Print Email Facebook Twitter Major surgery within the first 3 months of life and subsequent biobehavioral pain responses to immunization at later age Title Major surgery within the first 3 months of life and subsequent biobehavioral pain responses to immunization at later age: A case comparison study Author TNO Preventie en Gezondheid Peters, J.W.B. Koot, H.M. Boer, J.B.de Passchier, J. Bueno de Mesquita, J.M. Jong, F.H.de Duivenvoorden, H.J. Tibboel, D. Publication year 2003 Abstract Objectives. Pain exposure during early infancy affects the pain perception beyond infancy into childhood. The objective of this study was to examine whether major surgery within the first 3 months of life in combination with preemptive analgesia alters pain responses to immunization at 14 or 45 months and to assess whether these alterations are greater in toddlers with a larger number of negative hospital experiences. Methods. Two groups of 50 toddlers each were compared: index group and control group. All index toddlers had participated within the first 3 months of their life in a randomized, clinical trial that evaluated the efficacy of preemptive morphine administration for postoperative analgesia. The controls were matched by type of immunization and community health care pediatrician. Pain reactions were recorded at routine immunization at either 14 (measles-mumps-rubella immunization) or 45 months (diphtheria-tetanus-trivalent polio immunization) of age. Outcome measures were facial reaction, coded by the Maximum Discriminative Facial Movement Coding System; heart rate (HR); and cortisol saliva concentration. Negative hospital experiences included number of operations requiring postoperative morphine administration, cumulative Therapeutic Intervention Scoring System scores, and length of stay in the intensive care unit or total hospitalization days. Results. No differences were found between the index and control groups in the facial display of pain, anger, or sadness or in physiologic parameters such as HR and cortisol concentrations. Intragroup analyses of the index group showed that after measles-mumps-rubella vaccination, the number of negative hospital experiences correlated positively with the facial responsiveness and negatively with HR responses. No effect was seen after diphtheria-tetanus-trivalent polio immunization. Conclusions. Major surgery in combination with preemptive analgesia within the first months of life does not alter pain response to subsequent pain exposure in childhood. Greater exposure to early hospitalization influences the pain responses after prolonged time. These responses, however, diminish after a prolonged period of nonexposure. Chemicals/CAS: hydrocortisone, 50-23-7; morphine, 52-26-6, 57-27-2; opiate, 53663-61-9, 8002-76-4, 8008-60-4; Morphine, 57-27-2. Subject AnalgesiaBiobehavioral pain responseNewborn infantProspective studyRepetitive paindiphtheria tetanus vaccinehydrocortisonemeasles mumps rubella vaccinemorphineopiatetriple vaccineanalgesiaarticlechild behaviorchild hospitalizationclinical articlecontrolled studydrug efficacyfacefemaleheart ratehumanimmunizationlength of staymalenewborn surgerynociceptionpainpostoperative analgesiapreschool childpriority journalsaliva levelscoring systemAge FactorsCase-Control StudiesHumansImmunizationInfantInfant, NewbornLength of StayMorphineObserver VariationPainPain MeasurementPain, PostoperativeProspective StudiesSurgical Procedures, OperativeThoracic Surgical Procedures To reference this document use: http://resolver.tudelft.nl/uuid:66ca62a2-f2d9-45c4-8bdc-fa662a8b7a56 DOI https://doi.org/10.1542/peds.111.1.129 TNO identifier 236920 ISSN 0031-4005 Source Pediatrics, 111 (111), 129-135 Document type article Files To receive the publication files, please send an e-mail request to TNO Library.