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The study of neonatal gender differences in pain expression is important since neonatal pain behavior occurs prior to any learned reaction pattern. The objective of this study was to verify the presence of gender differences in pain expression in preterm and term newborn infants. Sixty-five consecutive neonates (37 female and 28 male infants) with gestational age between 28 and 42 weeks and with 25-120 h of life were studied. Healthy term neonates required a capillary puncture for PKU screening and clinically stable premature infants needed a capillary puncture for glucose dosage. The Neonatal Facial Coding System (NFCS) and the Neonatal Infant Pain Scale (NIPS) were evaluated at bedside prior to the puncture, when patients were at rest, during foot heating; during capillary puncture; and at 1, 3, and 5 min after heel lancing. Results were analyzed by repeated-measures ANOVA followed by the Multiple Comparison Method of Bonferroni. A significant difference among the mean NFCS scores during the six study periods was noted for the whole group of neonates (P<0.000001). Also, a significant interaction between the NFCS score profile in female and male neonates at the different study periods was observed (P=0.025). Regarding NIPS, ANOVA showed only a significant difference among the mean NIPS scores during the six study periods for the whole group of neonates (P<0.000001). No significant interactions between gestational age and time, nor between gestational age and gender were noted, for both NFCS and NIPS. In conclusion, recently born female neonates of all gestational ages expressed more facial features of pain than male infants, during the capillary puncture and 1 min afterwards. Maybe differences in pain processing and/or pain expression among genders may explain this finding.

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ResumoObjetivos: Avaliar a sensibilidade e a especificidade de duas escalas comportamentais de dor em recém-nascidos (RN) de diferentes idades gestacionais (IG).Método: 133 recém-nascidos estáveis, com menos de 72h de vida, sem alterações do SNC ou uso de analgesia/sedação e com Apgar aos 5' > 7 foram sorteados para receber punção capilar -P, ou fricção de pele -F. Os recém-nascidos foram divididos de acordo com a IG (28-33 sem. = A; 34-37 sem. = B; 38-41 sem. = C ) e com o procedimento (P/F): grupo A-P (n=17, 1,5+0,4kg); A-F (n=18, 1,5+0,4kg); B-P (n=25, 2,5+0,5kg); B-F (n=25, 2,4+0,6kg); C-P (n=23, 3,3kg+0,5kg); C-F (n=25; 3,3+0,4kg). Um neonatologista, cego em relação a P ou F, avaliou duas escalas de dor: NFCS (0-8 pontos, dor > 3) e NIPS (0-7 pontos, dor > 3). Todas as avaliações foram realizadas antes de P/F (Pr), no aquecimento do pé (a), durante (0), 1' e 3' após P ou F. A reprodutibilidade foi avaliada em 20% da amostra, com concordância de 97% da NFCS e 95% na NIPS.Resultados: Durante o procedimento, a mediana do NFCS e NIPS no grupo P foi superior à do F para os grupos A, B e C (M. Whitney, p<0,0001). Com 1', a NFCS e a NIPS foram superiores nos RN P, para os grupos A e C (MW, p< 0,04). Nos pacientes P, a NFCS e a NIPS mostraram resultados similares nas diferentes IG, durante todo o estudo (K. Wallis). Nos RN F, somente no tempo 0, os grupos A, B e C diferiram quanto à NIPS (K. Wallis, p<0,03). Durante o procedimento, a presença de NFCS>3 mostrou sensibilidade de 88-91% e especificidade de 80-84%, e a de NIPS>3 apresentou sensibilidade 77-78% e especificidade 68-83%.Conclusão: Ambas as escalas são instrumentos sensíveis para a detecção de dor em prematuros, parecendo ser a NFCS superior à NIPS.J. pediatr. (Rio J.). 1997; 73(6):411-418: dor, avaliação da dor, recém-nascido, recém-nascido prematuro. AbstractObjective: To establish the sensitivity and specificity of two behavioral pain scales in different gestational ages (GA).Methods: 133 clinically stable neonates, < 72h of life, without diseases, analgesic/sedative use or Apgar<7 at 5' were randomly assigned to receive capillary puncture -P or alcohol swab friction -F. Patients were divided according to GA (28-33 wk = A; 34-37 wk = B; 38-41 wk = C ) and procedure: Group A-P (n=17, BW 1.5+0.4kg); A-F (n=18, BW 1.5+0.4kg); B-P (n=25, BW 2.5+0.5kg); B-F (n=25, BW 2.4+0.6kg); C-P (n=23, BW 3.3kg+0.5kg); C-F (n=25; BW 3.3+0.4kg). A neonatologist, blind to P or F, evaluated the Neonatal Facial Action Coding System (NFCS 0-8 pts, pain >3) and the Neonatal Infant Pain Scale (NIPS 0-7 pts, pain>3). All evaluations were performed prior to P or F, without (pr) and with foot heating (h), during (0), 1' and 3' after P or F. Reliability was assessed in 20% of the sample. Agreement rate was NFCS-97% and NIPS-95%.Results: During the procedure, median NFCS and NIPS P score were greater than F (M. Whitney), p<0.0001) for A, B and C groups. At 1', NCFS and NIPS P scores were greater than F (MW, p<0.04) for A and C groups. For P patients, NFCS and NIPS scores were simila...

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