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Cortisol, behavior, and heart rate reactivity to immunization pain at 4 months corrected age in infants born very

Ruth E Grunau1, Mai Thanh Tu, Michael F Whitfield

  • 1Department of Pediatrics, University of British Columbia, Vancouver BC, Canada. rgrunau@cw.bc.ca

The Clinical Journal of Pain
|July 29, 2010
PubMed

Insights

Preterm infants show similar behavioral and heart rate responses to pain as full-term infants. However, preterm male infants exhibit altered stress regulation, indicated by lower cortisol levels during immunization.

Area of Science:

  • Neonatal development
  • Pediatric pain research
  • Neuroendocrinology

Background:

  • Infants born preterm may have altered pain responses due to neonatal intensive care unit (NICU) procedures.
  • Previous studies on behavioral and cardiac pain responses in preterm versus full-term infants have yielded inconsistent findings.
  • Cortisol reactivity to pain has not been previously compared between preterm and full-term infants.

Purpose of the Study:

  • To compare pain reactivity to immunization in preterm and full-term infants at 4 months corrected age.
  • To investigate differences in cortisol, facial behavior, and heart rate responses to pain between these groups.
  • To explore potential alterations in stress regulation in preterm infants.

Main Methods:

  • Examined cortisol, facial behavior, and heart rate reactivity before, during, and after immunization.
  • Included infants born preterm at extremely low gestational age (ELGA; 24-28 wk) and very low gestational age (VLGA; 29-32 wk), and full-term infants.
  • Assessments were conducted at 4 months corrected age.

Main Results:

  • All infants exhibited increased cortisol, facial behavior, and heart rate during immunization.
  • Cortisol concentrations were lower in preterm ELGA and VLGA boys compared to full-term boys.
  • Facial and heart rate responses to immunization did not differ between preterm and full-term infants.

Conclusions:

  • Pain responses, measured by behavior and heart rate, do not appear to differ between preterm and full-term infants at 4 months corrected age.
  • Stress regulation appears to be altered in preterm male infants, evidenced by lower cortisol reactivity.
  • Altered stress regulation in preterm males has significant implications for brain development and function beyond pain pathways.
Abstract

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