title: Neonatal morphine in extremely and very preterm neonates: its effect on the developing brain - a review.
abstract: OBJECTIVE
  Preterm infants requiring intensive care experience a large number of stressful and painful procedures. Management of stress and pain is therefore an important issue. This review provides an overview of the research on the use of morphine and its neurodevelopmental effects on this vulnerable group of neonates.
  
  
  METHODS
  A structural literature search of both experimental and clinical data has been done using an electronic database (PubMed), but also relevant reference lists and related articles were used.
  
  
  RESULTS
  A total of 39 sources were considered relevant for this review to elucidate the effects of morphine on the developing brain. The results showed that both animal experimental and clinical data displayed conflicting results on the effects of neonatal morphine on neurodevelopmental outcome. However, in contrast to specific short-term neurological outcomes long-term neurodevelopmental outcome does not seem to be adversely affected by morphine.
  
  
  CONCLUSIONS
  After a careful review of the literature, no definite conclusions concerning the effects of neonatal morphine on the long-term neurodevelopmental outcome in extremely premature neonates can be drawn. More prospectively designed trials should be conducted using reliable and validated pain assessment scores to evaluate effects of morphine on long-term neurodevelopmental outcome to demonstrate a beneficial or adverse effect of morphine in preterm infants.
authors.affiliation: Department of Neonatology, University Medical Center , Utrecht , The Netherlands.
authors.forename: Juliette
authors.initials: J
authors.lastname: Schuurmans
authors.forename: Manon
authors.initials: M
authors.lastname: Benders
authors.forename: Petra
authors.initials: P
authors.lastname: Lemmers
authors.forename: Frank
authors.initials: F
authors.lastname: van Bel
mesh_terms: D001921:Brain / Q000187:drug effects* / Q000254:growth & development*; D002657:Child Development / Q000187:drug effects; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D006801:Humans; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D009020:Morphine / Q000494:pharmacology* / Q000627:therapeutic use; D010146:Pain / Q000151:congenital / Q000517:prevention & control; D013315:Stress, Psychological / Q000517:prevention & control
chemical_list: D009020:Morphine
keywords: Extremely and very preterm neonates; long-term neurodevelopmental outcome; morphine