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Electrophysiological Measurements and Analysis of Nociception in Human Infants
Published on: December 20, 2011
Identification of pain indicators for infants at risk for neurological impairment: a Delphi consensus study
Bonnie Stevens1, Patrick McGrath, Janet Yamada
1Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. b.stevens@utoronto.ca
Insights
This study identified key behavioral and physiological indicators for assessing infant pain, crucial for developing a reliable measure for infants at risk of neurological impairments (NI). Findings will aid in creating a validated pain assessment tool for this vulnerable population.
Area of Science:
- Pediatric pain assessment
- Infant neurology
- Clinical consensus development
Background:
- Existing infant pain measures lack reliability and validity for infants at risk for neurological impairments (NI).
- The study aimed to establish expert consensus on pain indicators for infants across different NI risk levels (high, moderate, low).
Framework:
- A Delphi consensus exercise involving 14 pediatric pain experts was employed.
- A 39-item electronic survey assessed the importance and usefulness of infant behavioral, physiological, and contextual pain indicators.
Implementation:
- Experts anonymously rated pain indicators across three NI risk levels over two rounds.
- Round 1 showed moderate agreement; Round 2 showed fair agreement among experts.
Implications:
- Consensus identified key indicators: brow bulge, facial grimace, eye squeeze, and inconsolability across all risk groups.
- Physiological indicators like increased heart rate and reduced oxygen saturation were highly rated in moderate and severe risk groups.
- These findings are foundational for developing and validating a novel pain assessment tool for at-risk infants.
Background:
A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; however, no reliable or valid measure exists for infants who are at risk for neurological impairments (NI). The objective of this study was to establish consensus about which behavioural, physiologic and contextual indicators best characterize pain in infants at high, moderate and low levels of risk for NI.
Methods:
A 39- item, self-administered electronic survey that included infant physiologic, behavioral and contextual pain indicators was used in a two round Delphi consensus exercise. Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI.
Results:
The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2. In general, pain indicators with the highest concordance for all three groups were brow bulge, facial grimace, eye squeeze, and inconsolability. Increased heart rate from baseline in the moderate and severe groups demonstrated high concordance. In the severe risk group, fluctuations in heart rate and reduced oxygen saturation were also highly rated.
Conclusion:
These data constitute the first step in contributing to the development and validation of a pain measure for infants at risk for NI. In future research, we will integrate these findings with the opinions of (a) health care providers about the importance and usefulness of infant pain indicators and (b) the pain responses of infants at mild, moderate and high risk for NI.
