Skin conductance as a marker of pain in infants of different gestational age

Jozef Macko,Martina Kotikova,Lumir Kantor,Dagmar Moravcikova,Petr Humpolicek

doi:10.5507/bp.2013.066

Jozef Macko, Martina Kotikova + Show 3 more

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https://doi.org/10.5507/bp.2013.066

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Abstract

To assess the use of skin conductance as an objective measure of pain in infants of different gestational age. A second aim was to investigate the relationship between skin conductivity and selected physiological and behavioural variables (oxygen saturation, heart rate and behavioural state). Infants were divided according to gestational age into the following 3 groups; group A: 25+0-31+6 weeks (13 infants), group B: 32+0-35+6 weeks (25 infants), group C: 36+0-41+6 weeks (19 infants). The pain stimulus was blood sampling. The most sensitive parameter for describing changes in skin conductance related to pain was peak per second. No other parameter correlated with the physiological variables chosen. The results showed that the inability to determine basal skin conductance is a crucial disadvantage to practical application. The lack of correlation between conductance parameters and gestational age is surprising. We conclude that the Peak per Second is the best parameter for evaluating skin conductance in infants and it is not influenced by gestational age. Peaks per Second correlate only with Prechtl's Scale of behavioural state and not with the physiological parameters chosen.

Highlights

The International Association of Study of Pain – IASP defines pain as „unpleasant sensorial or emotional experience which is associated with immediate or potential damage of tissue“
Measurement of changes in electrical skin conductivity (SC) appears to be a suitable method for measurement and evaluation of pain in infants as it eliminates the above problems of scoring schemes5,6
The second aim was to investigate any relationship between skin conductivity changes, presented as parameters Area Small Peaks (ASP) and Peak per Second (PpS), and selected physiological and contextual parameters (Table 2).The results showed no significant relationship between the values of heart rate (HR), oxygen saturation (SatO2), Prechtl’s Scale and electrical SC parameters

Summary

Introduction

The International Association of Study of Pain – IASP defines pain as „unpleasant sensorial or emotional experience which is associated with immediate or potential damage of tissue“. More than 40 scoring schemes and pain evaluation scales have been published in the last two decades the IASP, as an international authority, recommend only the following scales: 1) Neonatal Infant Pain Scale and Premature Infant Pain Profile (PIPP) for evaluation of acute procedural pain, 2) Crying, Required O2, Increased Vital Signs, Expression, Sleeplessness for evaluation of postoperative pain, 3) Echelle Douleur Incomfort Nouveau-Né for evaluation of permanent, persisting or continuing pain. Measurement of changes in electrical skin conductivity (SC) appears to be a suitable method for measurement and evaluation of pain in infants as it eliminates the above problems of scoring schemes. Measurement of changes in electrical skin conductivity (SC) appears to be a suitable method for measurement and evaluation of pain in infants as it eliminates the above problems of scoring schemes5,6 The basis of this method is the reactions of the sympathetic nervous system. Measurement of electrical SC is an accepted method for assessing the new-born emotional state and is closely related to infant behaviour and crying, which is reflected in the behavioural state of the infant according to Prechtl’s method for the qualitative assessment of general movements (Prechtl’s Scale) (ref.13,14)

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