Document Detail

Are there developmentally distinct motor indicators of pain in preterm infants?
MedLine Citation:
PMID:  12782425     Owner:  NLM     Status:  MEDLINE    
The aims of this study were to examine preterm infant reactions to pain in detail over prolonged time periods using multiple measures, and to assess the value of including specific body movements of the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) system to evaluate pain. Ten preterm infants born at 31 weeks mean gestational age (GA) and mean birth weight 1676 g were studied during a routine blood collection in a Level III neonatal intensive care unit (NICU). At 32-week post-conceptional age, computerized physiologic and video recordings were obtained continuously for 60 min (prior to, during and after lance). Motor and facial behaviors were coded independently, using the NIDCAP and the NFCS (Neonatal Facial Coding System), respectively, and compared with heart rate (HR) and oxygen saturation responses. Of the movements hypothesized to be stress cues in the NIDCAP model, extension of arms and legs (80%) and finger splay (70%) were the most common following lance. Contrary to the model, most infants (70%) had lower incidence of twitches and startles post-lance compared to baseline. Whereas all infants showed some NFCS response to lance, for three infants, the magnitude was low. HR increased and oxygen saturation decreased post-lance. Infants with more prior pain exposure, lower Apgar, and lower GA at birth, displayed more motor stress cues but less facial activity post-lance. Extension of extremities and finger splay, but not twitches and startles, from the NIDCAP, appear to be stress cues and show promise as clinical pain indicators to supplement facial and physiological pain measures in preterm infants.
Sara J Morison; Liisa Holsti; Ruth Eckstein Grunau; Michael F Whitfield; Tim F Oberlander; Herbert W P Chan; Linda Williams
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Early human development     Volume:  72     ISSN:  0378-3782     ISO Abbreviation:  Early Hum. Dev.     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-03     Completed Date:  2003-10-16     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  7708381     Medline TA:  Early Hum Dev     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  131-46     Citation Subset:  IM    
Centre for Community Child Health Research, British Columbia Research Institute for Children's and Women's Health, Room L-408, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4.
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MeSH Terms
Child Development*
Facial Expression
Fetal Movement / physiology*
Gestational Age
Heart Rate
Infant, Newborn
Infant, Premature / physiology*,  psychology*
Infant, Very Low Birth Weight / physiology*,  psychology
Intensive Care, Neonatal
Pain / etiology,  physiopathology,  psychology
Pain Measurement / methods*
Stress, Psychological / complications,  physiopathology,  psychology
Videotape Recording
Grant Support
1-R01-HD39783-01/HD/NICHD NIH HHS; R01 HD039783-01/HD/NICHD NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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