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Quantification of Infant Distress Across Serial Clubfoot Casting Visits: A Prospective Pilot Study
Ruth H Jones1, Olivia C Tracey1, Patrick P Nian1
1Lerner Children's Pavilion, Hospital for Special Surgery, New York, NY, USA.
Background:
Idiopathic clubfoot is typically corrected with the Ponseti method, involving foot manipulation and serial casting followed by possible Achilles tenotomy and bracing. This process causes distress, but the quantification of infant distress during longitudinal casting visits has not been evaluated. The primary aim of this pilot study was to assess infant distress longitudinally across weekly casting sessions among children with clubfeet. Secondary aims included identifying patient characteristics associated with infant distress.
Methods:
Ten patients with idiopathic clubfoot were prospectively enrolled in this pilot study. Prenatal counseling, family history, baseline parental anxiety, and demographic data were recorded at the initial visit. The patient's pain response was assessed by the Neonatal Infant Pain Scale (NIPS) and heart rate (HR) at 5 designated casting steps during each visit. The primary outcome measures were NIPS score and HR at each casting step throughout the entire course of casting (ie, longitudinally across casting visits). HR range for each casting step was also recorded at every visit. Additionally, univariable and multivariable analyses were performed to identify predictors of infant distress.
Results:
There was a significant increase in NIPS across visits at casting steps 1, 2, and 3 (P = .03, P = .01, P = .05) and in HR at each of the 5 casting steps (P < .001, P < .001, P < .001, P < .001, P = .003). With the numbers available, no significant difference in HR range could be detected across visits (P = .51). Multivariable analysis demonstrated that visit number was independently associated with infant distress.
Conclusion:
This pilot study suggests that infant distress at certain casting steps increases from mild at the first visit to moderate at subsequent visits. The magnitude of heart rate elevation within each visit did not significantly change across visits in this pilot cohort, although whether this reflects infant acclimation or other factors warrants further investigation.
Level Of Evidence:
Level IV, prospective pilot study.