Electroencephalographic Activity in Response to Procedural Pain in Preterm Infants Born at 28 and 33 Weeks Gestational Age

Maimon, Neta B.; Grunau, Ruth E.; Cepeda, Ivan L.; Friger, Michael; Selnovik, Leonel; Gilat, Shlomo; Shany, Eilon

doi:10.1097/ajp.0b013e318284e525

Cited by 10 publications

(37 citation statements)

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“…The majority of these studies (n = 6) have utilised prospective observational and prospective cohort designs to characterise the neuronal electrical response to pain in the infant brain. Of these six studies, two exclusively examined EEG response to pain in full‐term infants , one combined late preterm and term infants in the same sample , and three included both full‐term and preterm infants to examine the development of pain‐specific electrophysiological response across gestational ages . The remaining two studies were randomised controlled trials conducted with full‐term infants to examine the analgesic effect of oral sucrose on pain‐specific EEG response .…”

Section: Resultsmentioning

confidence: 99%

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Neurophysiological assessment of acute pain in infants: a scoping review of research methods

et al. 2017

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Section: Resultsmentioning

confidence: 99%

“…These six studies utilised the same equipment, data sampling ranges and digitisation parameters. The remaining two studies reported minimal information with respect to sampling specifications . All of the included studies reported placing electrodes at midline electrode sites (e.g.…”

Section: Resultsmentioning

confidence: 99%

Neurophysiological assessment of acute pain in infants: a scoping review of research methods

et al. 2017

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“…Initially, EEG responses and facial reactivity of preterm infants are high in response to procedural pain, however, these measures decrease as the number of skin breaking procedures increases [11,14]. By 3 months of age, these infants show attenuated behavioral responses to acute noxious stimuli (e.g.…”

Section: The Long-term Impact Of Early Life Pain In Humansmentioning

confidence: 99%

“…In response to procedural pain, heart rate and cortisol levels of preterm infants are initially high, but like pain behavior, become blunted as the number of skin breaking procedures increase [11,14]. At 3 months of age, former preterm infants show reductions in both autonomic arousal and cortisol reactivity in response to immunization pain as compared with term peers [15].…”

Section: The Long-term Impact Of Early Life Pain In Humansmentioning

confidence: 99%

Exposure to early life pain: long term consequences and contributing mechanisms

Victoria

Murphy

2016

Current Opinion in Behavioral Sciences

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From an evolutionary perspective, adaptations of an organism to its early environment are essential for survival. The occurrence of early life perturbation, coincident with increased developmental plasticity, provides a unique opportunity for such adaptations to become programmed and persist throughout life. However, adaptations that are beneficial to maintaining homeostasis in one's early environment may result in extreme response strategies that confer vulnerability or dysfunction later in life. This review summarizes recent findings in human and animal studies demonstrating that early life pain results in a hypo-/hyper-sensitive phenotype in response to acute and persistent pain and stress later in life. Changes in cognition and immune function in response to early life pain have also been observed. Recent data on the neural mechanisms underlying these long-term changes are discussed, as well as potential strategies to minimize the impact of early life pain.

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“…Recently, researchers have begun to investigate more objective approaches to pain assessment, such as measurement of heart rate variability, skin conductance and cortisol as a biomarker of stress [23, 25]. To better understand and assess neonatal pain responses at cortical level, newer brain-oriented techniques, such as electroencephalography (EEG) [28, 29] and functional magnetic resonance imaging (fMRI) [30, 31], are used [11, 32–34]. However, for systematic clinical pain assessment, exclusively observable indicators need to be considered.…”

Section: Introductionmentioning

confidence: 99%

Individual contextual factors in the validation of the Bernese pain scale for neonates: protocol for a prospective observational study

et al. 2017

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BackgroundThe Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual factors. Therefore, the aim of this study is the validation of the BPSN using a large sample of neonates with different GAs. Furthermore, the influence of individual contextual factors on the variability in pain reactions across GA groups will be explored. The results will be used for a modification of the BPSN to account for individual contextual factors in future clinical pain assessment in neonates.Methods and designThis prospective multisite validation study with a repeated measures design will take place in three university hospital neonatal intensive care units (NICUs) in Switzerland (Bern, Basel and Zurich). To examine the impact of GA on pain responses and their variability, the infants will be stratified into six GA groups ranging from 24 0/7 to 42 0/7. Among preterm infants, 2–5 routine capillary heel sticks within the first 14 days of life, and among full-term infants, two heel sticks during the first days of life will be documented. For each heel stick, measurements will be video recorded for each of three phases: baseline, heel stick, and recovery. The infants’ pain responses will be rated according to the BPSN by five nurses who are blinded as to the number of each heel stick and as to the measurement phases. Individual contextual factors of interest will be extracted from patient charts.DiscussionUnderstanding and considering the influence of individual contextual factors on pain responses in a revised version of the BPSN will help the clinical staff to more appropriately assess pain in neonates, particularly preterm neonates hospitalized in NICUs. Pain assessment is a first step toward appropriate and efficient pain management, which itself is an important factor in later motor and cognitive development in this vulnerable patient population.Trial registrationThe study is registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461. Registration date: 12 April 2016.

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Electroencephalographic Activity in Response to Procedural Pain in Preterm Infants Born at 28 and 33 Weeks Gestational Age

Abstract: There are technical challenges in recording EEG during procedures, as pain induces motor movements. More research is needed to determine the most sensitive approach to measure EEG signals within the context of pain in infancy.

Cited by 10 publications

References 21 publications

Neurophysiological assessment of acute pain in infants: a scoping review of research methods

Neurophysiological assessment of acute pain in infants: a scoping review of research methods

Exposure to early life pain: long term consequences and contributing mechanisms

Individual contextual factors in the validation of the Bernese pain scale for neonates: protocol for a prospective observational study

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