2015-09-01
Neuroimaging, Pain Sensitivity, and Neuropsychological Functioning in School-Age Neonatal Extracorporeal Membrane Oxygenation Survivors Exposed to Opioids and Sedatives
Publication
Publication
Pediatric Critical Care Medicine , Volume 16 - Issue 7 p. 652- 662
Abstract
Objectives: Animal studies found negative long-term effects of
exposure to sedatives and opioids in early life, especially when
administered in the absence of pain. Around the world, children
who require extracorporeal membrane oxygenation receive opioids
and sedatives for extended periods, generally in the absence
of major pain as extracorporeal membrane oxygenation cannulation
is considered minor surgery. Therefore, our objective was
to determine the long-term effects of extracorporeal membrane
oxygenation treatment with respect to pain sensitivity, brain functioning
during pain, brain morphology, and neuropsychological
functioning in humans.
Design: Prospective follow-up study.
Setting: Level III university hospital.
Subjects: Thirty-six extracorporeal membrane oxygenation
survivors (8.1–15.5 yr) and 64 healthy controls (8.2–15.3 yr).
Measurements and Main Results: We measured detection and
pain thresholds, brain activity during pain (functional MRI), brain
morphology (high-resolution structural MRI), and neuropsychological
functioning and collected information regarding the
subject’s experience of chronic pain. We found a significant
difference in the detection threshold for cold measured in a
reaction time–dependent fashion (extracorporeal membrane oxygenation
group, 29.9°C [sd, 1.4]; control group, 30.6°C [sd, 0.8];
p < 0.01), but no differences in other modalities or in pain sensitivity
between groups. Furthermore, no differences in brain activation
during pain, brain morphology, or in the occurrence of chronic
pain were observed. However, extracorporeal membrane oxygenation
survivors performed significantly worse on a verbal memory
test compared with controls (p = 0.001).
Conclusions: While the most critically ill newborns receive extracorporeal
membrane oxygenation and, relatedly, large doses of
opioids and sedatives for extended periods, global measures of
pain sensitivity and neurobiological and neuropsychological development
appear to have minor long-term consequences. Possible
memory deficits in extracorporeal membrane oxygenation survivors
require additional study, but neonatal extracorporeal membrane
oxygenation treatment and associated exposure to opioids
and sedatives seem less harmful to humans than expected from
animal studies.
Additional Metadata | |
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doi.org/10.1097/PCC.0000000000000474, hdl.handle.net/1765/78701 | |
Pediatric Critical Care Medicine | |
Organisation | Department of Pediatric Surgery |
van den Bosch, G., IJsselstijn, H., van der Lugt, A., Tibboel, D., van Dijk, M., & White, T. (2015). Neuroimaging, Pain Sensitivity, and Neuropsychological Functioning in School-Age Neonatal Extracorporeal Membrane Oxygenation Survivors Exposed to Opioids and Sedatives. Pediatric Critical Care Medicine, 16(7), 652–662. doi:10.1097/PCC.0000000000000474 |