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Developmental changes in response to heelstick in preterm infants: a prospective cohort study
C C Johnston1, B Stevens, F Yang
1McGill University, School of Nursing, Montreal, Quebec, Canada.
Insights
Preterm infants show distinct pain responses that become more pronounced as they age. Recognizing these subtle cues is crucial for neonatal care professionals, even in the youngest infants.
Area of Science:
- Neonatal care
- Pediatric pain research
- Infant physiology
Background:
- Preterm infants experience significant pain during routine procedures.
- Accurate assessment of pain in preterm neonates is challenging.
- Understanding pain response development is vital for effective pain management.
Purpose of the Study:
- To investigate changes in pain response in preterm infants over time.
- To differentiate pain responses to noxious stimuli versus non-noxious stimuli.
- To identify reliable physiological and behavioral indicators of pain in early infancy.
Main Methods:
- Observational study of 28 preterm infants (28 weeks gestational age).
- Repeated assessments over eight weeks using heelstick and sham procedures.
- Measurement of heart rate, oxygen saturation, and upper facial actions.
Main Results:
- Real heelstick elicited significantly greater heart rate and facial action responses than sham procedures at 28 weeks gestational age.
- Oxygen saturation did not show significant differences between real and sham heelstick.
- The magnitude of response to both real and sham heelstick increased with infant age.
Conclusions:
- Preterm infants demonstrate differential pain responses even at the youngest ages.
- Pain responses become more robust and recognizable as preterm infants mature.
- Healthcare professionals must be trained to recognize subtle pain indicators in preterm neonates.
Abstract:
Twenty-eight preterm infants of 28 weeks gestational age were observed four times over eight weeks in order to determine changes in their pain response. Both routine and sham heelstick procedures were used. Physiological (heart rate and oxygen saturations) and behavioural parameters (three upper facial actions) were used as outcomes. The responses to real heelstick were significantly greater than to sham heelstick for heart rate and all facial actions except one at 28 weeks gestational age, but not for oxygen saturation. The magnitude of response to both real and sham heelstick increased over time. Thus, the older the infant, the more robust and recognisable the response. Since even the youngest infants showed a differential response to pain, professionals caring for such infants need to be able to recognize their more subtle pain responses.