Neurophysiological and behavioral measures of pain during neonatal hip examination

Abstract

Introduction The aim of this study was to test the hypothesis that neonatal hip examination causes pain in newborns. Pain assessment using instruments such as the Premature Infant Pain Profile‐Revised (PIPP‐R) scale is recommended, but recently physiological and neurophysiological measures, for example, near‐infrared spectroscopy (NIRS) and galvanic skin response (GSR), have been used as well. Methods Heart auscultation and hip examination were performed, and the response of the newborn was registered by NIRS optodes, GSR electrodes, and a pulse oximeter probe attached to the infant. The face of the newborn was filmed. Heart auscultation was used as a nonpainful reference. Results The pain scores for hip examination were higher than for the heart auscultation. Near‐infrared spectroscopy showed a significant higher increase from baseline in oxygenated hemoglobin (HbO2) on both sides of the cortex at hip examination compared with at heart auscultation (P = .011 and P = .017). Mean PIPP‐R scores for the hip examination compared with heart auscultation increased from 3.0 to 8.1 (P = .000). The GSR analyses of hip examination compared with heart auscultation showed a significant increase in area under small peaks during the hip examination (P = .016), however, not when measured in peaks per second (P = .104). Interrater reliability was calculated for the NIRS interpretations, with an intraclass correlation coefficient (ICC) range of 0.93‐1.0 (P = .000). Discussion Pain in newborns can have negative consequences, and pain prevention and treatment are therefore important. We conclude that neonatal hip examinations are painful and that the pain should be treated, for example, with oral sweet solution. This is a change from present routines during neonatal hip examination and is hoped to lead to a change in national guidelines.

Study protocol: parents as pain management in Swedish neonatal care – SWEpap, a multi-center randomized controlled trial

“…As an indicator of pain, skin conductance measurements have detected increased sweating in newborn infants < 28 + 0 postnatal age submitted to heel lancing [53]. GSR have been tested in several neonatal pain studies on term and preterm infants, measuring skin conductance that reflects pain-related activation of the sympathetic nervous system [52][53][54][55]. Analyses of GSR are presented with the following variables; area small peaks, area huge peaks (both representing forcefulness of sympathetic nerve firing), peaks per second (the rate of firing in the sympathetic nerves), average rise time, average peak.…”

The validity of skin conductance for assessing acute pain in mechanically ventilated infants: A cross‐sectional observational study

“…To our best knowledge, 34 previous studies focusing on the use of SC in infants have been published, including 28 studies synthesized in the recent scoping review and six studies published after the scoping review (Hu et al, 2019;Maillard et al, 2019;Meesters et al, 2019;Oji-Mmuo et al, 2019;Passariello et al, 2019;Pettersson et al, 2019;Roue et al, 2018). This present study is the first to evaluate different sources of validity evidence of SC for pain assessment in the same population of infants during the same time period.…”

Analysis of the infant’s acute pain assessment using developed conductance skin electric instrument compared to the behavioural and faces pain scale in painful injected vaccine

“…21 The FLACC scale is reliable and pain-sensitive for assessing procedural pain. 14,22 The study involves 26 physicians that performed a FLACC scale rating on 100 video segments of children aged 6 to 42 months undergoing the procedure. The video segment was rated by 4 reviewers.…”

“…Schubach used the Varioprot B SC apparatus, Zimmerman used the Q Sensor SC, and Petterson used the Sensormedic SC apparatus. 7,[9][10][11][12][13][14] In this study, the PaIncare-UI SC apparatus was used. The first reason is because this tool hasn't been comparing with other measuring instruments yet.…”