Brain-Based, Hormonal, and Biobehavioural Indicators of Pain Response: A Randomized Controlled Trial Comparing Intellectually Disabled Infants to Neurotypical Infants

All infants experience pain during their early days of life. When pain is left untreated, early pain exposure is associated with adverse consequences, such as increased pain response during later procedures. Infants with intellectual disability (ID) are at risk for high exposure to procedural pain. Despite the global investment in pediatric pain, little is known about how infants with ID perceive, process, and respond to pain. In efforts to optimally manage this population's pain and subsequently improve their future health outcomes, we must first investigate their multidimensional pain-related behaviours. This proposed project will: 1) examine infants with ID specific brain-based, hormonal, and physiologic responses to a painful stimulus compared to neurotypical infants, 2) compare the effectiveness of two pain-relieving interventions: a) direct breastfeeding with skin-to-skin contact (SSC) and b) oral sugar solution (24% sucrose) provided to infants with ID and neurotypical infants. Neurotypical and infants with ID will be randomized to one of two conditions during a medically indicated heel poke procedure: 1) direct breastfeeding with SSC or 2) sugar solution. The primary outcome measure will be pain-specific brain activity measured from an electroencephalogram (EEG) recording that is time-locked to the heel poke procedure. Behavioural and physiologic indicators of pain will also be obtained for comparison within and between groups. This will be the first study to compare the effectiveness of breastfeeding/SSC to sucrose administration on pain responses between infants with ID and neurotypical infants during an acute painful procedure, and simultaneously compare pain responses at large between neurotypical infants and infants with ID. Findings will have important implications for informing optimal pain assessment and management practices in infants with ID, and promoting equity, diversity and inclusion in health care research.