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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Cumulative Opioid Exposures in the First Year of Life and Cognitive Neurodevelopment in High-Risk Infants
Olivia A Keane1,2, Shadassa Ourshalimian1,2, Ashwini Lakshmanan3
1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Insights
High opioid exposure in infants can impair neurodevelopment. This study found that cumulative morphine milligram equivalents (MME) in the first year of life were linked to lower cognitive scores at 18 months.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Pharmacology
Background:
- High-risk infants often require opioids for neonatal-perinatal morbidities.
- Prolonged opioid exposure may negatively impact infant neurodevelopment.
- Evaluating cumulative opioid exposure's effect on neurodevelopment is crucial.
Purpose of the Study:
- To assess the association between cumulative opioid exposure, measured in morphine milligram equivalents (MME), and neurodevelopmental outcomes in high-risk infants within their first year of life.
Main Methods:
- Retrospective cohort study of high-risk infants (<1 year) at a tertiary children's hospital (2010-2020).
- Identified high-risk infants using ICD codes for specific morbidities and surgeries.
- Calculated cumulative MME and assessed neurodevelopmental scores at ≥18 months, using multivariable linear regression.
Main Results:
- 70.6% of 330 high-risk infants exhibited neurodevelopmental impairment.
- Cumulative MME showed a negative correlation with cognitive, motor, and language scores.
- Increased MME was significantly associated with decreased cognitive scores (P<.001) but not motor or language scores.
Conclusions:
- Higher cumulative opioid exposure in the first year of life is linked to reduced cognitive scores in children.
- Opioid stewardship programs may improve long-term neurodevelopmental outcomes for high-risk infants.
- Further research into opioid effects on infant neurodevelopment is warranted.
Background:
High-risk infants with significant neonatal-perinatal morbidities often require opioids, but prolonged exposures can impair neurodevelopment. We evaluated the effect of cumulative opioid exposures in the first year of life, measured by morphine milligrams equivalents (MME), on neurodevelopment.
Methods:
A retrospective cohort of high-risk infants younger than 1 year admitted to a tertiary children's hospital from 2010 to 2020 was identified. International Classification of Diseases, Ninth and Tenth Revisions (ICD-9/ICD-10) codes for congenital heart disease surgery, medical and surgical necrotizing enterocolitis, extremely low birth weight, very low birth weight, hypoxemic ischemic encephalopathy, extracorporeal membrane oxygenation, and thoracoabdominal surgery identified high-risk infants. Cumulative MME received over all hospitalizations in the first year of life were calculated alongside benzodiazepine dosing and neurodevelopmental scores at 18 months or older. Neurodevelopmental impairment was defined as a score more than 1 SD from the standardized mean. Multivariable linear regressions adjusted for demographics and comorbidities.
Results:
Overall, 330 high-risk infants were identified, and 70.6% demonstrated neurodevelopmental impairment. Cumulative MME negatively correlated with cognitive (P < .001), motor (P < .001), and language (P = .004) scores. On multivariable linear regression, increasing MME was significantly associated with decreasing cognitive (P < .001) scores but not motor or language scores.
Conclusion:
Higher cumulative opioid exposure in the first year of life was associated with reduced cognitive scores at 18 months or older, independent of comorbidities. Opioid stewardship initiatives extended to high-risk infants may further optimize long-term neurodevelopment.
