PEDIATRICS Vol. 111 No. 1 January 2003, pp. 129-135
Major Surgery Within the First 3 Months of Life and Subsequent Biobehavioral
Pain Responses to Immunization at Later Age: A Case Comparison Study
Jeroen W. B. Peters, PhD, RN*, Hans M.
Koot, PhD,
Josien B. de Boer, PhD,
Jan Passchier, PhD||, Jolien M. Bueno-de-Mesquita,
MD*, Frank H. de Jong, PhD¶,
Hugo J. Duivenvoorden, PhD|| and Dick Tibboel, MD, PhD*
* Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam,
the Netherlands Department of
Developmental Psychology, Free University Amsterdam, Amsterdam, the Netherlands Department of Child Health
Division, TNO Prevention and Health, Leiden, the Netherlands || Department of Medical Psychology and Psychotherapy, NIHES,
Erasmus-MC, Rotterdam, the Netherlands ¶ Department of Internal Medicine, Section of Endocrinology,
Erasmus-MC, Rotterdam, the Netherlands
Objectives. Pain exposure during early infancy affects the
painperception beyond infancy into childhood. The objective of thisstudy was to examine whether major surgery within the first3
months of life in combination with preemptive analgesia alterspain
responses to immunization at 14 or 45 months and to assesswhether
these alterations are greater in toddlers with a largernumber of
negative hospital experiences.
Methods. Two groups of 50 toddlers each were compared: indexgroup 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 administrationfor 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-trivalentpolio 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 controlgroups 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-rubellavaccination, the number of negative hospital experiences correlatedpositively 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 analgesiawithin the first months of life does not alter pain responseto
subsequent pain exposure in childhood. Greater exposure toearly
hospitalization influences the pain responses after prolongedtime.
These responses, however, diminish after a prolonged periodof
nonexposure.
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"