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 ≤800g and/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.

Prenatal Alcohol Exposure Alters Biobehavioral Reactivity to Pain in Newborns

“…Pain reactivity in this context may constitute a final common pathway that links prenatal exposure (i.e., alcohol), “programming” or resetting of neurotransmitter and autonomic systems, and arousal regulatory capacities that are predictive of subsequent childhood stress reactivity and developmental risk. In this sense, infant pain reactivity can be regarded as providing a “window” into the developing brain (Doussard‐Roosevelt et al., 1997; Grunau et al., 2006; Oberlander et al., 2002) and reflecting or indexing developmental vulnerability. Interpreting our biobehavioral measures in this context provides a meaningful approach to the data.…”

Efficacy of swaddling and heel warming on pain response to heel stick in neonates: a randomised control trial

“…According to anatomical, physiological and behavioural studies, neonates can perceive pain (Grunau et al . , Simons & Tibboel ). Because neonates cannot verbally express themselves, behavioural and physiological indicators are used to measure their pain responses.…”

Randomized Crossover Trial of Kangaroo Care to Reduce Biobehavioral Pain Responses in Preterm Infants: A Pilot Study

“…Unrelieved pain caused by invasive procedures is associated with adverse behavioral and biophysiologic outcomes such as increased heart rate, blood pressure, oxygen consumption, and stress hormone secretion, all of which cause marked fluctuation in intracranial pressure, possibly leading to intraventricular hemorrhage (IVH) and periventricular leukomalacia (Grunau et al, 2005;Holsti, Grunau, Oberlander, & Whitfield, 2004;Taddio, Shah, Gilbert-MacLeod, & Katz, 2002). Early and repeated exposure of preterm infants to pain may also have long-term cumulative sequelae, including prolonged structural and functional alterations in pain pathways that can last into adult life, permanently altering normal or common responses to pain (Abdulkader, Freer, Garry, Fleetwood-Walker, & McIntosh, 2008;Fitzgerald & Walker, 2009;Grunau, Whitfield, et al, 2006). Pain is also believed to be neurotoxic to hippocampal formation (Fitzgerald & Walker, 2009;Grunau et al, 2009;Thompson et al, 2008) and may have specific adverse effects on cognition, memory (Beauchamp et al, 2008;Grunau, Holsti, & Peters, 2006;Grunau et al, 2009), and motor development (Grunau et al, 2009;Holsti, Grunau, Oberlander, & Whitfield, 2005).…”