| Learning Objective #1: Discuss preterm infant responses to the same and to different "painful" procedures in the NICU | |||
| Learning Objective #2: Identify the gestational age at which preterm infant behaviors distinguish "painful" from "non-painful" caregiving procedures |
OBJECTIVE: Determine which biobehavioral responses within the Preterm Infant Pain Profile (PIPP) are reliably present in at least 80% of an individual infant's responses to repetitions of heelsticks and axillary temperatures.
DESIGN: Longitudinal descriptive comparative.
POPULATION: A convenience sample of 81 preterm infants was recruited from a Level III NICU between 1999-2001.
CONCEPTS: Theoretical model combined Levine's (1967) Conservation Model and Als (1982) Synactive Theory of Development. Biobehavioral variables: heart rate, oxygen saturation, eye squeeze, brow bulge, nasolabial furrow, and Preterm Infant Pain Profile (PIPP) scores. Contextual variables: gestational age, state, severity of illness, and number of prior painful procedures.
METHODS: Computer acquisition of physiological data synchronized with real time video recordings from 4 cameras captured caregiving activities and infant behavior for 4 hours every day during the first week of life, and weekly thereafter until discharge. Caregiving procedures and facial behaviors were coded from the videotapes into 3 epochs: two minute baseline, procedure, and two minutes following. Standard PIPP scores were also calculated. Data analysis included ANOVA, repeated measures ANOVA, regression, and descriptive statistics
FINDINGS: Preliminary analysis of the first caregiving procedures in a cluster yielded the following: A) Heelsticks: only heart rate increases were reliably present (96.2%), oxygen desaturations were present 59.2%, brow bulge 14.8%, eye squeeze 14.8% and nasolabial furrow 7.4%. B) Axillary temperature: again, only heart rate increases were reliably present (96.1%), oxygen desaturations were present 34.6%, brow bulge 1.9%, eye squeeze 3.8%, and nasolabial furrow 1.9%.
CONCLUSIONS: Heart rate increases did not discriminate between heelstick and axillary temperature. Oxygen desaturations, brow bulge, eye squeeze, and nasolabial furrow were not reliably present with either procedure.
IMPLICATIONS: Heart rate increases, oxygen desaturations, brow bulge, eye squeeze, and nasolabial furrows are not reliable indicators of pain in the preterm infant.
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