 12.5 months CA.
- This suggests a vulnerability to pain-related stress in this population.
Background:
Extensive exposure of preterm infants to pain-related stress (PRS) at a time of physiological immaturity and rapid brain development may contribute to altered neurodevelopment.
Objective:
To examine the relationship between early PRS and neurodevelopmental outcomes among low-risk very preterm infants at the age of one year corrected age (CA).
Methods:
Participants included 107 infants born <32weeks gestational age (GA) and monitored prospectively at 12.5months CA. Excluded were infants with severe neonatal morbidities associated with impaired neurodevelopment. PRS documentation was performed via the number of skin-breaking procedures (SBP) and by the use of the neonatal infant stressor scale (NISS). Adjustment was made for early neonatal morbidities.
Results:
Developmental outcomes among the study infants were within the norm (mean 100±11.03). Infants who underwent invasive mechanical ventilation (IMV) (n=31) were exposed to significantly more PRS than non-IMV infants (n=76) (p<0.000). Developmental outcomes were similar in both groups (99.7±11.1 vs. 100.8±11 p=0.63). Among IMV infants, increased exposure to PRS was associated with lower developmental scores independent of GA, gender or other sociodemographic factors.
Conclusion:
Increased exposure to PRS among low-risk preterm infants who underwent IMV is associated with lower developmental scores at 12.5month CA.