Prenatal opioid exposure heightens sympathetic arousal and facial expressions of pain/distress in term neonates at 24–48 hours post birth

Oji‐Mmuo, Christiana N.; Speer, Rebecca R.; Gardner, Fumiyuki C.; Marvin, Megan M.; Hozella, Alexia C.; Doheny, Kim K.

doi:10.1080/14767058.2019.1588876

Cited by 12 publications

(11 citation statements)

References 40 publications

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“…Skin conductance (SC) provides valuable information as a sensitive and specific adjuvant to clinical pain scales as its utility has been well demonstrated to assess sympathetic activation associated with noxious stimuli (i.e., heel stick, endotracheal intubation, post-operative pain) in infants ( 7 , 13 – 18 ). Less is known, however, regarding the extent to which autonomic measures such as SC would be useful during the ROP examination to measure sympathetic activation in real time.…”

Section: Introductionmentioning

confidence: 99%

Autonomic measures identify stress, pain, and instability associated with retinopathy of prematurity ophthalmologic examinations

Onuagu¹,

Gardner

Soni

et al. 2022

Front. Pain Res.

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BackgroundRetinopathy of prematurity (ROP) ophthalmologic examinations cause stress and pain. Infants’ stress and pain can be measured non-invasively using skin conductance (SC) and high frequency heart rate variability (HF-HRV), reflecting sympathetic-mediated sweating and parasympathetic activity, respectively.ObjectivesTo test the utility of SC to detect sympathetic activation during ROP examination, and the contribution of HF-HRV to predict stability post-examination.MethodsIn this prospective, single center study, we measured SC continuously pre-, during, and post-examination, and HRV at 24 h pre-ROP examination. Clinical data included stability [apneas, bradycardias, and desaturations (A/B/Ds)], and interventions post-examination.ResultsSC increased 56% above baseline during ROP examination (p = 0.001) and remained elevated post-examination (p = 0.02). Post-hoc analysis showed higher illness acuity, represented by need for respiratory support, was associated with lower HF-HRV at 24 h pre-ROP examination (p = 0.001). Linear regression indicated lower HF-HRV at 24 h pre-examination contributed to the need for higher intervention (i.e., stimulation to breathe, oxygen support) particularly among infants with higher illness acuity [F(1, 15) = 5.05, p = 0.04; β = −1.33, p = 0.04].ConclusionROP examination induced a 2-fold increase in sympathetic activation which remained above baseline in recovery. Also, we propose that the low parasympathetic tone associated with autonomic imbalance contributes to instability and need for higher intervention to assure stabilization with A/B/D events. Our findings provide insight into the underestimation of adverse events associated with ROP examination and identification of infants who may be more vulnerable to potential sequelae following ROP examinations.

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Section: Introductionmentioning

confidence: 99%

Autonomic measures identify stress, pain, and instability associated with retinopathy of prematurity ophthalmologic examinations

Onuagu¹,

Gardner

Soni

et al. 2022

Front. Pain Res.

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“…Based on the above-mentioned Eu-BTB@ d -carnitine effect on clonidine, the detection mechanism can be considered as follows: (1) Powder pattern of Eu-BTB@ d -carnitine immersed in clonidine for 24 h did not change, proving that its skeleton structure was extremely stable and did not collapse during the detection process. (2) As shown in the UV–vis absorption of clonidine (Figure S6), most of clonidine should be located in the supernatant of Eu-BTB@ d -carnitine ; therefore, in the detection process, clonidine should be located on the surface of Eu-BTB@ d -carnitine through weak hydrogen bonding interactions. , (3) In the lifetime test, when the concentration of clonidine gradually increases, both the luminescence lifetime of ligand and Eu 3+ in Eu-BTB@ d -Carnitine gradually decreases (Tables S1 and S2; Figures and ); the lifetime of the ligand decreased from 3.90 to 2.38 ns, and the lifetime of Eu 3+ simultaneously decreased from 1.201 to 1.072 ns, indicating that the dynamic sensing mechanism possibly exists as demonstrated in the recently reported work. , …”

Section: Resultsmentioning

confidence: 99%

“…(2) As shown in the UV−vis absorption of clonidine (Figure S6), most of clonidine should be located in the supernatant of Eu-BTB@D-carnitine; therefore, in the detection process, clonidine should be located on the surface of Eu-BTB@Dcarnitine through weak hydrogen bonding interactions. 68,69 (3) In the lifetime test, when the concentration of clonidine gradually increases, both the luminescence lifetime of ligand and Eu 3+ in Eu-BTB@D-Carnitine gradually decreases (Tables S1 and S2; Figures 8 and 9); the lifetime of the ligand decreased from 3.90 to 2.38 ns, and the lifetime of Eu 3+ simultaneously decreased from 1.201 to 1.072 ns, indicating that the dynamic sensing mechanism possibly exists as demonstrated in the recently reported work. 70,71 Figure 6.…”

