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Are there developmentally distinct motor indicators of pain in preterm infants?
Sara J Morison1, Liisa Holsti, Ruth Eckstein Grunau
1Centre for Community Child Health Research, British Columbia Research Institute for Children's and Women's Health, Room L-408, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4. lholsti@cw.bc.ca
Insights
Preterm infants
Area of Science:
- Neonatal care
- Pain assessment
- Developmental pediatrics
Background:
- Pain management in preterm infants is crucial.
- Current pain assessment tools may not capture all infant responses.
- The Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) offers potential indicators.
Purpose of the Study:
- To comprehensively evaluate preterm infant pain responses over time.
- To assess the utility of specific NIDCAP motor movements for pain evaluation.
- To compare NIDCAP motor cues with facial and physiological pain indicators.
Main Methods:
- Studied 10 preterm infants (31 weeks GA) during routine blood collection.
- Used continuous computerized physiological and video recordings (60 min).
- Coded motor behaviors (NIDCAP) and facial actions (Neonatal Facial Coding System - NFCS), comparing with heart rate and oxygen saturation.
Main Results:
- Arm/leg extension and finger splay were common NIDCAP stress cues post-procedure.
- Twitches and startles were less frequent post-procedure, contrary to the NIDCAP model.
- All infants showed NFCS responses, but some were of low magnitude.
- Heart rate increased and oxygen saturation decreased post-procedure.
- Infants with higher prior pain exposure showed more motor cues but less facial activity.
Conclusions:
- NIDCAP's extremity extension and finger splay show promise as clinical pain indicators.
- These motor cues may supplement facial and physiological measures in preterm infants.
- Further validation of NIDCAP motor movements in pain assessment is warranted.
Abstract:
The aims of this study were to examine preterm infant reactions to pain in detail over prolonged time periods using multiple measures, and to assess the value of including specific body movements of the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) system to evaluate pain. Ten preterm infants born at 31 weeks mean gestational age (GA) and mean birth weight 1676 g were studied during a routine blood collection in a Level III neonatal intensive care unit (NICU). At 32-week post-conceptional age, computerized physiologic and video recordings were obtained continuously for 60 min (prior to, during and after lance). Motor and facial behaviors were coded independently, using the NIDCAP and the NFCS (Neonatal Facial Coding System), respectively, and compared with heart rate (HR) and oxygen saturation responses. Of the movements hypothesized to be stress cues in the NIDCAP model, extension of arms and legs (80%) and finger splay (70%) were the most common following lance. Contrary to the model, most infants (70%) had lower incidence of twitches and startles post-lance compared to baseline. Whereas all infants showed some NFCS response to lance, for three infants, the magnitude was low. HR increased and oxygen saturation decreased post-lance. Infants with more prior pain exposure, lower Apgar, and lower GA at birth, displayed more motor stress cues but less facial activity post-lance. Extension of extremities and finger splay, but not twitches and startles, from the NIDCAP, appear to be stress cues and show promise as clinical pain indicators to supplement facial and physiological pain measures in preterm infants.