Ranger M, Synnes A R, Vinall J, Grunau R E
Department of Paediatrics, University of British Columbia, Vancouver, Canada; Developmental Neurosciences & Child Health, Child & Family Research Institute, Vancouver, BC, Canada.
Eur J Pain. 2014 Jul;18(6):844-52. doi: 10.1002/j.1532-2149.2013.00431.x. Epub 2013 Dec 9.
Greater neonatal pain is associated with higher internalizing behaviours in very preterm infants at 18 months corrected age, but it is unknown whether this relationship persists to school age. Moreover, it is unclear whether morphine ameliorates or exacerbates the potential influence of neonatal pain/stress on internalizing behaviours. We examined whether neonatal pain-related stress is associated with internalizing behaviours at age 7 years in children born very preterm, and whether morphine affects this relationship.
One hundred one children born very preterm (≤32 weeks gestation) were seen at mean age 7.7 years. A parent completed the Parenting Stress Index and Child Behavior Checklist questionnaires. Neonatal pain-related stress (the number of skin-breaking procedures adjusted for clinical factors associated with prematurity) was examined in relation to internalizing behaviour, separately in subjects mechanically ventilated and exposed to both pain and morphine (n = 57) and those never mechanically ventilated, exposed to pain but not morphine (n = 44).
In the non-ventilated group, higher skin-breaking procedures (p = 0.037) and parenting stress (p = 0.004) were related to greater internalizing behaviours. In the ventilated group, greater morphine exposure (p = 0.004) was associated with higher child internalizing scores.
In very preterm children who undergo mechanical ventilation, judicious use of morphine is important, since morphine may mitigate the negative effects of neonatal pain on nociception but adversely affect internalizing behaviours at school age. Management of procedural pain needs to be addressed in very preterm infants in the neonatal intensive care unit, to prevent long-term effects on child behaviour.
在矫正年龄为18个月的极早产儿中，更高的新生儿疼痛与更高的内化行为相关，但尚不清楚这种关系是否持续到学龄期。此外，尚不清楚吗啡是减轻还是加剧新生儿疼痛/应激对内化行为的潜在影响。我们研究了极早产儿7岁时与新生儿疼痛相关的应激是否与内化行为有关，以及吗啡是否会影响这种关系。
101名极早产儿（孕周≤32周）在平均年龄7.7岁时接受检查。家长完成了育儿压力指数和儿童行为检查表问卷。分别在接受机械通气且暴露于疼痛和吗啡的受试者（n = 57）以及从未接受机械通气、暴露于疼痛但未暴露于吗啡的受试者（n = 44）中，研究了与内化行为相关的新生儿疼痛相关应激（根据与早产相关的临床因素调整的破皮操作次数）。
在未通气组中，更高的破皮操作次数（p = 0.037）和育儿压力（p = 0.004）与更高的内化行为有关。在通气组中，更高的吗啡暴露量（p = 0.004）与更高的儿童内化得分相关。
在接受机械通气的极早产儿中，谨慎使用吗啡很重要，因为吗啡可能减轻新生儿疼痛对伤害感受的负面影响，但会对学龄期的内化行为产生不利影响。新生儿重症监护病房的极早产儿需要解决程序性疼痛的管理问题，以防止对儿童行为产生长期影响。
