Abstract
The study of the development of neonatal pain responses is of key importance, both for research and for clinical reasons, with particular regard to the population of preterm neonates, given the amount of painful procedures they are exposed to on a daily basis. The aim of this work was to systematize our knowledge about the development of pain responses in prematurely born neonates by focusing on some key methodological issues. Studies on the impact of age variables, namely gestational age (GA), postmenstrual age (PMA) and chronological age (CH), on pain responsivity in premature neonates were identified using Medline and Scopus. Studies (N = 42) were categorized based on terminological and methodological approaches towards age variables, and according to output variables considered (facial, nonfacial behavioral, physiological). Distinct multidimensional developmental patterns were found for each age-sampling strategy. Overall, each of the three age variables seems to affect pain responsivity, possibly differently across age windows. Targeted as well as integrated approaches, together with a renewed attention for methodological consistency, are needed to further our knowledge on this topic.
Highlights
The early ontogeny of pain reactivity is a key theme for the study of the emergence of human consciousness and emotions [1,2]
We selected studies for review based on the following eligibility criteria—(1) the study was a full-report written in English language and published in a peer reviewed journal; (2) the study included at least 20 preterm neonates within its participants; (3) the study included statistical analyses aimed at investigating age-related differences in pain responsivity; (4) the study included, as outcome measures, at least one physiological, behavioral or multidimensional index of pain responsivity; (5) the demographic information provided included data about at least two age variables
Despite all the issues and limitations highlighted, a general trend emerged across different approaches, albeit based on limited evidence, a gestational age (GA)- and postmenstrual age (PMA)-related increase in facial pain responses, with more immature neonates showing dampened responsivity, was seen
Summary
The early ontogeny of pain reactivity is a key theme for the study of the emergence of human consciousness and emotions [1,2]. The variability known to characterize pain ontogeny during the perinatal period [14,15,16,17] makes crucial the issue of understanding its early dynamics Given their peculiar status, the development of preterm neonates (i.e., those born before 37 completed weeks of gestation) can be framed in terms of the interaction between three separate chronological variables, i.e., the duration of the gestation (gestational age, GA), the time from birth to observation (chronological age, GA) and the sum of the two measures above (postmenstrual age, PMA). Understanding their separate and joint effects would enhance our diagnostic ability in recognizing atypical performances, allowing clinicians to
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