Relations Between Behavioral and Cardiac Autonomic Reactivity to Acute Pain in Preterm Neonates

Overview

Journal Clin J Pain

Specialties Neurology
Psychiatry

Date 2002 Jan 11

PMID 11783816

Citations 18

Authors

S J Morison

R E Grunau

T F Oberlander

M F Whitfield

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of this study was to assess relations and concordance between behavioral and physiologic reactivity to pain in preterm neonates at 32 weeks postconceptional age as a function of gestational age at birth.

Setting: Level III neonatal intensive care unit.

Design/patients: The study group comprised 136 preterm neonates (mean [range] birthweight, 1,020 g [445-1,500 g]: gestational age at birth, 28 weeks [23-32 weeks]) separated into three groups according to gestational age at birth as follows: 23 to 26 weeks (n = 48), 27 to 29 weeks (n = 52), and 30 to 32 weeks (n = 36).

Outcome Measures: Reactivity to routine blood collection at 32 weeks postconceptional age was assessed using bedside-recorded behavioral and autonomic measures. Coders who were blinded to the study design scored behavioral responses (facial activity using the Neonatal Facial Coding System, sleep/waking state, and finger splay). Autonomic reactivity was assessed by change in heart rate and spectral analysis of heart rate variability (change in low-frequency and high-frequency power, and the ratio of low-frequency to high-frequency power during blood collection).

Results: Facial activity and state correlated moderately with change in heart rate across gestational age groups (r = 0.41-0.62). Facial activity and state did not correlate significantly with change in low-frequency and high-frequency power, or the ratio of low-frequency to high-frequency power (r = 0.00-0.31). Finger splay did not correlate with any autonomic recording (r = 0.03-0.41). Concordance between established biobehavioral measures of pain revealed individual differences. Although some neonates showed high behavioral but low physiologic reactivity, other neonates displayed the opposite reaction; however, the majority displayed concordant reactions.

Conclusions: The study findings confirm the value of measuring domains independently, especially in neonates born at a very young gestational age.

Citing Articles

The Influence of Postmenstrual Age and Neurological Impairments on the Modified Pain Assessment Tool Score in Infants Admitted to Neonatal Intensive Care: A Retrospective Medical Record Review.

Murray J, Lam J, Jyoti J, Spence K, Popat H, Ilhan E Paediatr Neonatal Pain. 2025; 7(1):e12133.

PMID: 39950151 PMC: 11817033. DOI: 10.1002/pne2.12133.

Biomarkers for assessing pain and pain relief in the neonatal intensive care unit.

Ten Barge J, Baudat M, Meesters N, Kindt A, Joosten E, Reiss I Front Pain Res (Lausanne). 2024; 5:1343551.

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Personal perspectives: Infant pain-A multidisciplinary journey.

Grunau R Paediatr Neonatal Pain. 2022; 2(2):50-57.

PMID: 35548594 PMC: 8975238. DOI: 10.1002/pne2.12017.

Neonatal heart rate variability: a contemporary scoping review of analysis methods and clinical applications.

Latremouille S, Lam J, Shalish W, SantAnna G BMJ Open. 2021; 11(12):e055209.

PMID: 34933863 PMC: 8710426. DOI: 10.1136/bmjopen-2021-055209.

Quantifying noxious-evoked baseline sensitivity in neonates to optimise analgesic trials.

Cobo M, Hartley C, Gursul D, Andritsou F, van der Vaart M, Mellado G Elife. 2021; 10.

PMID: 33847561 PMC: 8087440. DOI: 10.7554/eLife.65266.

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