Effect of increased opiate exposure on three years neurodevelopmental outcome in extremely preterm infants

• Published in: Early human development Vol. 123; pp. 1 - 5
• Main Authors: Giordano, V., Deindl, P., Fuiko, R., Unterasinger, L., Waldhoer, T., Cardona, F., Berger, A., Olischar, M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-08-2018
• Subjects: Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Bayley scale of infant development; Case-Control Studies; Child Development - drug effects; Child, Preschool; Extremely preterm infants; Female; Humans; Infant, Extremely Premature - growth & development; Infant, Newborn; Male; Neurodevelopmental outcome; Opiate exposure; BSID-ll; SDQ; BRS; ELBWI; NICU; N-PASS; Bayley scale of infant development; MDI; PDI; EPIPAGE; CRIB; V-PNPS; Opiate exposure; Neurodevelopmental outcome; Extremely preterm infants
• ISSN: 0378-3782; 1872-6232
• DOI: 10.1016/j.earlhumdev.2018.06.010

International guidelines recommend the use of item based scales for the assessment of pain and sedation. In our previous study, the implementation of the Neonatal Pain Agitation and Sedation Scale (N-PASS), and the associated systematic assessment and treatment of pain and sedation reduced pain and over-sedation in our intervention group, but lead to a significant increase of individual opiate exposure. This increased opiate exposure was not associated with impaired motor and mental development at one year of age. As one-year follow-up is not necessarily representative for future outcomes, we retested our sample at three years of age.
Fifty-three patients after (intervention group) and 61 before implementation (control group) of the N-PASS and the Vienna Protocol for the Management of Neonatal Pain and Sedation (VPNPS), were compared for motor, mental and behavioural development at three-years follow-up using the Bayley Scales of Infant Development.
Cumulative opiate exposure was not associated with mental (p = .31) and motor (p = .20) problems when controlling for other important medical conditions, but was associated to lower behavioural scores (p = .007). No statistically significant differences were found with regard to mental (p = .65), psychomotor (p = .12) and behavioural (p = .61) development before and after the implementation of the N-PASS and the VPNPS.
Implementing a neonatal pain and sedation protocol increased opiate exposure without affecting neurodevelopmental outcome at three-years of age.
•Systematic assessment and treatment of pain led to an increased of opiate exposure in extremely preterm neonates.•Increased cumulative opiate exposure was not associated with worse mental and motor development.•Higher exposure to opiates was associated with inferior behavioural performance, suggesting a vigilant use of opioids.