|
|||||
|
|
Changes in physiological and behavioural pain indicators over time in preterm and term infants at risk for neurologic impairment |
|
| Authors: | Gibbins Sharyn Stevens Bonnie McGrath Patrick Dupuis Annie Yamada Janet Beyene Joseph Breau Lynn Camfield Carol Finley G Allen Franck Linda Johnston Celeste McKeever Patricia O'Brien Karel Ohlsson Arne |
| Institution: | a Interdisciplinary Research, NICU, Sunnybrook Health Sciences Centre, Canada b The Hospital for Sick Children, Toronto, ON, Canada M5S 1B2 c Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada M5S 3H4 d Faculty of Medicine, University of Toronto, Canada e Nursing Research, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada f IWK Health Centre, Canada g Department of Psychology, Dalhousie University, Canada h Department of Pediatrics, Dalhousie University, Canada i Department of Psychiatry, Dalhousie University, Canada j CIHR, Canada k Research Institute, Sick Kids, Toronto, ON, Canada M5G 1X8 l School of Nursing, Dalhousie University, Halifax, NS Canada m Department of Pediatric Neurology, IWK Health Centre, Halifax, NS, Canada B3K 6R8 n Department of Anesthesia, Dalhousie University, Canada o Pediatric Pain Management, IWK Health Centre, Halifax, NS, Canada B3K 6R8 p Children's Nursing Research, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London WC1N 3JH, UK q School of Nursing, McGill University, Montreal, Quebec, Canada H3B 2B4 r Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5 s Department of Paediatrics, University of Toronto, Canada t Department of Obstetrics and Gynaecology, University of Toronto, Canada u Department of Health Policy, Management and Evaluation, University of Toronto, Canada |
| Abstract: | BackgroundApproximately 10% of infants admitted to a Neonatal Intensive Care Unit (NICU) are at risk for Neurological Impairment (NI). While we have limited knowledge on the influence of NI risk on pain responses, we have no knowledge of how these responses change over time.ObjectiveTo compare physiological and behavioural pain responses of infants at three levels of NI risk during the NICU neonatal period (Session 1) and at 6 months of age (Session 2).Design/methodsProspective observational design with 149 preterm and term infants at high (Cohort A, n = 54), moderate (Cohort B, n = 45) and mild (Cohort C, n = 50) risks for NI from 3 Canadian tertiary level NICUs. Infants were observed in the NICU during 3 standardized phases of a heel lance: baseline, stick and return-to-baseline. At 6 months, infants were observed during the same three phases during an intramuscular immunization injection. Physiological (heart rate, oxygen saturation) and behavioural (9 facial actions, cry) responses were continuously recorded.ResultsA significant interaction of Phase by Session was found with less total facial activity observed during Session 2 (all p values < 0.04). A significant interaction for Session by Cohort was found, showing that infants in Cohort A had significantly more change from baseline-to-stick phase for brow bulge, eye squeeze, nasolabial furrow and open lips between sessions with less facial actions demonstrated at Session 2 (all p < 0.02). There were significantly lower mean and minimum heart rate (all p < 0.02) and higher minimum and maximum oxygen saturation (p < 0.04) at Session 2. Significantly higher mean and minimum fundamental cry frequencies (pitch) in Cohort B (p < 0.04) were found in Session 1. Cohort A had significantly longer cry durations, but no significant differences in cry dysphonation.ConclusionsBehavioural and physiological infant pain responses were generally diminished at 6 months of age compared to those in the neonatal period with some differences between NI risk groups in cry responses. Future exploration into the explanation for these differences between sessions and cohorts is warranted. |
| Keywords: | Infant Pain Assessment Changes Neurological Impairment |
| 本文献已被 ScienceDirect PubMed 等数据库收录！ | |