Pain and tactile stimuli during arterial puncture in preterm neonates

Abstract

The purpose of this study was to assess the behavioral and physiological reactivity of preterm neonates during different phases of a blood collection procedure involving arterial puncture. The sample consisted of 43 preterm and very low birth weight neonates with a postnatal age of 1 to 21 days who were hospitalized in the Neonatal Intensive Care Unit. The neonates were evaluated during the whole blood collection procedure. The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was videotaped and analyzed using the Neonatal Facial Coding System (NFCS). The sleep-wake state and heart rate were registered at the bedside. There was a significant increase in NFCS score and heart rate, and more active behavior during phases A, P, and RD relative to BL. Regarding the tactile stimulation of the infant in pre-puncture (A) and post-puncture (RD), it was observed increased NFCS score, heart rate, and active behavior in comparison to the BL and RR phases. There was evidence of distress responses immediately before and after a painful event, quite apart from the pain reaction to the puncture procedure.

Neurobehavioral development prior to term-age of preterm infants and acute stressful events during neonatal hospitalization

“…Infants' physiological functions are not yet sufficiently mature to survive independently in the external environment [9]. Paradoxically, NICUs represent a risk factor for infants' development because of multiple painful, distressful, and uncomfortable stimuli [10,11]. For example, preterm neonates who were hospitalized in a NICU were found to be exposed to at least 44 acute stressful events and 24 chronic stressful events that were related to examinations and medical treatments [12].…”

Alterações nos parâmetros fisiológicos dos recém-nascidos sob oxigenoterapia na coleta de gasometria

“…The results showed that in- fants anticipated the reaction to painful stimulation of the arterial puncture, with significant changes in facial activity, HR, wakefulness and sleep, at the moment of antisepsis prior to arterial puncture. (9) When evaluating the set of physiological variables related to the blood gas procedure, it was found that RR was significantly lower five minutes after this practice in the newborn on MV, when compared to the time immediately after, with no influence of this variable for the groups in an Oxyhood and nasal CPAP. It is possible that, for this painful procedure, neonates using MV were more sensitive to pain, considering that all infants who were receiving this mode of oxygen therapy were premature and were not sedated.…”

Non-pharmacological management of neonatal pain: Research and clinical practice in the Neonatal Intensive Care Unit

“…During hospitalization in the NICU, preterm newborns experience an average of six painful procedures daily (Gaspardo, Chimello, Cugler, Martinez, & Linhares, 2008), and additionally suffer other extreme or moderate stressful events, such as, intubation, eye examination, lumbar puncture, heel pricks, and nasogastric tube insertion (Gorzílio, Garrido, Gaspardo, Martinez, & Linhares, 2015). The scientific, evidence-based, non-pharmacological management of neonatal acute pain (Cignacco et al, 2007;Fernandes, Campbel-Yeo, & Johnston, 2011) includes the following: (i) breastfeeding or human milk (as well as the unquestionable nutritional benefits of human milk for the infants, it is a potent pain relief intervention when used with breastfeeding or via oral-gastric tube); (ii) non-nutritive sucking (32 sucking behaviors per minute have an analgesic effect; a pacifier can be used); (iii) facilitatedtucking (placing the arms and legs of the infant near the trunk to maintain a flexed in utero posture, with limbs placed in body midline); (iv) swaddling (wrapping the infants in a sheet or blanket, limbs flexed, head, shoulders and hips neutral without rotation and hands accessible for exploration); (v) skin-to-skin (positioning of clinically stable infants against the breast of the mother allows them to be warmed, facilitates breastfeeding, sensitizes them to attachment, and relieves pain during medical procedures).…”