Morphine affects brain activity and volumes in preterms: An observational multi-center study

Area of Science:

• Neonatal neuroscience
• Developmental pediatrics
• Clinical neurophysiology

Background:

• Extremely preterm infants often require interventions like morphine for pain and sedation.
• Early brain activity monitoring is crucial for assessing neurological status in neonates.
• The impact of morphine on developing brains in preterm infants requires further investigation.

Purpose of the Study:

• To investigate the effect of morphine on early brain activity in preterm infants using quantitative aEEG/EEG.
• To determine the association between morphine exposure and brain volumes at term equivalent age.
• To explore the dose-dependent relationship between morphine and neurodevelopmental outcomes.

Main Methods:

• 174 preterm infants (mean GA 26 weeks) were monitored using 2-channel aEEG for 72 hours.
• Quantitative aEEG parameters (min aEEG, % time <5 μV, SAT rate, ISI) were calculated.
• Brain volumes (TBV, cerebellar) were assessed via MRI at term equivalent age in a subgroup of 58 infants.

Main Results:

• Morphine significantly depressed early brain activity, indicated by longer ISI, reduced SAT rate, decreased min aEEG, and increased % time <5 μV.
• Gestational age and postnatal age also significantly affected aEEG/EEG measures.
• Cumulative morphine dose showed a significant negative correlation with total brain volume and cerebellar volume.

Conclusions:

• Morphine administration demonstrably depresses early brain activity in preterm infants.
• A dose-dependent negative impact of morphine on brain development, specifically total and cerebellar volumes, was observed.
• Consideration of sedative drug effects, particularly morphine, is essential when interpreting aEEG/EEG data and assessing neurodevelopmental outcomes.