Neonatal pain control and neurologic effects of anesthetics and sedatives in preterm infants

Abstract

Preclinical and clinical studies have demonstrated the adverse consequences of untreated pain and stress on brain development in the preterm infant. Sucrose has widely been implemented as standard therapy for minor procedural pain. Anesthetics are commonly utilized in preterm infants during major surgery. Pharmacologic agents (benzodiazepines and opioids) have been examined in clinical trials of preterm infants requiring invasive mechanical ventilation. Controversy exists regarding the safety and long-term impact of these interventions. Ongoing multidisciplinary research will help define the impact of these agents and identify potential alternative therapies.

Keywords: Analgesia; Anesthesia; Newborn; Pain; Premature; Sedation.

Copyright © 2014 Elsevier Inc. All rights reserved.

Figures

Figure 1

Intrinsic and extrinsic apoptotic pathways

Figure 2

Role of brain-derived neurotrophic factor in regulation of apoptosis. Arrows indicate promotion, blocked connectors indicate inhibition. Trk, tropomyosin receptor kinase.

Figure 3

Potential mechanisms of opioid-induced anti-proliferative and apoptotic effects.