Biobehavioural reactivity to pain in preterm infants: a marker of neuromotor development

Abstract

In this preliminary study, it was examined whether capacity to react to external stress (acute pain) during neonatal intensive care predicts later neuromotor development at 4 and 8 months corrected chronological age (CCA) in high-risk preterm infants. Behavioural and cardiac reactivity to blood collection at 32 weeks postconceptional age (PCA) were recorded in addition to developmental outcomes at 4 and 8 months CCA in 35 preterm infants (17 males, 18 females) born <or=800 g and/or <or=25 weeks gestational age (GA). Pain reactivity during routine heel lance for blood collection at 32 weeks GA was measured using a composite score derived from the Neonatal Facial Coding System, change in infant sleep/wake state, and spectral analysis of heart rate. Motor development was assessed using the Movement Assessment of Infants scale and the Bayley Scales of Infant Development. Low biobehavioural pain reactivity at 32 weeks PCA was associated with poorer overall quality of motor function at 8 months CCA, but not at 4 months CCA. It was concluded that pain reactivity before discharge from the neonatal intensive care unit may be a useful marker of neuromotor development in infancy.

Personal perspectives: Infant pain—A multidisciplinary journey

“… 15 Subsequently, we established that indeed neonatal pain (quantified as the number of invasive procedures in the NICU), beyond clinical factors of prematurity, was associated with later pain sensitivity, 16 neurodevelopment, and behavior during infancy and childhood. 17 , 18 Many clinical factors such as gestational age at birth, illness, duration of respiratory support on mechanical ventilation, infections, and surgeries are correlated with how many invasive procedures are conducted on infants undergoing intensive care. Therefore, we controlled statistically for these factors in our cohort studies as far as possible.…”

Perinatal management of harlequin ichthyosis: a case report and literature review

“…In the long term, inadequate neonatal pain control has been associated with developmental delay and abnormal stressor responses. [10][11][12] However, it is important to balance pain and over-sedation as an over-medicated neonate can have feeding issues and suffer respiratory depression.…”

The Emergence and Development of Physiological Regulatory Systems of Newborn Infants in a Neonatal Intensive Care Unit

“…The adverse consequences of pain response during the early neonatal period have been documented by numerous study (Grunau et al, 2006), and an emphasis has been placed on pain responses in the NICU (Brown, 2009;Johnston et al, 2010;Stevens et al, 2006Stevens et al, , 2010. The most common pain event in NICU is blood procurement including heel lance and venepuncture (Carbajal et al, 2008).…”

“…These indices are very helpful to investigate the pain response in preterm infants (Lindh et al, 1999;Morison et al, 2001;Oberlander & Saul, 2002;Padhye et al, 2009). The intensity of pain response in infants has been thought to be related with ANS activity maturation (Grunau et al, 2006). We have experimentally observed three cases with different GA (26, 31, 35 weeks) to analyse the differences in the intensity of the response to the pain stimuli during blood sampling.…”