Behaviors of Very Preterm Neonates as Documented Using NIDCAP Observations

Pressler, Jana L.; Hepworth, Joseph T.; Helm, J M; Wells, Nancy

doi:10.1891/0730-0832.20.8.15

Cited by 15 publications

(18 citation statements)

References 27 publications

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“…However, these investigators did not specify the procedures that they observed. 26 The most important finding of this study was that we found a subset of 8 NIDCAP movements that seem to be associated with acute pain in preterm infants. Although some of the 8 NIDCAP movements that we identified are included in other pain measures, others have not been described as behavioral pain cues before this study.…”

Section: Discussionmentioning

confidence: 64%

Specific Newborn Individualized Developmental Care and Assessment Program Movements Are Associated With Acute Pain in Preterm Infants in the Neonatal Intensive Care Unit

Holsti

Grunau²,

Oberlander

et al. 2004

Pediatrics

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Objective. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is widely used in neonatal intensive care units and comprises 85 discrete infant behaviors, some of which may communicate infant distress. The objective of this study was to identify developmentally relevant movements indicative of pain in preterm infants.Methods. Forty-four preterm infants were assessed at 32 weeks' gestational age (GA) during 3 phases (baseline, lance/squeeze, and recovery) of routine blood collection in the neonatal intensive care unit. The NIDCAP and Neonatal Facial Coding System (NFCS) were coded from separate continuous bedside video recordings; mean heart rate (mHR) was derived from digitally sampled continuous electrographic recordings. Analysis of variance (phase × gender) with Bonferroni corrections was used to compare differences in NIDCAP, NFCS, and mHR. Pearson correlations were used to examine relationships between the NIDCAP and infant background characteristics.Results. NFCS and mHR increased significantly to lance/squeeze. Eight NIDCAP behaviors also increased significantly to lance/squeeze. Another 5 NIDCAP behaviors decreased significantly to lance/squeeze. Infants who had lower GA at birth, had been sicker, had experienced more painful procedures, or had greater morphine exposure showed increased hand movements indicative of increased distress.Conclusions. Of the 85 NIDCAP behaviors, a subset of 8 NIDCAP movements were associated with pain. Particularly for infants who are born at early GAs, addition of these movements to commonly used measures may improve the accuracy of pain assessment.Major advances in neonatal care now enable a high proportion of preterm infants to survive. During a time when medical concerns focused primarily on stabilizing the physiologic needs of preterm infants, Als, a developmental psychologist, developed a theory and systematic method of assessing the developmental needs of preterm newborns, the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).1 Als hypothesized is a high priority for caregivers in the NICU because early pain exposure may alter nociceptive pathways 9 , 10 and may also contribute to changes in other areas of development. , 12Although improved pain assessment and management is a clinical priority, accurate identification of pain responses is complex for a number of reasons. First, preterm infants respond with facial, motor, and physiologic changes to acute pain, but they differ from termborn infants in that their responses are of smaller magnitude, particularly at younger gestational ages (GAs). 13 , 14 Second, preterm infants at earlier GAs may display different pain behaviors than infants at later GAs as a result of neurologic immaturity. Such behaviors may not be captured in the current pain scales because the behaviors chosen have been based on behaviors seen in term infants. Third, no physiologic or behavioral threshold specifically marks the presence of pain. Finally, although using a single pain index is eas...

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Section: Discussionmentioning

confidence: 64%

Specific Newborn Individualized Developmental Care and Assessment Program Movements Are Associated With Acute Pain in Preterm Infants in the Neonatal Intensive Care Unit

Holsti

Grunau²,

Oberlander

et al. 2004

Pediatrics

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“…Studies using the NIDCAPÒ to evaluate the effects of routine care giving in the NICU are not only few in number, but have pooled all handling to make general comments regarding the infants' responses, 14 have not included the full range of NIDCAPÒ behaviors, 19 have not specified the procedures observed in the study, 20 or have not included diaper changing as one of the procedures being evaluated. 13,15 Thus, the aims of this study are the following: 1.…”

mentioning

confidence: 99%

Body Movements: An Important Additional Factor in Discriminating Pain From Stress in Preterm Infants

Holsti

Grunau²,

Oberlander³

et al. 2005

The Clinical Journal of Pain

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Changes in facial activity and heart rate remain the most sensitive markers of pain in preterm infants. Tactile procedures, such as diaper changing, produce lower intensity facial and physiological responses than pain procedures, but greater body reactions. Also, the effects from tactile procedures appear to last longer. Adding observations of a small number of specific body movements to the assessment of pain and stress provides complementary information particularly for those infants who may show dampened facial reactivity as a result of repeated pain exposure.

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“…No differences were found in stress behaviors related to the respiratorycirculatory system and the digestive system. Regulation of the respiratory-circulatory system tends to be observed at the gestational age of 24-30 weeks in premature infants 10) , and physiological stress decreases over time until it stabilizes at 32 weeks 11) . As participants in this study were at term age at the time of the NIDCAP behavioral observations, respiratory-circulatory system stresses were expected to have stabilized.…”

Section: Discussionmentioning

confidence: 99%

“…Stress signs of the motor system are also easily observed in premature infants at the gestational age of 24-30 weeks. Pressler et al and Grunau et al suggested that stress signs of the motor system arise from the organization of the n e u r o b e h a v i o r a l s y s t e m a c c o m p a n i e d b y g e s t a t i o n a l a g e ( m a t u r i t y ) , d i s e a s e , a n d environmental factors 10,12) . Grunau et al also…”

Section: Discussionmentioning

confidence: 99%

Stress Behavior in Premature Infants with Periventricular Leukomalacia

et al. 2010

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Abstract.[Purpose] The aim of this study was to evaluate the stress behavior of infants with preventricular leukomalacia (PVL) using direct behavioral observation.[Subjects] The participants were 15 infants with and 73 infants without PVL. [Methods] This research examined infants' stress behaviors in response to handling during a Brazelton Neonatal Behavioral Assessment Scale (NBAS) exam. Observation of the stress behaviors was recorded at the bedside. Infants' behaviors were simultaneously videotaped. The assessment was performed at the postconceptional age of 38-40 weeks (term).[Results] The with-PVL group showed significantly higher frequency of stress behaviors in the autonomic (pale/cyanotic, tremor, startle, twitch), motor (arm flexion, legs extension, jerky movements, finger splay, arching, salute, hand clasp, foot clasp, holding on, flaccidity, grimacing) and state-orientation (fuss, panicked or worried alertness, gaze aversion, high pitched cry) subsystems compared with the without-PVL group.[Conclusion] Behavioral observations may help clinicians assess preterm infant neurological status and provide useful information for facilitating the development and adaptability of infants' behavioral organization.

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Behaviors of Very Preterm Neonates as Documented Using NIDCAP Observations

Cited by 15 publications

References 27 publications

Specific Newborn Individualized Developmental Care and Assessment Program Movements Are Associated With Acute Pain in Preterm Infants in the Neonatal Intensive Care Unit

Specific Newborn Individualized Developmental Care and Assessment Program Movements Are Associated With Acute Pain in Preterm Infants in the Neonatal Intensive Care Unit

Body Movements: An Important Additional Factor in Discriminating Pain From Stress in Preterm Infants

Stress Behavior in Premature Infants with Periventricular Leukomalacia

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