| Learning Objective #1: Examine longitudinal pain responses of preterm infants to heelstick procedures | |||
| Learning Objective #2: Examine factors that influence preterm infant responses to repeated heelstick procedures |
OBJECTIVE: Compare pain responses following repeated heelstick procedures in preterm infants of varying gestational age. DESIGN: Longitudinal intensive within subject and cross sectional. POPULATION: Preterm infants in a large regional Level III NICU were recruited from 1999 -2001. Gestational age at birth ranged from 23-34 weeks and was used to create four groups from the convenience sample of 81 infants. CONCEPTS: Theoretical framework 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. Heelstick procedures and facial behaviors were coded from the videotapes into 3 epochs: 2 minute baseline, heelstick, and two minutes after the stick. Standard PIPP scores were also calculated. Data analysis included ANOVA, repeated measures ANOVA, stepwise regression, and descriptive statistics. FINDINGS: The total number of heelstick procedures was 294 and the number per infant ranged from 1 - 11. Responses to heelsticks that occurred first or alone in a cluster differed significantly from those that occurred following other caregiving activities ( p <.0001). Therefore each category was analyzed separately. CONCLUSIONS: Responses to heelstick differ depending upon whether the heelstick is first in a caregiving cluster or follows other procedures. Responses also differ according to contextual variables such as gestational age and number of prior painful procedures. Infants less than 28 weeks gestational age can demonstrate facial responses to heelsticks. IMPLICATIONS: Contextual variables need to be considered when evaluating preterm infant responses to heelstick procedures.
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Back to 14th International Nursing Research Congress
Sigma Theta Tau International
10-12 July 2003