Early Procedural Pain Is Associated with Regionally-Specific Alterations in Thalamic Development in Preterm Neonates.

Authors

Emma G Duerden
Ruth E Grunau
Ting Guo
Justin Foong
Alexander Pearson
Stephanie Au-Young
Raphael Lavoie
M Mallar Chakravarty
Vann Chau
Anne Synnes
Steven P Miller

Document Type

Article

Publication Date

Winter 1-24-2018

Journal

The Journal of neuroscience : the official journal of the Society for Neuroscience

Volume

38

Issue

4

First Page

878

Last Page

886

URL with Digital Object Identifier

https://doi.org/10.1523/JNEUROSCI.0867-17.2017

Abstract

Very preterm human neonates are exposed to numerous invasive procedures as part of life-saving care. Evidence suggests that repetitive neonatal procedural pain precedes long-term alterations in brain development. However, to date the link between pain and brain development has limited temporal and anatomic specificity. We hypothesized that early exposure to painful stimuli during a period of rapid brain development, before pain modulatory systems reach maturity, will predict pronounced changes in thalamic development, and thereby cognitive and motor function. In a prospective cohort study, 155 very preterm neonates (82 males, 73 females) born 24-32 weeks' gestation underwent two MRIs at median postmenstrual ages 32 and 40 weeks that included structural, metabolic, and diffusion imaging. Detailed day-by-day clinical data were collected. Cognitive and motor abilities were assessed at 3 years, corrected age. The association of early (skin breaks, birth-Scan 1) and late pain (skin breaks, Scans 1-2) with thalamic volumes and