Determining behavioural and physiological responses to pain in infants at risk for neurological impairment

Bonnie Stevens; Patrick McGrath; Sharyn Gibbins; Joseph Beyene; Lynn Breau; Carol Camfield; Allen Finley; Linda Franck; Alexandra Howlett; Celeste Johnston; Patricia McKeever; Karel O'Brien; Arne Ohlsson; Janet Yamada

doi:10.1016/j.pain.2006.08.012

Determining behavioural and physiological responses to pain in infants at risk for neurological impairment

Bonnie Stevens, Patrick McGrath, Sharyn Gibbins, Joseph Beyene, Lynn Breau, Carol Camfield, Allen Finley, Linda Franck, Alexandra Howlett, Celeste Johnston, Patricia McKeever, Karel O'Brien, Arne Ohlsson, Janet Yamada

Medicine

Research output: Contribution to journal › Article › peer-review

52 Citations (Scopus)

Abstract

Multiple researchers have validated indicators and measures of infant pain. However, infants at risk for neurologic impairment (NI) have been under studied. Therefore, whether their pain responses are similar to those of other infants is unknown. Pain responses to heel lance from 149 neonates (GA > 25-40 weeks) from 3 Canadian Neonatal Intensive Care units at high (Cohort A, n = 54), moderate (Cohort B, n = 45) and low (Cohort C, n = 50) risk for NI were compared in a prospective observational cohort study. A significant Cohort by Phase interaction for total facial action (F_{(6, 409)} = 3.50, p = 0.0022) and 4 individual facial actions existed; with Cohort C demonstrating the most facial action. A significant Phase effect existed for increased maximum Heart Rate (F_{(3, 431)} = 58.1, p = 0.001), minimum Heart Rate (F_{(3, 431)} = 78.7, p = 0.001), maximum Oxygen saturation (F_{(3, 425)} = 47.6, p = 0.001), and minimum oxygen saturation (F_{(3, 425)} = 12.2, p = 0.001) with no Cohort differences. Cohort B had significantly higher minimum (F_{(2, 79)} = 3.71, p = 0.029), and mean (F_{(2, 79)} = 4.04, p = 0.021) fundamental cry frequencies. A significant Phase effect for low/high frequency Heart Rate Variability (HRV) ratio (F_{(2, 216)} = 4.97, p = 0.008) was found with the greatest decrease in Cohort A. Significant Cohort by Phase interactions existed for low and high frequency HRV. All infants responded to the most painful phase of the heel lance; however, infants at moderate and highest risk for NI exhibited decreased responses in some indicators.

Original language	English
Pages (from-to)	94-102
Number of pages	9
Journal	Pain
Volume	127
Issue number	1-2
DOIs	https://doi.org/10.1016/j.pain.2006.08.012
Publication status	Published - Jan 2007

Bibliographical note

Funding Information:
Funding is acknowledged from the Canadian Institutes of Health Research (MOP-37884) and the Bloorview Childrens Hospital Foundation. We would also like to acknowledge financial support from the Ontario Ministry of Health for the Career Scientist Award and the Signy Hildur Eaton Chair in Paediatric Nursing Research at Sick Kids to B. Stevens and a Canada Research Chair award to Patrick McGrath. We acknowledge the research nurses who participated in the collection and management of study data including, Anne Jack, Marie Bagg, Mary Anne Fagan, Janet Narciso, Kim Caddell, Janet Chee, Salena Mohammed-Breault, Sandy Lin and Karolina Kupczyk. Finally, we are grateful for the willingness of the families of infants who agreed to participate in this research study.

ASJC Scopus Subject Areas

Neurology
Clinical Neurology
Anesthesiology and Pain Medicine

PubMed: MeSH publication types

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

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10.1016/j.pain.2006.08.012

Cite this

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title = "Determining behavioural and physiological responses to pain in infants at risk for neurological impairment",

abstract = "Multiple researchers have validated indicators and measures of infant pain. However, infants at risk for neurologic impairment (NI) have been under studied. Therefore, whether their pain responses are similar to those of other infants is unknown. Pain responses to heel lance from 149 neonates (GA > 25-40 weeks) from 3 Canadian Neonatal Intensive Care units at high (Cohort A, n = 54), moderate (Cohort B, n = 45) and low (Cohort C, n = 50) risk for NI were compared in a prospective observational cohort study. A significant Cohort by Phase interaction for total facial action (F(6, 409) = 3.50, p = 0.0022) and 4 individual facial actions existed; with Cohort C demonstrating the most facial action. A significant Phase effect existed for increased maximum Heart Rate (F(3, 431) = 58.1, p = 0.001), minimum Heart Rate (F(3, 431) = 78.7, p = 0.001), maximum Oxygen saturation (F(3, 425) = 47.6, p = 0.001), and minimum oxygen saturation (F(3, 425) = 12.2, p = 0.001) with no Cohort differences. Cohort B had significantly higher minimum (F(2, 79) = 3.71, p = 0.029), and mean (F(2, 79) = 4.04, p = 0.021) fundamental cry frequencies. A significant Phase effect for low/high frequency Heart Rate Variability (HRV) ratio (F(2, 216) = 4.97, p = 0.008) was found with the greatest decrease in Cohort A. Significant Cohort by Phase interactions existed for low and high frequency HRV. All infants responded to the most painful phase of the heel lance; however, infants at moderate and highest risk for NI exhibited decreased responses in some indicators.",

