Neonatal Pain Assessment After Night Shifts in NICU Professionals: A Within-Subject Exploratory Eye-Tracking Study

Night-shift work may influence attention and emotion processing, potentially affecting clinical assessment. We investigated whether neonatal pain evaluation and associated visual-attentional and pupillary responses differed between rested and post-night-shift assessments in experienced NICU professionals.

In this prospective within-subject study, 20 NICU professionals evaluated 42 standardized video clips of term neonates exposed to nonnoxious, short noxious, or prolonged noxious stimuli. Participants were assessed after at least 1 day off work and within 2 h after completing one or more consecutive night shifts. Pain ratings, eye-tracking metrics, and pupil diameter were compared between conditions.

Overall pain ratings did not differ significantly between rested and post-night-shift assessments (3.56 ± 0.69 vs. 3.61 ± 0.72; p = 0.643; Cohen's d = 0.11). Pupillary responses also showed no statistically significant differences. Exploratory eye-tracking analyses suggested reduced visual exploration after night-shift exposure, including fewer visits across several areas of interest and shorter fixation duration on the infant's body. These secondary analyses were unadjusted for multiple comparisons and should therefore be considered hypothesis-generating.

No statistically significant differences in neonatal pain ratings or pupillary responses were detected following routine night-shift work, whereas exploratory eye-tracking measures suggested differences in visual-attentional patterns. Given the small, selected sample and exploratory design, these findings do not establish equivalent or preserved performance between conditions. Larger prospective studies incorporating objective sleep measures and clinically relevant outcomes are warranted.