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Effect of increased opiate exposure on three years neurodevelopmental outcome in extremely preterm infants

V Giordano1, P Deindl2, R Fuiko1

  • 1Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria.

Early Human Development
|June 24, 2018
PubMed

Insights

Implementing the Neonatal Pain Agitation and Sedation Scale (N-PASS) protocol increased opiate exposure in newborns. However, this did not negatively impact neurodevelopmental outcomes at three years of age.

Area of Science:

  • Neonatal care
  • Pediatric pharmacology
  • Neurodevelopmental outcomes

Background:

  • International guidelines advocate for item-based scales in pain and sedation assessment.
  • Previous implementation of the Neonatal Pain Agitation and Sedation Scale (N-PASS) reduced pain and over-sedation but increased opiate exposure.
  • One-year follow-up showed no adverse effects of increased opiate exposure on motor and mental development.

Purpose of the Study:

  • To re-evaluate neurodevelopmental outcomes at three years of age following the implementation of a neonatal pain and sedation protocol.
  • To assess the long-term impact of increased opiate exposure on motor, mental, and behavioral development.

Main Methods:

  • A cohort of 53 patients (intervention group) and 61 patients (control group) were compared.
  • The study utilized the Neonatal Pain Agitation and Sedation Scale (N-PASS) and the Vienna Protocol for the Management of Neonatal Pain and Sedation (VPNPS).
  • Neurodevelopmental assessment at three years was conducted using the Bayley Scales of Infant Development.

Main Results:

  • Cumulative opiate exposure was not linked to mental or motor problems, controlling for other medical conditions.
  • Increased opiate exposure was associated with lower behavioral scores (p=0.007).
  • No significant differences in mental, psychomotor, or behavioral development were observed between groups before and after protocol implementation.

Conclusions:

  • Implementing a neonatal pain and sedation protocol, including the N-PASS, led to increased opiate exposure.
  • This increased opiate exposure did not adversely affect neurodevelopmental outcomes at three years of age.
Abstract

Keywords:
Bayley scale of infant developmentExtremely preterm infantsNeurodevelopmental outcomeOpiate exposure

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