title: Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants.
abstract: Procedural pain in the neonatal intensive care unit triggers a cascade of physiological, behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm, who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development. The aim of this study was to examine relationships between cumulative procedural pain (number of skin-breaking procedures from birth to term, adjusted for early illness severity and overall intravenous morphine exposure), and later cognitive, motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age (CCA), and further, to evaluate the extent to which parenting factors modulate these relationships over time. Participants were N=211 infants (n=137 born preterm 32 weeks gestational age [GA] and n=74 full-term controls) followed prospectively since birth. Infants with significant neonatal brain injury (periventricular leucomalacia, grade 3 or 4 intraventricular hemorrhage) and/or major sensori-neural impairments, were excluded. Poorer cognition and motor function were associated with higher number of skin-breaking procedures, independent of early illness severity, overall intravenous morphine, and exposure to postnatal steroids. The number of skin-breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation. In general, greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months, but not at 18 months CCA, however, specific protocols for morphine administration were not evaluated. Lower parenting stress modulated effects of neonatal pain, only on cognitive outcome at 18 months.
authors.affiliation: Centre for Community Child Health Research, Child and Family Research Institute, Room F605B, 4480 Oak St., Vancouver, BC, Canada V6H 3V4. rgunau@cw.bc.ca
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Grunau
authors.forename: Michael F
authors.initials: MF
authors.lastname: Whitfield
authors.forename: Julianne
authors.initials: J
authors.lastname: Petrie-Thomas
authors.forename: Anne R
authors.initials: AR
authors.lastname: Synnes
authors.forename: Ivan L
authors.initials: IL
authors.lastname: Cepeda
authors.forename: Adi
authors.initials: A
authors.lastname: Keidar
authors.forename: Marilyn
authors.initials: M
authors.lastname: Rogers
authors.forename: Margot
authors.initials: M
authors.lastname: Mackay
authors.forename: Philippa
authors.initials: P
authors.lastname: Hubber-Richard
authors.forename: Debra
authors.initials: D
authors.lastname: Johannesen
mesh_terms: D003071:Cognition; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009048:Motor Skills; D010146:Pain / Q000503:physiopathology* / Q000523:psychology*; D010287:Parent-Child Relations; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology*