Skin blood flow changes during routine nursery procedures

The objective of this study was to establish that changes in skin blood flow could serve as an index of pain and discomfort in newborn infants.

Skin blood flow changes during intensive care procedures and during morphine administration were measured in a group of newborn infants using a laser Doppler technique. Heart rate, respiratory rate and oxygen saturation were also measured. Changes in skin blood flow and physiologic variables that occurred during procedures were analyzed and compared among procedures.

Measurements were made during 145 procedures in 15 infants 2-32 days old with birth weights of 500-2900 g and gestational ages of 23-37 weeks. Ten of the infants were receiving mechanical ventilation. Skin blood flow increased 27-134% during lancet puncture of the heel, physical handling, standard suctioning and chest physiotherapy, and there were no changes during closed system suctioning. Skin blood flow decreased 35% by 20 min after intravenous morphine. Changes seen in heart rate, respiratory rate and oxygen saturation were generally minimal.

We conclude that laser Doppler skin blood flow changes could be an index of neonatal pain and discomfort; even noninvasive handling procedures are associated with increases in skin blood flow; and changes in skin blood flow may be more useful than conventional physiologic variables in assessing the response to intensive care nursery procedure.