The aim was to describe current reports in the scientific literature on sleep in the intensive care environment and sleep deprivation associated with painful experiences in premature infant. A systematic search was conducted for studies on sleep, pain, premature birth and care of the newborn. Web of Knowledge, MEDLINE, LILACS, Cochrane Library, PubMed, EMBASE, Scopus, VHL and SciELO databases were consulted. The association between sleep deprivation and pain generates effects that are observed in the brain and the behavioral and physiological activity of preterm infants. Polysomnography in intensive care units and pain management in neonates allow comparison with the first year of life and term infants. We have found few references and evidence that neonatal care programs can influence sleep development and reduce the negative impact of the environment. This evidence is discussed from the perspective of how hospital intervention can improve the development of premature infants.Keywords: sleep, pain, prematurity, polysomnography, neonatal intensive care.RESUMO O objetivo foi descrever o estado atual na literatura científica sobre privação do sono associado a experiências dolorosas no prematuro e o papel na evolução do sono em ambiente de terapia intensiva. Realizou-se uma busca sistemática para estudos sobre sono, dor, prematuridade e programas de atenção ao neonato. Foram consultados as bases Web-of-Knowledge, MEDLINE, LILACS, Biblioteca Cochrane, PubMed, EMBASE, Scopus, BVS e SciELO. A associação entre privação do sono e dor gera efeitos que são observados na atividade cerebral, fisiológica e comportamental dos prematuros. A polissonografia nas unidades intensivas e o manejo da dor em neonatos permitem comparação no primeiro ano de vida com crianças nascidas a termo. Encontraram-se poucas evidências de que programas de cuidado neonatal podem influenciar o desenvolvimento do sono e diminuir o impacto negativo do ambiente. Estas evidências são discutidas na perspectiva de como a intervenção hospitalar pode melhorar o desenvolvimento do prematuro.Palavras-chave: sono, dor, prematuridade, polissonografia, terapia intensiva neonatal.In recent decades there has been a considerable increase in the number of premature births and in the survival rate of these babies as a consequence of also increasing the effectiveness of intervention in Neonatal Intensive Care Unit (NICU). This relatively recent phenomenon has opened various fronts of research on the development of the fetus outside the uterus and its challenges. Among the areas that have aroused more interest and generated publications are the investigations on the development of sleep and pain perception and the future implications of sleep deprivation and exposure to pain at early ages. The uterine environment is suitable for the full growth and development of the human fetus site. The challenge of preterm birth and hospitalization in the NICU promotes an abrupt environmental difference for newborns which can bring challenges for future development. The inst...

All scale indicators were related to skin conductance activity in all periods, indicating pain perception. Facial tension was the most efficient indicator, while others varied in performance after painful events and possibly indicated stress after trauma. These results are discussed from a phenomenological approach and in an anxiety paradigm.

Heart rate variability (HRV), oxygen saturation variability (OSV) and skin conductance activity (SCA) are recognized physiological markers of acute pain. In order to verify which of them has the best correlation with psychophysical parameters of pain (intensity, reactivity, direction, regulation and slope), an observational prospective study was performed, including 41 healthy full term newborns. The measurements studied were the HRV, the OSV, and the following SCA variables: number of waves per second (NWps) and relative area under the curve of waves (AUC). The measurements were performed in periods labeled before, during, and after a heel prick. The variation measured for intensity between periods was significant for the NWps (p=0.001), AUC (p=0.03), HRV (p=0.001) and OSV (p=0.004). Also, the reactivity and direction were significant for all variables, except AUC. The regulation parameter was significant for the variables NWps (p<0.01), AUC (p<0.05), HRV (p<0.01) and OSV (p<0.01). The slope was statistically significant only for the OSV variable (p=0.000). We concluded that the responses of the SCA, HRV and OSV to painful events fit the psychophysical parameters of a physiological marker and serve as valuable measures for pain diagnostic working the use in accordance with the needs of the context.

The Premature Infant Pain Profile (PIPP) is a promising multidimensional tool for comparison and testing of new technologies in newborn pain assessment studies since it may adhere to basic psychophysical parameters of intensity, direction, reactivity, regulation and slope described in analyses of physiological pain indicators. The aim of this study was to evaluate whether these psychophysical parameters can be achieved using the PIPP in acute pain assessment. Thirty-six healthy term newborn infants were conveniently sampled whilst being videotaped before, during and after heel prick blood sampling. The images were blind-scored by three trained independent raters and scored against the PIPP. The PIPP and its facial action indicators met the parameters of intensity, reactivity and regulation (all p < 0.001). The heart rate variability did not meet any parameter (all p > 0.05). The oxygen saturation variability met only the intensity parameter (p < 0.05). The behavioural state indicator met all parameters and had the best correlation to the psychophysical parameters of all indicators of PIPP (all p < 0.001). We concluded that the overall PIPP meets the assumptions of these psychophysical parameters, being the behavioural state indicator which best fit the model.

Background A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2–exposed children. Objective The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children. Methods The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children’s growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2–exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. Results Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. Conclusions Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2–exposed mothers and children and support the development of evidence-based public health policies. Trial Registration Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2 International Registered Report Identifier (IRRID) DERR1-10.2196/26477