Does prone or supine position influence pain responses in preterm infants at 32 weeks gestational age?
OBJECTIVE
The purpose of this study was to examine the influence of prone and supine position in preterm infants during acute pain of blood collection.


METHODS
Level III Neonatal Intensive Care Unit (NICU).


METHODS
Thirty-eight preterm infants (birthweight 1339 [590-2525] g, GA 29 [25- 32] wks) were in 2 groups depending on their position in the isolette prior to and during heel lance at 32 weeks post-conceptional age. The study design was a comparison between groups (Prone, Supine) during 2 events (Baseline, Heel lance).


METHODS
Pain measures were multidimensional, including behavioral (sleep-wake state and facial activity) and physiological (heart rate) responses measured continuously prior to (Baseline) and during blood collection (Lance).


RESULTS
Both groups of infants displayed statistically significant shifts in sleep-wake state to greater arousal, and increased facial activity and heart rate, from Baseline to Lance. Prone position was associated with significantly more deep sleep during Baseline, compared with Supine position, but there were no differences in sleep-wake state during Lance. Minor increased facial activity was shown in some time segments of Baseline for infants in Supine compared with Prone, but did not differ overall between positions. Prone and Supine position did not affect heart rate significantly during Baseline or Lance events.


CONCLUSIONS
Prone position promotes deep sleep in preterm neonates at 32 weeks post-conceptional age when they are undisturbed. However, placement in prone position is not a sufficient environmental comfort intervention for painful invasive procedures such as heel lance for blood sampling in the NICU. Neonates require other environmental supports to promote coping with this stressful event.
Grunau
Ruth Eckstein
RE
Centre for Community Child Health Research, B.C. Research Institute for Children's & Women's Health, Vancouver, British Columbia, Canada. rgunau@cw.bc.ca
Linhares
Maria Beatriz Martins
MB
Holsti
Liisa
L
Oberlander
Tim F
TF
Whitfield
Michael F
MF
D005149:Facial Expression; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D010146:Pain / Q000503:physiopathology*; D016684:Prone Position / Q000502:physiology*; D012890:Sleep / Q000502:physiology; D016683:Supine Position / Q000502:physiology*; D014851:Wakefulness / Q000502:physiology