{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:08:18Z","timestamp":1777939698020,"version":"3.51.4"},"reference-count":40,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Hypothermia and Temperature Management"],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"<jats:p>\n                    Although therapeutic hypothermia (TH) improves outcomes after neonatal encephalopathy (NE), the safety and efficacy of preemptive opioid sedation during cooling therapy is unclear. We performed a secondary analysis of the data from a large multicountry prospective observational study (Magnetic Resonance Biomarkers in Neonatal Encephalopathy [MARBLE]) to examine the association of preemptive morphine infusion during TH on brain injury and neurodevelopmental outcomes after NE. All recruited infants had 3.0 Tesla magnetic resonance imaging and spectroscopy at 1 week, and neurodevelopmental outcome assessments at 22 months. Of 223 babies recruited to the MARBLE study, the data on sedation were available from 169 babies with moderate (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u2009150) or severe NE (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200919). Although the baseline characteristics and admission status were similar, the babies who received morphine infusion (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u2009141) were more hypotensive (49% vs. 25%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.02) and had a significantly longer hospital stay (12 days vs. 9 days,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.009) than those who did not (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200928). Basal ganglia\/thalamic injury (score \u22651) and cortical injury (score \u22651) was seen in 34\/141 (24%) and 37\/141 (26%), respectively, of the morphine group and 4\/28 (14%) and 3\/28 (11%) of the nonmorphine group (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&gt;\u20090.05). On regression modeling adjusted for potential confounders, preemptive morphine was not associated with mean (standard deviation [SD]) thalamic N-acetylaspartate (NAA) concentration (6.9\u2009\u00b1\u20090.9 vs. 6.5\u2009\u00b1\u20091.5;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.97), and median (interquartile range) lactate\/NAA peak area ratios (0.16 [0.12\u20130.21] vs. 0.13 [0.11\u20130.18];\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.20) at 1 week, and mean (SD) Bayley-III composite motor (92\u2009\u00b1\u200923 vs. 94\u2009\u00b1\u200910;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.98), language (89\u2009\u00b1\u200922 vs. 93\u2009\u00b1\u20098;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.53), and cognitive scores (95\u2009\u00b1\u200921 vs. 99\u2009\u00b1\u200913;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.56) at 22 months. Adverse neurodevelopmental outcome (adjusted for severity of encephalopathy) was seen in 26 (18%) of the morphine group, and none of the nonmorphine group (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.11). Preemptive morphine sedation during TH does not offer any neuroprotective benefits and may be associated with increased hospital stay. Optimal sedation during induced hypothermia requires further evaluation in clinical trials.\n                  <\/jats:p>","DOI":"10.1089\/ther.2018.0052","type":"journal-article","created":{"date-parts":[[2019,2,26]],"date-time":"2019-02-26T12:46:18Z","timestamp":1551185178000},"page":"45-52","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":24,"title":["Preemptive Morphine During Therapeutic Hypothermia After Neonatal Encephalopathy: A Secondary Analysis"],"prefix":"10.1177","volume":"10","author":[{"given":"Natasha","family":"Liow","sequence":"first","affiliation":[{"name":"Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Montaldo","sequence":"additional","affiliation":[{"name":"Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom."},{"name":"Neonatal Unit, Universit\u00e0 degli Studi della Campania, \u201cLuigi Vanvitelli,\u201d Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter J.","family":"Lally","sequence":"additional","affiliation":[{"name":"Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justinas","family":"Teiserskas","sequence":"additional","affiliation":[{"name":"Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Bassett","sequence":"additional","affiliation":[{"name":"Statsconsultancy Ltd., Amersham, London."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V\u00e2nia","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebeccah","family":"Slater","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Oxford, Oxford, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seetha","family":"Shankaran","sequence":"additional","affiliation":[{"name":"Neonatal\u2013Perinatal Medicine, Wayne State University, Detroit, Michigan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhin","family":"Thayyil","sequence":"additional","affiliation":[{"name":"Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,2,10]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(85)80390-0"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16251-X"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1203\/01.PDR.0000157676.45088.8C"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1592\/phco.28.1.102"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0900854"},{"key":"e_1_3_3_7_1","first-page":"CD004212","article-title":"Opioids for neonates receiving mechanical ventilation","author":"Bell\u00f9 R","year":"2008","unstructured":"Bell\u00f9 R, , de Waal KA, , Zanini R. 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