author = "Bonnie Stevens and Patrick McGrath and Sharyn Gibbins and Joseph Beyene and Lynn Breau and Carol Camfield and Allen Finley and Linda Franck and Alexandra Howlett and Celeste Johnston and Patricia McKeever and Karel O'Brien and Arne Ohlsson and Janet Yamada",

note = "Funding Information: Funding is acknowledged from the Canadian Institutes of Health Research (MOP-37884) and the Bloorview Childrens Hospital Foundation. We would also like to acknowledge financial support from the Ontario Ministry of Health for the Career Scientist Award and the Signy Hildur Eaton Chair in Paediatric Nursing Research at Sick Kids to B. Stevens and a Canada Research Chair award to Patrick McGrath. We acknowledge the research nurses who participated in the collection and management of study data including, Anne Jack, Marie Bagg, Mary Anne Fagan, Janet Narciso, Kim Caddell, Janet Chee, Salena Mohammed-Breault, Sandy Lin and Karolina Kupczyk. Finally, we are grateful for the willingness of the families of infants who agreed to participate in this research study. ",

year = "2007",

month = jan,

doi = "10.1016/j.pain.2006.08.012",

language = "English",

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AU - Stevens, Bonnie

AU - McGrath, Patrick

AU - Gibbins, Sharyn

AU - Beyene, Joseph

AU - Breau, Lynn

AU - Camfield, Carol

AU - Finley, Allen

AU - Franck, Linda

AU - Howlett, Alexandra

AU - Johnston, Celeste

AU - McKeever, Patricia

AU - O'Brien, Karel

AU - Ohlsson, Arne

AU - Yamada, Janet

N1 - Funding Information: Funding is acknowledged from the Canadian Institutes of Health Research (MOP-37884) and the Bloorview Childrens Hospital Foundation. We would also like to acknowledge financial support from the Ontario Ministry of Health for the Career Scientist Award and the Signy Hildur Eaton Chair in Paediatric Nursing Research at Sick Kids to B. Stevens and a Canada Research Chair award to Patrick McGrath. We acknowledge the research nurses who participated in the collection and management of study data including, Anne Jack, Marie Bagg, Mary Anne Fagan, Janet Narciso, Kim Caddell, Janet Chee, Salena Mohammed-Breault, Sandy Lin and Karolina Kupczyk. Finally, we are grateful for the willingness of the families of infants who agreed to participate in this research study.

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N2 - Multiple researchers have validated indicators and measures of infant pain. However, infants at risk for neurologic impairment (NI) have been under studied. Therefore, whether their pain responses are similar to those of other infants is unknown. Pain responses to heel lance from 149 neonates (GA > 25-40 weeks) from 3 Canadian Neonatal Intensive Care units at high (Cohort A, n = 54), moderate (Cohort B, n = 45) and low (Cohort C, n = 50) risk for NI were compared in a prospective observational cohort study. A significant Cohort by Phase interaction for total facial action (F(6, 409) = 3.50, p = 0.0022) and 4 individual facial actions existed; with Cohort C demonstrating the most facial action. A significant Phase effect existed for increased maximum Heart Rate (F(3, 431) = 58.1, p = 0.001), minimum Heart Rate (F(3, 431) = 78.7, p = 0.001), maximum Oxygen saturation (F(3, 425) = 47.6, p = 0.001), and minimum oxygen saturation (F(3, 425) = 12.2, p = 0.001) with no Cohort differences. Cohort B had significantly higher minimum (F(2, 79) = 3.71, p = 0.029), and mean (F(2, 79) = 4.04, p = 0.021) fundamental cry frequencies. A significant Phase effect for low/high frequency Heart Rate Variability (HRV) ratio (F(2, 216) = 4.97, p = 0.008) was found with the greatest decrease in Cohort A. Significant Cohort by Phase interactions existed for low and high frequency HRV. All infants responded to the most painful phase of the heel lance; however, infants at moderate and highest risk for NI exhibited decreased responses in some indicators.

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Determining behavioural and physiological responses to pain in infants at risk for neurological impairment

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

Access to Document

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