Long-term consequences of early infant injury and trauma upon somatosensory processing.

摘要

Long-term consequences of early infant injury upon somatosensory processing were tested in school aged children. The aim was to test whether the long-term changes in sensitivity reported in animal models, in regions both local to and distant from the injury site, could be observed in humans. To do this we used quantitative sensory testing (QST) in children aged 9-12 years who had undergone cardiac surgery in infancy. Cutaneous mechanical and thermal thresholds were measured at the thoracic scar region and at control contralateral thoracic and reference thenar areas in this early surgery group (n=9), and compared with thresholds at the same regions in age and gender-matched controls (n=9). The results showed that the cardiac surgery group was significantly less sensitive to von Frey hair tactile stimulation in the non-injured thenar area than the control group; mean threshold 5.02, SD+/-1.59 compared to 2.76, SD+/-0.79 (von Frey hair number, p=0.04). In addition, their lateral thoracotomy scar areas were significantly less sensitive to von Frey hair stimulation (mean=9.82, SD+/-1.97, p<0.001) and to cooling and warming than any other site tested. Eight of the nine children in the early surgery group did not perceive warmth on their scars and were only able to detect uncomfortable heat as the temperature was raised. Three of these children felt a paradoxical cold prior to the hot sensation and all reported subtle abnormalities in everyday sensations. Questionnaires revealed perceived differences in pain perception, individual aberrant sensations and pain interfering with daily life that warrant further study. We conclude that tissue injured in early infancy remains measurably altered to mechanical and thermal stimulation in later life. These findings are consistent with the results of animal studies that early infant injury has not only local, but also global long-term consequences upon sensory processing.