Objectives: Neonates born extremely prematurely are at high risk of acute and prolonged pain. Effective treatment requires reliable pain assessment, which is currently missing. Our study explores if existing pain assessment tools and physiological indicators measure pain and comfort accurately in this population. Methods: We prospectively collected data in 16 neonates born less than 29 weeks gestational age during three conditions: skin-to-skin care, rest and heelstick procedure for capillary blood sampling in the incubator. The neonates were video recorded in these situations and recordings were coded using five observational pain assessment tools and numeric rating scales for pain and distress. We simultaneously collected heart rate, respiratory rate, arterial oxygen saturation, regional cerebral oxygenation and number of skin conductance peaks. All measures across the three conditions were compared using general linear modeling. Results: The median gestational age was 27.1 weeks (range 24.1 to 28.7). Forty measurement periods across the three conditions were analyzed. Heart rate was significantly higher during heelstick procedures compared to during rest with a mean difference of 10.7 beats/minute (95% CI 2.7 to 18.6). Oxygen saturation was significantly higher during skin-to-skin care compared to during heelstick procedures with a mean difference of 5.5% (95% CI 0.2 to 10.8). The Premature Infant Pain Profile-revised (PIPP-R) score was significantly higher during heelstick procedures compared to skin-to-skin care with a mean difference of 3.2 points (95% CI 1.6 to 5.0). Discussion: Pain measurement in clinical practice in prematurely born infants <29 weeks remains challenging. The included behavioral and physiological indicators did not adequately distinguish between a painful situation, rest and skin-to-skin care in premature neonates.

Additional Metadata
Keywords ELGA, pain assessment, premature
Persistent URL dx.doi.org/10.1097/AJP.0000000000000762, hdl.handle.net/1765/119793
Series VSNU Open Access deal
Journal Clinical Journal of Pain
Meesters, N.J, Simons, S.H.P, van Rosmalen, J.M, Holsti, L, Reiss, I.K.M, & Van Dijk, M. (Monique). (2019). Acute pain assessment in prematurely born infants less than 29 weeks: A long way to go. Clinical Journal of Pain. doi:10.1097/AJP.0000000000000762