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Outcome at 5-6 years of prematurely born children who received morphine as neonates
R MacGregor1, D Evans, D Sugden
1Department of Paediatrics and Child Health, University of Leeds, General Infirmary at Leeds.
Insights
Neonatal morphine exposure for mechanical ventilation in very preterm infants showed no adverse effects on intelligence, motor skills, or behavior at 5-6 years. A trend towards better performance was observed in the morphine group.
Area of Science:
- Neonatal care
- Pediatric neurology
- Clinical trial research
Background:
- Very preterm infants (< 34 weeks gestation) often require mechanical ventilation.
- Neonatal pain management and sedation are critical during mechanical ventilation.
- Long-term neurodevelopmental outcomes of neonatal analgesic exposure require thorough investigation.
Purpose of the Study:
- To evaluate the long-term neurodevelopmental outcomes (intelligence, motor function, behavior) at 5-6 years of age.
- To compare outcomes in very preterm infants exposed to morphine versus non-morphine treatments during neonatal mechanical ventilation.
- To assess potential adverse effects of neonatal morphine exposure on cognitive, motor, and behavioral development.
Main Methods:
- A cohort of 87 very preterm infants from two controlled clinical trials (1989-92) were assessed at 5-6 years.
- Infants requiring mechanical ventilation were randomly allocated to receive morphine or other solutions from day one.
- Neurodevelopmental assessments included WPPSI-R (intelligence), Movement ABC (motor function), and Child Behaviour Checklist (behavior).
- Thyroid stimulating hormone (TSH) levels were measured in a subgroup to assess thyroid function.
Main Results:
- No significant differences were found in intelligence, motor function, or behavior between the morphine and non-morphine groups at 5-6 years.
- A trend towards better performance in all three assessment scales was observed in the group exposed to morphine.
- Thyroid function, assessed by TSH levels, showed no differences between the groups.
Conclusions:
- Neonatal exposure to morphine for facilitating mechanical ventilation does not appear to have adverse neurodevelopmental effects.
- The findings suggest that morphine can be safely used for neonatal mechanical ventilation without compromising long-term cognitive, motor, or behavioral outcomes.
- Further research may explore the observed trend of improved performance in the morphine-exposed group.
Aim:
To assess outcome at 5-6 years in a cohort of very preterm infants (< 34 weeks of gestation) who had been randomly allocated within a controlled clinical trial to receive morphine or non-morphine treatment in the neonatal period.
Methods:
Assessments were made on 87 children at 5-6 years who had been recruited in the neonatal period to two sequential controlled studies (1989-92). Infants requiring mechanical ventilation had been randomly allocated to receive either morphine (n = 62) or other (n = 33) solutions starting on the first day of life. Each child was seen by a single experienced observer and assessed at 5-6 years using the WPPSI-R, Movement ABC, and the Child Behaviour Checklist. The performance of children exposed to morphine was compared with that of those in the non-morphine group. Blood samples for thyroid stimulating hormone (TSH) measurement were obtained from children whose parents gave consent.
Results:
There was no significant difference in any of the three test scales between infants in the two groups, but there was a trend towards better performance in all three tests in the morphine group. Assessment of TSH values in a subgroup of the survivors showed no difference in thyroid function between the two groups.
Conclusion:
Exposure to morphine in the neonatal period to facilitate mechanical ventilation does not seem to have any adverse effects on intelligence, motor function, or behaviour when these children are assessed at 5-6 years of age.