189 Salivary Cortisol and Pain Profiles During Nappy Change in Neonatal Care.

Abstract

Background: Infants in neonatal intensive care are exposed to an extremely stressful environment along with several potentially harmful or intrusive interventions as a part of their medical care. The aim of the present study was to investigate if infants exposed to neonatal intensive care have the same pattern of stress response as fullterm healthy infants. Methods: Infants in neonatal intensive care with gestational age range 23–38 w. (NICU) (n=34) and infants with congenital heart disease 36– 42 w. (CHD) (n=23) were compared to a group of healthy fullterm newborns (controls) (n=30). Salivary cortisol was measured at baseline and after a standardised nappy change. The premature infant pain profile (PIPP) and the neonatal infant pain scale (NIPS) were measured before, during, directly after, three minutes after and 30 minutes after the nappy change. The investigation was performed at two different occasions, on day 2–7 (1st) and on day 10–18 (2nd) respectively. Results: NICU and CHD infants had significantly higher cortisol than controls at 1st baseline. At the 2nd occasion all three groups had significantly lower cortisol compared to 1st occasion. NICU infants had a significant decrease in cortisol after their 2nd nappy change compared to baseline which was not seen at 1st occasion or in CHD infants and controls. All groups had a significant increase in pain scores during both nappy changes. The highest pain scores were found in NICU and CHD infants (p=0.000 and 0.008 respectively). The CHD infants had the shortest duration of response to the nappy change. The NICU infants had a prolonged increase in pain score that sustained until the three minutes measure point at 1st occasion and until the 30 minutes measure point at 2nd occasion. Conclusion: Infants exposed to neonatal intensive care (NICU and CHD infants) have a higher salivary cortisol during their first days of life than healthy fullterm infants. The NICU infants expressed a high and prolonged pain response to the nappy change. CHD infants on the other hand, expressed a high but shortlasting pain response to the nappy change. Our results show that infants exposed to neonatal intensive care have a different pattern of stress response than healthy fullterm infants.