Document Detail

Specific Newborn Individualized Developmental Care and Assessment Program movements are associated with acute pain in preterm infants in the neonatal intensive care unit.
MedLine Citation:
PMID:  15231909     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is widely used in neonatal intensive care units and comprises 85 discrete infant behaviors, some of which may communicate infant distress. The objective of this study was to identify developmentally relevant movements indicative of pain in preterm infants.
METHODS: Forty-four preterm infants were assessed at 32 weeks' gestational age (GA) during 3 phases (baseline, lance/squeeze, and recovery) of routine blood collection in the neonatal intensive care unit. The NIDCAP and Neonatal Facial Coding System (NFCS) were coded from separate continuous bedside video recordings; mean heart rate (mHR) was derived from digitally sampled continuous electrographic recordings. Analysis of variance (phase x gender) with Bonferroni corrections was used to compare differences in NIDCAP, NFCS, and mHR. Pearson correlations were used to examine relationships between the NIDCAP and infant background characteristics.
RESULTS: NFCS and mHR increased significantly to lance/squeeze. Eight NIDCAP behaviors also increased significantly to lance/squeeze. Another 5 NIDCAP behaviors decreased significantly to lance/squeeze. Infants who had lower GA at birth, had been sicker, had experienced more painful procedures, or had greater morphine exposure showed increased hand movements indicative of increased distress.
CONCLUSIONS: Of the 85 NIDCAP behaviors, a subset of 8 NIDCAP movements were associated with pain. Particularly for infants who are born at early GAs, addition of these movements to commonly used measures may improve the accuracy of pain assessment.
Liisa Holsti; Ruth E Grunau; Tim F Oberlander; Michael F Whitfield
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Pediatrics     Volume:  114     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-02     Completed Date:  2004-09-30     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  65-72     Citation Subset:  AIM; IM    
Centre for Community Child Health Research, British Columbia Research Institute for Children's and Women's Health, Vancouver, British Columbia, Canada.
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MeSH Terms
Acute Disease
Analysis of Variance
Facial Expression
Heart Rate
Infant Behavior* / classification
Infant Care
Infant, Newborn
Infant, Premature / physiology*,  psychology
Intensive Care Units, Neonatal
Pain / diagnosis*
Pain Measurement / methods*
Grant Support
HD39783/HD/NICHD NIH HHS; R01 HD039783-01/HD/NICHD NIH HHS; R01 HD039783-02/HD/NICHD NIH HHS; R01 HD039783-03/HD/NICHD NIH HHS; R01 HD039783-04/HD/NICHD NIH HHS; R01 HD039783-05/HD/NICHD NIH HHS

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

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