Neonatal morphine exposure in very preterm infants-cerebral development and outcomes.
OBJECTIVE
To investigate the association of morphine exposure in very preterm infants with cerebral volumes and neurodevelopmental outcome from birth through middle childhood.


METHODS
Observational study of very preterm infants in the Victorian Infant Brain Study cohort. A total of 230 infants born <30 weeks' gestational age or <1250 g were recruited from all admissions to the neonatal intensive care unit of the Royal Women's Hospital. Fifty-seven (25%) infants received morphine analgesia during their neonatal intensive care unit stay at the attending physician's discretion. Primary outcomes were regional brain volumes at term and 7 years; neurobehavioral performance at term; and cognitive, motor, emotional, behavioral, communication, and executive function scores at age 2 and 7 years. Linear regressions were used to compare outcomes between participants who did and did not receive morphine.


RESULTS
At term, preterm infants who received morphine had similar rates of gray matter injury to no-morphine infants, but a trend toward smaller cortical volumes in the orbitofrontal (Pleft=.002, Pright=.01) and subgenual (Pleft=.01) regions. At 7 years, cortical volumes did not differ between groups. At 2 years, morphine-exposed children were more likely to show behavioral dysregulation (P=.007) than no-morphine children, but at 7 years no detrimental impacts of morphine on neurobehavioral outcome were observed.


CONCLUSIONS
Low-dose morphine analgesia received during neonatal intensive care was associated with early alterations in cerebral structure and short-term neurobehavioral problems that did not persist into childhood.
Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
Rachel
R
Steinhorn
Department of Pharmacy, Brigham and Women's Hospital, Boston, MA; Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA.
Christopher
C
McPherson
Department of Pediatrics, Royal Women's Hospital, The University of Melbourne, Carlton, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Peter J
PJ
Anderson
Department of Neurology, Boston Children's Hospital, Boston, MA.
Jeffrey
J
Neil
Department of Pediatrics, Royal Women's Hospital, The University of Melbourne, Carlton, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Carlton, Victoria, Australia.
Lex W
LW
Doyle
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: tinder@partners.org.
Terrie
T
Inder
D001921:Brain / Q000187:drug effects* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009020:Morphine / Q000009:adverse effects*; D009929:Organ Size; D012044:Regression Analysis; D016896:Treatment Outcome; D014739:Victoria
D009020:Morphine