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Are twitches, startles, and body movements pain indicators in extremely low birth weight infants?
R E Grunau1, L Holsti, M F Whitfield
1Centre for Community Child Health Research, British Columbia Research Institute for Children's and Women's Health, Vancouver, Canada. rgrunau@cw.bc.ca
Insights
Some body movements in preterm infants may signal pain. Extensor movements like leg extension were linked to distress, but tremors and twitches were not. Further research is needed to understand infant pain cues.
Area of Science:
- Neonatal care
- Infant pain assessment
- Developmental pediatrics
Background:
- Preterm infants in Neonatal Intensive Care Units (NICUs) experience numerous medical procedures.
- Identifying reliable pain cues in these vulnerable infants is crucial for appropriate care.
- Current understanding of motor activity as pain indicators in preterm infants requires further investigation.
Purpose of the Study:
- To investigate if specific body movements, including postural, trunk, and limb actions, serve as pain indicators in preterm infants.
- To differentiate between movements associated with distress and those that are not during routine NICU procedures.
Main Methods:
- A convenience sample of 64 extremely low birth weight preterm infants in a Level III NICU was observed.
- Behaviors during procedures like endotracheal suctioning and chest physical therapy were recorded using the Neonatal Individualized Developmental Care and Assessment Program.
- Heart rate and sleep/waking state changes were also monitored as indicators of distress.
Main Results:
- While heart rate and sleep state changes correlated with procedures, arching, squirming, startles, and twitching were not significantly increased during procedures.
- Finger splay and leg extension were significantly associated with ongoing medical procedures.
- Facial brow raising indicated sensitization, correlating with the number of invasive procedures in the prior 24 hours.
Conclusions:
- Certain extensor movements may indicate distress in preterm infants, whereas tremors, startles, and twitches did not appear to be related to discomfort during the study.
- Motor behaviors may manifest differently during prolonged or more invasive events.
- Further research with extended observation periods is recommended to comprehensively evaluate motor activity patterns as potential stress and pain indicators in NICU infants.
Objective:
The goal of this study was to examine whether body activity such as postural, trunk, and limb movements may be potential pain cues in preterm infants.
Design:
Convenience sample.
Setting:
Level III neonatal intensive care unit (NICU).
Patients:
Extremely low birth weight (< or = 1,000 g) preterm infants (n = 64) undergoing routine NICU medical care.
Outcome Measures:
Procedures likely to differ in evoking distress (i.e., endotracheal suctioning, chest physical therapy, diaper change, or nasogastric feed) were observed. Behaviors were recorded at bedside using the Neonatal Individualized Developmental Care and Assessment Program system.
Results:
Changes in heart rate and sleep/waking state were related to the procedures, supporting the assumption of differing relative disruption to the infant. Arching, squirming, startles, and twitching were not observed significantly more during procedures than at baseline. After controlling for background variables, finger splay and leg extension were significantly related to ongoing procedures. Facial brow raising was a function of the number of invasive procedures in the past 24 hours; thus, it may be a useful cue of sensitization.
Conclusions:
Some extensor movements seemed to be distress signals, whereas tremors, startles, and twitches were not related to discomfort during the observation period. These behaviors may differ qualitatively during longer lasting tissue invasive events. The results of this study indicate the need for more in-depth study of patterns of motor activity in preterm infants over longer observation periods to evaluate potential signs of stress and pain in babies undergoing NICU medical care.