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Updated: Jul 4, 2026
Electrophysiological Measurements and Analysis of Nociception in Human Infants
Published on: December 20, 2011
Electroencephalographic response to procedural pain in healthy term newborn infants
Elisabeth Norman1, Ingmar Rosén, Sampsa Vanhatalo
1Department of Pediatrics, Lund University Hospital, Lund SE-22185, Sweden. elisabeth.norman@med.lu.se
Insights
Electroencephalography (EEG) measures did not effectively assess pain in neonates. Increased muscle tone, not cortical activity, correlated with pain responses, indicating EEG is not a reliable clinical tool for infant discomfort.
Area of Science:
- Neonatal care
- Neuroscience
- Pain research
Background:
- Neonatal intensive care units (NICUs) frequently expose infants to painful stimuli.
- Accurate pain assessment in neonates is crucial for appropriate clinical management.
- Electroencephalography (EEG) is explored as a potential objective measure of pain and discomfort.
Purpose of the Study:
- To characterize EEG changes in response to noxious stimuli in neonates.
- To evaluate the utility of EEG measures for assessing pain and discomfort in neonates during NICU procedures.
Main Methods:
- Seventy-two healthy term infants underwent procedures including heel prick and venous blood sampling.
- EEG data were recorded during stimuli, with interventions like oral glucose or water.
- Behavioral pain responses were assessed using the Premature Infant Pain Profile Scale.
Main Results:
- Noxious stimuli induced significant increases in higher frequency EEG components (10-30 Hz).
- This increased activity was localized frontotemporally and correlated with behavioral pain measures, indicating increased muscle tone.
- No changes in frontal EEG asymmetry were observed, and EEG cortical activity did not prove useful for clinical pain assessment.
Conclusions:
- EEG-based measures, particularly cortical activity and frontal asymmetry, are not reliable indicators of pain or discomfort in neonates.
- Observed EEG changes primarily reflect increased muscle tone (electromyographic artifacts) rather than direct cortical responses to pain.
- Current EEG measures are not recommended for clinical assessment of pain in infants undergoing NICU procedures.
Abstract:
The current study aimed to characterize changes in EEG-related measures after noxious stimuli in neonates and to assess their potential utility as measures of pain and/or discomfort during neonatal intensive care. Seventy-two healthy term infants were investigated: Twenty-eight had a non-skin-breaking pin-prick on the heel, randomized to receive either oral glucose (n = 16) or water (n = 12) before the stimulus. Twenty-one infants were studied during a venous blood sample from the dorsum of the hand, 23 infants during a capillary heel stick. Behavioral pain responses were assessed with the Premature Infant Pain Profile Scale. The stimulus evoked a significant increase in higher frequency components (10-30 Hz) which also correlated to behavioral measures. The frontotemporal localization of the increased activity with frequency bands similar to electromuscular artifacts and the relation to behavioral measures confirmed that this activity corresponds to an increase in muscle tone. There was no change in frontal EEG asymmetry in any of the groups. The present results indicate that responses in cortical activity recorded by EEG are not useful for clinical assessment of infants' responses to noxious stimuli.
