Does neonatal morphine use affect neuropsychological outcomes at 8 to 9 years of age?

• Published in: Pain (Amsterdam) Vol. 154; no. 3; pp. 449 - 458
• Main Authors: DE GRAAF, Joke, LINGEN, Richard A. Van, VALKENBURG, Abraham J, WEISGLAS-KUPERUS, Nynke, GROOT JEBBINK, Liesbeth, WIJNBERG-WILLIAMS, Barbara, ANAND, Kanwaljeet J. S, TIBBOEL, Dick, DIJK, Monique Van
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier 01.03.2013
• Subjects: Analgesics; Biological and medical sciences; Birth Weight; Child; Child Behavior - drug effects; Executive Function - drug effects; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - drug therapy; Intelligence - drug effects; Intensive Care, Neonatal; Medical sciences; Morphine - adverse effects; Morphine - therapeutic use; Narcotics - adverse effects; Narcotics - therapeutic use; Neuropharmacology; Neuropsychological Tests; Pain - drug therapy; Pain, Postoperative - drug therapy; Parents - psychology; Pharmacology. Drug treatments; Pilot Projects; Problem Solving - drug effects; Psychomotor Performance - drug effects; Human; Pediatrics; Neonatal; Prognosis; Opiates; Controlled therapeutic trial; Morphine; Narcotic analgesic; Randomized controlled trial; Follow-up; Pain; Newborn; Neonate; Follow up study; Child; Age
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1016/j.pain.2012.12.006

Morphine is widely used to treat severe pain in neonatal intensive care unit patients. Animal studies suggest adverse long-term side effects of neonatal morphine, but a follow-up study of 5-year-old children who participated in a morphine-placebo controlled trial as newborns found no such effects on the child's general functioning. This study indicated that morphine may negatively affect response inhibition, a domain of executive functions. Therefore, we performed a second follow-up study in the same population at the age of 8 to 9 years, focused on the child's general functioning in terms of intelligence, visual motor integration, and behavior and on executive functions. Children in the morphine group showed significantly less externalizing problems according to the parents but more internalizing behavior according to the teachers, but only after adjustment for intelligence quotient (IQ), potential confounders using a propensity score, and additional open-label morphine. Morphine-treated children showed significantly fewer problems with executive functions in daily life as rated by parents for the subscales inhibition and organization of materials and for planning/organizing as rated by the teachers. After adjustment for IQ and the propensity score, executive functioning as rated by the parents remained statistically significantly better in the morphine-treated group. The influence of the additional morphine given was not of a significant influence for any of the outcome variables. Overall, the present study demonstrates that continuous morphine infusion of 10 μg/kg/h during the neonatal period does not harm general functioning and may even have a positive influence on executive functions at 8 to 9 years.