Objectives: My clinical experience has provided a rich framework and many opportunities to develop questions for inquiry along with a deep understanding of the needs of premature infants. My future program of research will encompass cerebral function analysis, pain management, and ultimately nursing care strategies to promote optimal neurodevelopment of the early born. This work is closely aligned with the critical objectives of multiple NIH divisions including: NINR, NICHD, NINDS and more remotely NIMH and NIDA. Problem: Premature birth is associated with physiologic stress and pain that may be procedural, surgical, prolonged, or more likely a combination of all forms. The treatment of pain in this population is largely based on adult practices without knowledge of the long-term effects of repetitive pain or treatment on the vulnerable developing brain. Purpose: To describe patterns of brain waves in relation to opioid administration among premature infants 26-34 weeks postconceptional age (PCA) undergoing ventilation for respiratory failure associated with prematurity. Describe differences in four pattern characteristics of limited channel EEG before and after standard morphine bolus administration. 1. Continuity of dominant background electrical activity (overall density of tracing) 2. Presence or absence of rhythmic cycling (smooth sinusoidal variations especially in the lower margin) 3. Amplitude (in ?V) of the lower border (lower microvolt level during the recording epoch) 4. Bandwidth of the limited channel EEG (calculated as the difference between the upper and lower voltage margins of the narrowest part of the tracing) (Primary Aim) Further evaluation of changes in brain wave signal variability with quantification of signal cyclicity is proposed by extracting raw EEG signal and examining differences in power spectral density distribution before and after standard morphine administration. (Secondary Aim) Design and methods: An intensive within-subject experimental design with ABAB withdrawal phasing will be employed. Fifteen infants will be studied under baseline (no morphine) and treatment (bolus dose) conditions with an FDA approved limited channel amplitude-integrated EEG device. Continuous recording will capture the conditions within a natural experiment in the clinical setting of opioid dosing and administration under standard neonatal intensive care. Descriptive and time series analyses are planned. Relevance to public health: Premature birth is a major perinatal health issue in the U.S. Neural function and developmental outcomes of low birth weight infants may be improved by the findings of this research. Understanding the effects of opioids on brain function will lead to more optimal pain management and care giving strategies for this vulnerable population.
