Grant: CIHR Fellowship

It is estimated that nearly 13 million premature infants are born worldwide each year. Due to modern technology the majority of very preterm infants now survive, but the tiniest babies spend weeks to months hospitalized in the neonatal intensive care (NICU) often undergoing essential life-saving invasive procedures that can be painful. In children born very preterm (less than 32 weeks of gestation), rates of cognitive problems remain high despite major advances in neonatal medicine. These infants are biologically very immature and their brains are rapidly developing during this period. Recently it has been shown that greater neonatal procedural pain is associated with reduced brain maturation, and giving morphine does not ameliorate these effects. However, there is no knowledge of the specific brain structures affected, and whether the impact of pain persists into childhood. The proposed project will examine the relationship between neonatal procedural pain, exposure to morphine and brain development in children born very preterm. At present, pain management strategies are advocated in NICU care (e.g. morphine) with no understanding of effects on the developing brain. Methods are needed to evaluate long term effects of both pain exposure and pain management on the brain. Identifying specific areas of the brain that are affected long term and found to be associated with school-age outcomes could become useful markers of these effects on the brain. The proposed study will provide a way to validate if growth in certain brain regions could be used as an indicator of the long-term effects of pain exposure, thereby providing a way to evaluate pain management in the future.