Clinical Neurosciences (Pain Research), UCL Great Ormond Street Institute of Child Health, London, UK; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Translational Imaging Group, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
Br J Anaesth. 2018 Sep;121(3):623-635. doi: 10.1016/j.bja.2018.03.035. Epub 2018 Jun 19.
Surgery or multiple procedural interventions in extremely preterm neonates influence neurodevelopmental outcome and may be associated with long-term changes in somatosensory function or pain response.
This observational study recruited extremely preterm (EP, <26 weeks' gestation; n=102, 60% female) and term-born controls (TC; n=48) aged 18-20 yr from the UK EPICure cohort. Thirty EP but no TC participants had neonatal surgery. Evaluation included: quantitative sensory testing (thenar eminence, chest wall); clinical pain history; questionnaires (intelligence quotient; pain catastrophising; anxiety); and structural brain imaging.
Reduced thermal threshold sensitivity in EP vs TC participants persisted at age 18-20 yr. Sex-dependent effects varied with stimulus intensity and were enhanced by neonatal surgery, with reduced threshold sensitivity in EP surgery males but increased sensitivity to prolonged noxious cold in EP surgery females (P<0.01). Sex-dependent differences in thermal sensitivity correlated with smaller amygdala volume (P<0.05) but not current intelligence quotient. While generalised decreased sensitivity encompassed mechanical and thermal modalities in EP surgery males, a mixed pattern of sensory loss and sensory gain persisted adjacent to neonatal scars in males and females. More EP participants reported moderate-severe recurrent pain (22/101 vs 4/48; χ=0.04) and increased pain intensity correlated with higher anxiety and pain catastrophising.
After preterm birth and neonatal surgery, different patterns of generalised and local scar-related alterations in somatosensory function persist into early adulthood. Sex-dependent changes in generalised sensitivity may reflect central modulation by affective circuits. Early life experience and sex/gender should be considered when evaluating somatosensory function, pain experience, or future chronic pain risk.
极早产儿（<26 周）的外科手术或多次介入性操作会影响神经发育结局，并且可能与体感功能或疼痛反应的长期变化有关。
这项观察性研究招募了来自英国 EPICure 队列的 18-20 岁的极早产儿（EP，<26 周；n=102，60%为女性）和足月出生对照组（TC；n=48）。30 名 EP 中有但没有 TC 参与者接受了新生儿手术。评估包括：指腹、胸壁的定量感觉测试；临床疼痛史；问卷（智商；疼痛灾难化；焦虑）；以及结构脑成像。
与 TC 参与者相比，EP 参与者的热阈值敏感性在 18-20 岁时仍较低。性别依赖性效应随刺激强度而变化，并因新生儿手术而增强，EP 手术男性的阈值敏感性降低，但 EP 手术女性对长时间的有害冷刺激的敏感性增加（P<0.01）。热敏感性的性别依赖性差异与杏仁核体积较小相关（P<0.05），但与当前智商无关。虽然 EP 手术男性的机械和热感觉模式普遍存在敏感性降低，但在男性和女性的新生儿疤痕附近仍存在感觉丧失和感觉增益的混合模式。更多的 EP 参与者报告有中度至重度复发性疼痛（22/101 比 4/48；χ=0.04），疼痛强度增加与焦虑和疼痛灾难化程度增加相关。
在早产儿出生和新生儿手术后，体感功能的一般和局部疤痕相关改变的不同模式持续到成年早期。一般敏感性的性别依赖性变化可能反映了情感回路的中枢调节。在评估体感功能、疼痛体验或未来慢性疼痛风险时，应考虑早期生活经历和性别/性别差异。
