The painful, life-saving procedures that premature babies often undergo in their first few months of life are associated with altered brain development and lower IQ scores at seven years of age, a new study has found. The findings were published in the March 2014 issue of Pediatrics.

A multidisciplinary team of CFRI researchers led this long-term study of infants who were born 2 to 4 months early. On average, these infant underwent roughly 74 invasive and medically-necessary procedures during their stay in the Neonatal Intensive Care Unit (NICU) at BC Women’s Hospital, an agency of the Provincial Health Services Authority.


“We found that early pain and stress matters long after infants leave the neonatal intensive care unit,” says Jillian Vinall, the study’s lead author. “Even when we account for how sick these infants were, their immaturity at birth, and medical treatments such as need for assisted breathing, the number of invasive procedures they undergo in these early weeks is related to their brain and cognitive development at age seven.”


Researchers used MRI scans and IQ tests to assess the children’s brain development and cognitive ability at seven years of age.


Fifty children participated in the study. Children who’d had more than the average number of procedures while in the NICU tended to have lower IQ scores at 7 years of age. Of this group, those whose scans revealed less brain white matter in the brain had IQs that were 13 points lower. White matter is responsible for transmitting signals from one part of the brain to another and affects how the brain learns and functions.

All of the children on the study had IQ scores within the broadly normal range.


Each year, approximately 3600 preterm babies are born in B.C. and nearly 31,700 are born in Canada.


A number of pain and stress management strategies are used in NICUs, such as swaddling, tucking, and sucking on soothers. Babies who are on a mechanical ventilator to help them breathe are often given morphine.


“There is a need for pain management strategies to be evaluated for the extent to which they are able to protect the developing brain, so that we can treat neonatal pain in a way that will give these vulnerable children the best possible start,” says Jillian.


Jillian Vinall is a UBC PhD candidate supervised by Dr. Ruth Grunau, CFRI scientist and UBC professor. Jillian is also supervised by Dr. Steven Miller, CFRI affiliate scientist, UBC affiliate professor, head of Neurology at SickKids, professor at the University of Toronto, and holder of the Bloorview Children’s Hospital Foundation Chair in Pediatric Neuroscience.


Dr. Bruce Bjornson, Dr. Ken Poskitt, Dr. Rollin Brant, Dr. Anne Synnes, Dr. Ivan Cepeda and Kevin Fitzpatrick are also collaborators on this research.

For more information: