Personal perspectives: Infant pain—A multidisciplinary journey

Abstract

Given the dearth of knowledge of infant pain at that time, it was exhilarating to undertake research in this field in the 1980s. The multidisciplinary nature of this field was evident from the beginning; my background in developmental psychology was ideal, as complementary to other researchers in the field. Maria Fitzgerald, a developmental biologist, was in the forefront of discovering and elucidating the neurobiology of early pain in immature rodents and human neonates, 1,2 and continues to lead this field. Anand (pediatric critical care medicine) published the landmark study showing neonates benefit from anesthesia during surgery, 3 and Celeste Johnston 4 (nursing) began to address infant pain measurement. Ken Craig-a clinical psychologist-was already a well-established expert in facial action coding in adult pain. As his PhD student, together we applied facial coding principles to newborns, developing the first quantitative reliable validated measure of behavioral reactivity to pain in infants. 5,6 At that time, the Neonatal Facial Coding System (NFCS) was viewed as the gold standard for infant pain, comprising objective-specific discrete facial movements and sleep-wake state changes. The NFCS substantively influenced the field of infant pain assessment, as the NFCS core facial actions and sleep/wake state coding became incorporated into many of the multifactorial scales which followed, for example the Premature Infant Pain Profile. 7 | Personal timelineModern high technology intensive care for extremely preterm infants was established in the early 1980s. I completed my PhD in 1985, and became the first psychologist in the newly founded Neonatal Follow-up Program at BC Children's Hospital in Vancouver. Our Research Institute was incorporated in 1995 in conjunction with the University of British Columbia (UBC) and the BC Children's and Women's Hospitals. I was invited to join as a clinical researcherawarded one day a week "protected time" for research in 1996-1998. As of 1999, I was very fortunate to receive a series of highly competitive salary awards continuing to this day. In 2001, I moved from

Assessment and Correction of Stress in Preterm Infants and Their Mother

“… 3 Higher baseline salivary cortisol that positively correlated to the amount of experienced pain has been reported in preterm infants at 8 months corrected age as compared with the full-term healthy neonates. 17 Thus, the higher salivary cortisol level, found in the present study, could be an early sign of a disturbance in the HPA system related to stress in preterm infants in the NICU. Also, stress in preterm newborns has been associated with long-term consequences such as disorders in cognitive, motor, and behavioral development, anxiety, depression, autism spectrum disorder, high blood pressure, and metabolic syndrome.…”

To know where we came from

“…She moved on to establish a multidisciplinary research program on the long-term effects of repetitive pain exposure in infants born very preterm. 6 The four of them have published groundbreaking research that has helped move the field forward, but the overall impact of their life's work may be more easily comprehended when put into context and/or told as a story. However, their stories are about more than the research findings in themselves.…”

“…Ruth Grunau describes how she started her career as a PhD student with Kenneth Craig, using facial action coding to study facial expression of pain empirically. She moved on to establish a multidisciplinary research program on the long‐term effects of repetitive pain exposure in infants born very preterm 6 …”

“…She moved on to establish a multidisciplinary research program on the long‐term effects of repetitive pain exposure in infants born very preterm. 6 …”

Maternal Mood and Perception of Infant Temperament at Three Months Predict Depressive Symptoms Scores in Mothers of Preterm Infants at Six Months

“…Preterm birth is a multifold risk for child development (Wolke et al, 2019). Biological immaturity, medical complications, pain exposure, and exposure to overwhelming sensory input in the NICU are among the risk mechanisms that can alter a child's neurobehavioral functioning (Als et al, 2004;Feldman, 2009;Valeri et al, 2015;Grunau, 2020). For example, exposure to procedural pain and pain-related stress in neonatal period was found associated with the alterations in brain architecture and function (see Gaspardo et al, 2018, for review), which, in turn, may be related to poorer regulatory competencies in later developmental periods.…”