Contextual factors associated with pain response of preterm infants to heel-stick procedures

Background Evidence indicates that medical and demographic contextual factors (cFs) impact pain responses in preterm neonates, but the existing evidence is very heterogeneous. Aim To explore the effect of cFs on pain responses to heel‐stick procedures of preterm infants. Methods This study was a sec...

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Bibliographic Details
Published in:	European journal of pain Vol. 17; no. 2; pp. 255 - 263
Main Authors:	Sellam, G., Engberg, S., Denhaerynck, K., Craig, K.D., Cignacco, E.L.
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-02-2013
Subjects:	Analgesics - therapeutic use Apgar Score Blood Specimen Collection - adverse effects Continuous Positive Airway Pressure - adverse effects Female Gestational Age Heel Humans Infant Infant Behavior Infant, Newborn Infant, Premature - physiology Male Pain - etiology Pain Measurement Predictive Value of Tests Regression Analysis Respiration, Artificial - adverse effects Sex Characteristics
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Summary:	Background Evidence indicates that medical and demographic contextual factors (cFs) impact pain responses in preterm neonates, but the existing evidence is very heterogeneous. Aim To explore the effect of cFs on pain responses to heel‐stick procedures of preterm infants. Methods This study was a secondary analysis of data collected during a randomized controlled trial examining pain response to non‐pharmacological interventions across repeated heel sticks. Five heel sticks across the first 14 days of life were videotaped. Pain response was rated with the Bernese Pain Scale for Neonates (BPSN) by four raters blinded to the heel‐stick phases (baseline, heel stick, recovery). Demographic and medical cFs were extracted from medical charts. Mixed single and multiple regression analyses were performed controlling for the intervention group, site and heel‐stick phase. Results Apgar scores at 1 min were negatively associated with behavioural (p = 0.002) BPSN scores, while Apgar scores at 5 min after birth were positively associated with behavioural (p = 0.006) scores. Accumulated number of painful procedures (p = 0.002) and gender (p = 0.02) were positively associated with physiological scores while continuous positive airway pressure CPAP (p = 0.009) and mechanical ventilation (p = 0.005) were negatively associated. Conclusion Higher exposure to painful procedures, male infants and having CPAP or mechanical ventilation were cFs associated with physiological response. The only variables significantly associated with behavioural BPSN scores were Apgar scores but these relationships were inconsistent.
Bibliography:	ark:/67375/WNG-K9C01BFX-6 istex:92F7D7FAE5BB92A4ADD1CE49829B5625804FAE2B ArticleID:EJP182 Conflicts of interest Funding Sources None. None declared. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	1090-3801 1532-2149
DOI:	10.1002/j.1532-2149.2012.00182.x