Shadows on the past : Does neonatal morphine use foreshadow neuropsychological functioning, stress response and pain sensitivity at primary school age?

Critically ill newborns often need to undergo invasive procedures that may bring discomfort and pain. This is very worrying because at newborn age the brain undergoes, in a relatively short time, an extreme growth and transformation, which makes the brain more susceptible to perturbation than at any other time of life. From a study performed in our Neonatal Intensive Care Unit (NICU) – at the Erasmus MC-Sophia Children’s hospital Rotterdam, the Netherlands – we learned that patients on average experienced an astonishingly high number of 14 painful procedures per day. Up to 65% of these patients did not receive appropriate analgesic therapy. At the time of that study, some ten years ago, pain treatment generally consisted of opioids as these had been proven effective for postoperative pain relief in preterm born infants. However, there was no evidence that they would be equally effective for other types of pain than postoperative pain. To learn more about the effects of morphine administration to critically ill newborns we set up a next study together with the Isala Clinics Zwolle. This randomized controlled trial (RCT), in which 150 neonates on ventilatory support received either continuous morphine or placebo, demonstrated no beneficial effect of continuous morphine on neurological outcome or pain and was therefore not recommended as ‘standard of care’ in this vulnerable population. This was later confirmed by a larger RCT, the so-called NEOPAIN trial3, and a meta-analysis.

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