title: Prolonged sedation and/or analgesia and 5-year neurodevelopment outcome in very preterm infants: results from the EPIPAGE cohort.
abstract: OBJECTIVE
  To describe the long-term outcome of very preterm infants receiving prolonged sedation and/or analgesia and examine the relationship between prolonged sedation and/or analgesia and this long-term outcome.
  
  
  METHODS
  A prospective population-based study (Etude EPIdémiologique sur les Petits Ages GEstationnels [EPIPAGE]). To reduce bias, the propensity score method was used.
  
  
  METHODS
  Nine regions of France.
  
  
  METHODS
  The study population included very preterm infants of fewer than 33 weeks' gestational age, born in 1997, who received mechanical ventilation and/or surgery. Main Exposure Prolonged exposure to sedative and/or analgesic drugs in the neonatal period, defined as exposure of more than 7 days to sedative and/or opioid drugs.
  
  
  METHODS
  Presence of moderate or severe disability at 5 years of age.
  
  
  RESULTS
  The analysis concerns 1572 premature infants who received mechanical ventilation for whom information about exposure to prolonged sedation and/or analgesia in the neonatal period was available. A total of 115 were exposed and 1457 were not exposed. There was no significant difference between the number of patients lost to follow-up from the group of very preterm infants who were exposed to prolonged sedation and/or analgesia and the group who were not. Exposed very preterm infants had severe or moderate disability at 5 years (41/97; 42%) more often than those who were not exposed (324/1248; 26%). After adjustment for gestational age and propensity score, this association was no longer statistically significant (adjusted relative risk, 1.0; 95% confidence interval, 0.8-1.2).
  
  
  CONCLUSIONS
  Prolonged sedation and/or analgesia is not associated with a poor 5-year neurological outcome after adjustment for the propensity score.
authors.affiliation: Department of Neonatal Medicine and Centre d'Investigation Clinique INSERM CIC004, Hôpital de Mère et l'Enfant, Boulevard Jean Monet, 44000 Nantes, France. jcroze@chu-nantes.fr
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Rozé
authors.forename: Sophie
authors.initials: S
authors.lastname: Denizot
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel
authors.forename: Monique
authors.initials: M
authors.lastname: Kaminski
authors.forename: Catherine
authors.initials: C
authors.lastname: Arnaud
authors.forename: Patrick
authors.initials: P
authors.lastname: Truffert
authors.forename: Stéphane
authors.initials: S
authors.lastname: Marret
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Matis
authors.forename: Gérard
authors.initials: G
authors.lastname: Thiriez
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
authors.forename: Monique
authors.initials: M
authors.lastname: André
authors.forename: Béatrice
authors.initials: B
authors.lastname: Larroque
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
mesh_terms: D017677:Age Distribution; D000698:Analgesia / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D002675:Child, Preschool; D016001:Confidence Intervals; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008607:Intellectual Disability / Q000453:epidemiology* / Q000209:etiology; D007363:Intensive Care Units, Neonatal; D008297:Male; D015337:Multicenter Studies as Topic; D011336:Probability; D012016:Reference Values; D012121:Respiration, Artificial / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013997:Time Factors