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Factors that influence the behavioral pain responses of premature infants
Bonnie J Stevens1, Celeste C Johnston, Linda Horton
1University of Toronto, Perinatal Nursing Research, Mount Sinai Hospital, Toronto, OntarioCanada McGill University, Montreal Children's Hospital, Montreal, QuebecCanada Royal Victoria Hospital, Montreal, QuebecCanada.
Insights
Pain responses in preterm neonates are influenced by illness severity and behavioral state. Understanding these factors is crucial for accurately identifying pain in premature infants during procedures like heel lance.
Area of Science:
- Neonatal care
- Pain assessment
- Infant physiology
Background:
- Limited understanding of factors influencing preterm neonates' responses to pain.
- Previous research focused on describing responses, not contextual influences.
Purpose of the Study:
- To investigate how severity of illness and behavioral state affect preterm neonates' behavioral and acoustic responses to acute pain.
- To identify key variables influencing pain perception in this vulnerable population.
Main Methods:
- Observational study of 124 preterm infants undergoing a routine heel lance.
- Assessment of behavioral (facial actions) and acoustic (cry) responses.
- Analysis of contextual variables: severity of illness and behavioral state.
Main Results:
- Significant changes in facial actions and cry characteristics (fundamental frequency, harmonic structure, peak spectral energy) during the heel lance.
- Behavioral state significantly influenced facial actions.
- Severity of illness significantly modified acoustic cry variables.
Conclusions:
- Accurate pain identification in preterm neonates necessitates considering both behavioral state and illness severity.
- Contextual factors play a critical role in modulating pain responses in premature infants.
- Further research is needed to refine pain assessment tools for neonates.
Abstract:
The responses of preterm neonates to acute tissue-damaging stimuli have been described. However, factors which influence these responses have received little attention. In this study, we observed 124 premature infants before, during and after a routine heel lance and determined how two contextual variables (severity of illness and behavioral state) influenced their behavioral responses. Significant changes in facial actions occurred between baseline and the most invasive phase of the heel lance procedure, stick. The fundamental frequency, harmonic structure and peak spectral energy of the infant's cry were also significantly increased during the stick phase. Behavioral state was found to influence the facial action variables and severity of illness modified the acoustic cry variables. Accurate identification of pain in premature infants requires consideration of factors that influence their response.