Pain reactivity and recovery in preterm neonates: latency, magnitude, and duration of behavioral responses

Abstract

BackgroundStudies on acute-procedural pain in neonates have been based more on single behavioral scores than on response patterns. AimTo assess the individual reactivity and recovery pattern to the painful procedure of blood collection. Study designA cross-sectional, within-group comparison trial. SubjectsForty-eight preterm and very low birth weight neonates hospitalized in a Neonatal Intensive Care Unit. Outcome measuresThe assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was recorded by video, and sleep–wake state was recorded at the bedside. The facial activity of the neonates was analyzed according to Neonatal Facial Coding System (NFCS). The pain reactivity pattern was analyzed using the measures of latency, magnitude, and duration of behavioral responses and by comparison between the different phases. ResultsIn the Antisepsis phase, the neonates showed higher NFCS score and behavioral arousal than at Baseline. In the Puncture phase, the neonates showed higher NFCS score and behavioral activation than in Baseline and in Antisepsis. In Recovery-Dressing, 31% of neonates continued to show more behavioral activation than at Baseline. ConclusionTo better assess and manage pain in preterm neonates, it is relevant to analyze the individual patterns of changes, focusing on the reactivity and also the recovery, during painful stimuli.