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

Grunau, Ruth E.; Whitfield, Michael F.; Fay, Taryn; Holsti, Liisa; Oberlander, Tim F.; Rogers, Marilynn L

doi:10.1016/j.acpain.2006.08.033

Cited by 5 publications

(4 citation statements)

References 26 publications

(27 reference statements)

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“…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 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).…”

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confidence: 99%

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

Cong

Ludington‐Hoe

Walsh

2010

Biological Research For Nursing

103

106

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Kangaroo care (KC), skin-to-skin contact between mother and infant, is a promising method for blunting pain responses. This crossover pilot tested KC effects on biobehavioral responses to heel stick in preterm infants (30-32 weeks' gestational age, 2-9 days old) measured by Premature Infant Pain Profile (PIPP) and salivary and serum cortisol. Mother-infant dyads were randomly assigned to KC heel stick (KCH) first or incubator heel stick (IH) first. Study 1 (80-min study, N = 18) tested the effect of 80 min of KC before and throughout the heel stick procedure versus incubator care. Study 2 (30-min study, N = 10) tested 30 min of KC before and throughout the heel stick versus incubator care. KCH and IH began during a premeasurement phase and continued through four data collection phases: baseline, heel warming, heel stick, and recovery. PIPP responses were measured every 30 s during data collection; salivary cortisol was measured at the end of baseline and recovery; and serum cortisol was measured during heel stick. Study 1 showed no differences between KCH and IH. Study 2 showed lower PIPP scores at four time points during recovery (p < .05 to p < .001), lower salivary cortisol at the end of recovery (p < .05), and lower serum cortisol during heel stick for the KCH condition (p < .05) as well as clinically lower PIPP scores in the KCH condition during heel stick. Thirty minutes of KC before and throughout the heel stick reduced biobehavioral responses to pain in preterm infants.

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mentioning

confidence: 99%

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

Cong

Ludington‐Hoe

Walsh

2010

Biological Research For Nursing

103

106

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“…Our findings likely reflect a critical immaturity of the autonomic nervous system in sick preterm infants 46. Recent studies showed reduced physiologic responses to noxious stimuli in preterm infants,47-50 including reduced autonomic (especially sympathetic) activity and central behavioral responses 51. Recent cerebral NIRS studies demonstrated cortical responses to noxious stimuli in infants as young as 25 weeks' gestation,28,52 which decreased significantly with lower gestational age.…”

Section: Discussionmentioning

confidence: 54%

Cerebral Hemodynamic Changes During Intensive Care of Preterm Infants

Limperopoulos

Gauvreau

O’Leary³

et al. 2008

Pediatrics

118

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OBJECTIVES The objectives of this study were to examine the circulatory changes experienced by the immature systemic and cerebral circulations during routine events in the critical care of preterm infants and to identify clinical factors that are associated with greater hemodynamic-oxygenation changes during these events. METHODS We studied 82 infants who weighed <1500 g at birth and required intensive care management and continuous blood pressure monitoring from an umbilical arterial catheter. Continuous recording of cerebral and systemic hemodynamic and oxygenation changes was performed. We studied 6 distinct types of caregiving events during 10-minute epochs: (1) quiet baseline periods; (2) minor manipulation; (3) diaper changes; (4) endotracheal tube suctioning; (5) endotracheal tube repositioning; and (6) complex events. Each event was matched with a preceding baseline. We examined the effect of specific clinical factors and cranial ultrasound abnormalities on the systemic and cerebral hemodynamic oxygenation changes that were associated with the various event types. RESULTS There were highly significant differences in hemodynamics and oxygenation between events overall and baseline epochs. The magnitude of these circulatory changes was greatest during endotracheal tube repositioning and complex caregiving events. Lower gestational age, higher illness severity, chorioamnionitis, low Apgar scores, and need for pressor-inotropes all were associated with circulatory changes of significantly lower magnitude. Cerebral hemodynamic changes were associated with early parenchymal ultrasound abnormalities. CONCLUSIONS Routine caregiving procedures in critically ill preterm infants are associated with major circulatory fluctuations that are clinically underappreciated and underdetected by current bedside monitoring. Our data underscore the importance of continuous cerebral hemodynamic monitoring in critically ill preterm infants.

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“…This finding justifies the birth term range chosen in our study to homogenise the preterm population. Furthermore, Grunau et al (23) postulated that the severity of autonomic dysfunction during the neonatal period could be predictive of a poor neurologic outcome in the extreme preterm population. All this data was in favour of overall alteration of central and autonomic nervous system development secondary to preterm birth.…”

Section: Discussionmentioning

confidence: 99%

Prematurity alters skin conductance and behavioural scoring after acute stress in term‐equivalent age infants

et al. 2019

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Aim The primary objective was to assess the effect of prematurity at term‐equivalent age on skin conductance and behavioural responses to acute stress. The secondary objective was to explore the reliability of skin conductance in detecting neonatal discomfort in preterm and full‐term populations. Methods Very preterm infants at term‐equivalent age and healthy full‐term neonates, 34 infants in each group, underwent the hip dysplasia screening test. The acute pain in newborn infants (APN) scale was scored before and 15, 45 and 90 seconds after stimulus. Skin conductance was measured in the 30‐second time‐lap before and after stimulus. Results The APN score was lower in preterm infants after intervention (term: 5.4 ± 2.8 vs. preterm: 3.9 ± 2.2; p = 0.03). Peaks‐per‐second, a skin conductance parameter, exhibited lower basal values in preterm infants than in term infants, with similar rise induced by stressful challenge. Peaks‐per‐second values were correlated to the 15‐second APN score in both groups (term: r = 0.55, p < 0.001; preterm: r = 0.43, p = 0.01). Conclusion Preterm birth changed skin conductance signal and behavioural response to stress at term‐equivalent age. The skin conductance device may be an objective tool for a continuous monitoring of acute neonatal stress.

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

Cited by 5 publications

References 26 publications

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

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

Cerebral Hemodynamic Changes During Intensive Care of Preterm Infants

Prematurity alters skin conductance and behavioural scoring after acute stress in term‐equivalent age infants

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