Section: Sensing Mechanism Formentioning

confidence: 99%

Chiral Luminescent Sensor Eu-BTB@d-Carnitine Applied in the Highly Effective Ratiometric Sensing of Curing Drugs and Biomarkers for Diabetes and Hypertension

et al. 2022

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Chiral drugs are of great significance in drug development and life science because one pair of enantiomers has a different combination mode with target biological active sites, leading to a vast difference in physical activity. Metal–organic framework (MOF)-based chiral hybrid materials with specific chiral sites have excellent applications in the highly effective sensing of drug enantiomers. Sitagliptin and clonidine are effective curing drugs for controlling diabetes and hypertension, while insulin and norepinephrine are the biomarkers of these two diseases. Excessive use of sitagliptin and clonidine can cause side effects such as stomach pain, nausea, and headaches. Herein, through post-synthetic strategy, MOF-based chiral hybrid material Eu-BTB@ d -carnitine (H3BTB = 1,3,5-benzenetrisbenzoic acid) was synthesized. Eu-BTB@ d -carnitine has dual emission peaks at 417 and 616 nm when excited at 330 nm. Eu-BTB@ d -carnitine can be applied in luminescent recognition toward sitagliptin and clonidine with high sensitivity and low detection limit (for sitagliptin detection, K sv is 7.43 × 106 [M–1]; for clonidine detection, K sv is 9.09 × 106 [M–1]; limit of detection (LOD) for sitagliptin is 10.21 nM, and LOD of clonidine is 8.34 nM). In addition, Eu-BTB@ d -carnitine can further realize highly sensitive detection of insulin in human fluids with a high K sv (2.08 × 106 [M–1]) and a low LOD (15.48 nM). On the other hand, norepinephrine also can be successfully discriminated by the hybrid luminescent platform of Eu-BTB@ d -carnitine and clonidine with a high K sv value of 4.79 × 106 [M–1] and a low LOD of 8.37 nM. As a result, the chiral hybrid material Eu-BTB@ d -carnitine can be successfully applied in the highly effective ratiometric sensing of curing drugs and biomarkers for diabetes and hypertension.

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“…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.…”

Section: Main Findingsmentioning

confidence: 96%

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

Harrold

Squires

et al. 2021

European Journal of Pain

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Background: Assessing pain in mechanically ventilated infants is challenging. The assessment of skin conductance (SC) is based on the sympathetic nervous system response to stress. This study purpose was to evaluate the validity of SC for assessing pain in mechanically ventilated infants. Methods: A prospective cross-sectional observational design was used to study SC and its relation to: the category of procedure (i.e., painful or non-painful); the phase of procedure (i.e., before, during and after), and referent pain measurements (i.e., Premature Infant Pain Profile-Revised (PIPP-R) and Neonatal Facial Coding System (NFCS)). Eligible infants were those up to 12 months of age, in intensive care units, who were mechanically ventilated, and required painful and non-painful procedures. Results: From October 2017 to November 2018, 130 eligible infants were identified, and 55 infants were studied. SC (number of waves per second) during painful procedures (median 0.27, interquartile range 0.2-0.4) was statistically significantly higher than those during non-painful procedures (0, 0-0.09). SC during painful procedures was statistically significantly higher than those before (0, 0-0.07) and after painful procedures (0, 0-0.07). SC showed moderate statistically significant positive correlations with PIPP-R (Spearman's rho = 0.4-0.62) and the four-item NFCS (Spearman's rho = 0.31-0.67) before, during and after painful or non-painful procedures respectively. SC had excellent performance (area under the receiver operator curve = 0.979) with excellent sensitivity (92.31%), specificity (95.42%) and negative predictive value (99.21%) but only sufficient positive predictive value (66.67%) when used to discriminate moderate-to-severe pain. Conclusions: SC showed good validity for assessing pain in critically ill infants requiring mechanical ventilation. Significance of the study: Pain assessment in mechanically ventilated infants is challenging. In this study, the validity of skin conductance (SC) for pain assessment is evaluated in the same population of infants during painful and nonpainful procedures. SC showed good validity for assessing acute pain in relation to category of procedure, phase of procedure, and referent pain measurements. SC is a promising method, especially with other pain assessment methods and other determinants of 1995

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Prenatal opioid exposure heightens sympathetic arousal and facial expressions of pain/distress in term neonates at 24–48 hours post birth

Cited by 12 publications

References 40 publications

Autonomic measures identify stress, pain, and instability associated with retinopathy of prematurity ophthalmologic examinations

Autonomic measures identify stress, pain, and instability associated with retinopathy of prematurity ophthalmologic examinations

Chiral Luminescent Sensor Eu-BTB@d-Carnitine Applied in the Highly Effective Ratiometric Sensing of Curing Drugs and Biomarkers for Diabetes and Hypertension

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

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