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Updated: Jun 2, 2026
Electrophysiological Measurements and Analysis of Nociception in Human Infants
Published on: December 20, 2011
Behavioral response to pain in drowsy and sleeping neonates: a randomized control study
Sheila S Mathai1, Amit Naresh, Sathyajit Sahu
1INHS Asvini (Naval Hospital), Colaba, Mumbai, India. sheilamathai@yahoo.com
Insights
Newborns who are drowsy or sleeping during a heel prick show a less intense pain response. This study found lower pain scores and shorter crying duration in sleeping infants compared to awake ones.
Area of Science:
- Neonatal care
- Pediatric pain management
- Infant behavior
Background:
- Heel prick procedures are common for newborn screening.
- Assessing pain in neonates is crucial for appropriate care.
- Pain perception and response can vary based on infant state.
Purpose of the Study:
- To investigate the impact of neonatal state (drowsy/sleeping vs. awake) on pain response during heel prick.
- To compare pain scores and crying duration between different infant states.
Main Methods:
- A randomized controlled trial involving 100 healthy term neonates.
- Infants were assigned to either a drowsy/sleeping state or an awake state during heel prick.
- The Neonatal Infant Pain Score (NIPS) and cry duration were measured.
Main Results:
- Infants in the drowsy/sleeping state had significantly lower NIPS scores at 30 seconds post-stimulus (median 5 vs. 6).
- The duration of crying was shorter in the drowsy/sleeping group (29.17 sec vs. 32.67 sec).
- No significant difference in NIPS scores was observed at 45 seconds post-stimulus.
Conclusions:
- Neonatal state significantly influences behavioral pain responses to heel prick.
- Drowsy or sleeping infants exhibit a reduced behavioral response to painful stimuli.
- Optimizing infant state may be a strategy to minimize pain during neonatal procedures.
Abstract:
In a randomized controlled design, 100 healthy, term neonates in the first week of life, undergoing heel prick for routine screening were randomized to receive a heel prick in either the drowsy/sleeping state or the awake (but not fussy or crying) state. 48 babies in sleeping or drowsy states and 47 in the awake states were analyzed. Infants in the drowsy/sleeping states scored significantly lower on the Neonatal Infant Pain Score (NIPS) (median score 5) at 30 seconds post stimulus compared with infants in higher states of alertness (median score 6). They also had a shorter total duration of cry (29.17 sec ± 8.95 vs 32.67 sec ± 9.82). However, there was no difference in the NIPS score between the two groups at 45 seconds post stimulus. We concluded that babies in the drowsy/sleeping states of alertness at the time of a painful stimulus appear to show a less intense behavioral response to pain as compared to those in the awake state.
