Reducing Painful Procedures Helps Premature Infants' Brains

Premature infants who experience needle injections while receiving life-saving care in the neonatal intensive care unit may have better growth of a part of the brain called the thalamus.

Premature infants who experience needle injections while receiving life-saving care in the neonatal intensive care unit may have better growth of a part of the brain called the thalamus, said researchers.

The findings of the study are published in the online issue of Neurology®, the medical journal of the American Academy of Neurology.

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‘The infants who had prolonged use of the central lines had an average of 34 needle pokes while the infants who had restricted use of the central lines had an average of 91 invasive procedures during their hospital stay.’

The thalamus is present at the center of the brain. It relays sensory information from the body to the rest of the brain.

Researchers compared premature babies who had a catheter placed in their central veins and central or peripheral arteries for more than 14 days to infants who had the catheter for a shorter time.

These catheters, known as central arterial lines and venous lines, act as portals for blood draws, blood pressure checks, nutrition, and medication, reducing the number of individual needle pokes.

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Study Findings

Premature infants for whom the central lines were maintained for a long time had fewer needle pokes and less painful procedures.
Premature infants with prolonged use of a central line had longer volumes of the thalamus.
Thalamus volume is linked to overall brain development in early childhood.

"Babies born very prematurely are exposed to multiple unpleasant and painful yet necessary procedures every day," said study author Emma Duerden, Ph.D., who conducted the research while at The Hospital for Sick Children (SickKids) in Toronto, Canada.

"Placing central arterial and venous lines in a premature infant's skin to deliver care and monitor their progress dramatically reduces the number of painful skin breaks. However, some clinicians don't place these catheters for longer periods of time due to concerns about possible infection. Our research not only found that prolonged use of central arterial and venous lines was associated with larger thalamus volumes, it also found that prolonged use was not associated with a greater number of infections."

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Researchers analyzed two groups of very premature infants born earlier than 28 weeks gestation at two hospitals. The first group of 86 infants had central lines that were in place for 14 days or more. The second group of 57 infants had the central lines in place for fewer than 14 days. Almost every day, the central lines were exchanged with peripheral lines. The average hospital stay for all premature infants was 28 days.

Brain scans were used to measure the thalamus size, a few weeks after birth. After adjusting for factors like sex, age at birth, and age at a brain scan, researchers found that the infants who experienced 34 or fewer needle pokes had an average thalamus size of 1,233 cubic millimeters (mm3) compared to a smaller average size of 1,110 mm3 for the infants who experienced 91 or more needle pokes.

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Children who had larger thalamus size as premature infants scored better on average on cognitive and motor tests than those who had smaller thalamus size.

"Babies born prematurely can have numerous health struggles, so if clinicians can reduce their pain during the first few weeks after they are born, this could possibly lead to improved brain development over time, with a potential to have a huge impact on their lives," said Duerden.

"While our study shows an association between pain reduction and brain development, it is important to note that more research is needed. We found no increased risk of infection with extended central arterial and venous line use, however future studies in larger groups of premature infants should examine this more closely to determine if the benefits to the brain outweigh any possible risks."

Source-Medindia