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Neonatal pain in relation to postnatal growth in infants born very preterm

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VINALL, J. et al. Neonatal pain in relation to postnatal growth in infants born very preterm. Pain, 2012. 12(153): p. 1374-1381.

Procedural pain is associated with poorer neurodevelopment in infants born very preterm (632 weeks gestational age), however, the etiology is unclear. Animal studies have demonstrated that early environ-mental stress leads to slower postnatal growth; however, it is unknown whether neonatal pain-relate stress affects postnatal growth in infants born very preterm. The aim of this study was to examine whether greater neonatal pain (number of skin-breaking procedures adjusted for medical confounders) is related to decreased postnatal growth (weight and head circumference [HC] percentiles) early in lifeand at term-equivalent age in infants born very preterm. Participants were n=78 preterm infants born 632weeks gestational age, followed prospectively since birth. Infants were weighed and HC measured at birth, early in life (median: 32weeks [interquartil e range 30.7–33.6]) and at term-equivalent age (40weeks [interquartil e range 38.6–42.6]). Weight and HC percentiles were computed from sex specific British Columbia population based data. Greater neonatal pain predicted lower body weight (Wald v2=7.36, P =0.01) and HC (Wald v2=4.36, P =0.04) percentiles at 32weeks post conceptional age, after adjusting for birth weight percentile and postnatal risk factors of illness severity, duration of mechanical ventilation, infection, and morphine and corticosteroid exposure. However, later neonatal infection pre-dicted lower weight percentile at term (Wald v2=5.09, P =0.02). Infants born very preterm undergo repetitive procedural pain during a period of physiological immaturity that appears to impact postnatal growth, and may activate a downstream cascade of stress signaling that affects later growth in the neonatal intensive care unit. 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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