Development of Cardiovascular Indices of Acute Pain Responding in Infants: A Systematic Review

Abstract

Background. Cardiovascular indices of pain are pervasive in the hospital setting. However, no prospective research has examined the development of cardiac responses to acutely painful procedures in the first year of life. Objectives. Our main goal was to synthesize existing evidence regarding the development of cardiovascular responses to acutely painful medical procedures over the first year of life in preterm and term born infants. Methods. A systematic search retrieved 6994 articles to review against inclusion criteria. A total of 41 studies were included in the review. Results. In response to acutely painful procedures, most infants had an increase in mean heart rate (HR) that varied in magnitude both across and within gestational and postnatal ages. Research in the area of HR variability has been inconsistent, limiting conclusions. Conclusions. Longitudinal research is needed to further understand the inherent variability of cardiovascular pain responses across and within gestational and postnatal ages and the causes for the variability.

Nociceptive Cortical Activity Is Dissociated from Nociceptive Behavior in Newborn Human Infants under Stress

“…However, some individuals demonstrate an uncoordinated relationship between these stress response systems, when one response compensates for another [ 25 , 26 , 27 ]. In older infants, the autonomic nervous system and HPA response are not always coordinated at an individual level, in keeping with research on adults [ 28 , 29 ] and the results reported here.…”

Objective assessment of induced acute pain in neonatology with the Newborn Infant Parasympathetic Evaluation index

“…For these particularly premature children, we established marked physiological changes during provoked acute pain. First of all, we found significantly increased HR by more than 10 bpm ( p < 0.001) between basal state and painful state, illustrating that HR is a sensitive marker of neonatal pain frequently used in studies (Lindh et al., ; Oberlander et al., , ; Grunau et al., ; Waxman et al., ) and integrated in several pain assessment scales, such as the PIPP‐R and COMFORT scales. However, HR is not specific of pain and cannot be used alone as a pain marker.…”

“…() showed increased HF and LF and paradoxical decrease in the LF/HF ratio during a painful event. A recent systematic review reported the great heterogeneity among results about frequency indices of HRV during acute pain in preterm neonates (Waxman et al., ). Part of them showed decreased HF, unlike others (Lindh et al., , ; Gormally et al., ; Greenberg, ; Oberlander et al., ; Weissman et al., ; De Oliveira et al., ).…”

Convergence of behavioral and cardiac indicators of distress in toddlerhood: A systematic review and narrative synthesis

“…Additional analyses. Only approximately half of the studies (12/22) included in our review measured and adjusted for key potential confounding variables that are known to impact physiology (i.e., age, sex, baseline characteristics, time of day, activity level, and respiration; Oberlander & Saul, 2002;Waxman et al, 2016). Moreover, the covariates and moderators used were not consistent across studies and included child-level (i.e., sex, age, baseline HR, and activity) and dyad-level (i.e., attachment, early adversity) factors.…”