title: Specific Newborn Individualized Developmental Care and Assessment Program movements are associated with acute pain in preterm infants in the neonatal intensive care unit.
abstract: OBJECTIVE
  The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is widely used in neonatal intensive care units and comprises 85 discrete infant behaviors, some of which may communicate infant distress. The objective of this study was to identify developmentally relevant movements indicative of pain in preterm infants.
  
  
  METHODS
  Forty-four preterm infants were assessed at 32 weeks' gestational age (GA) during 3 phases (baseline, lance/squeeze, and recovery) of routine blood collection in the neonatal intensive care unit. The NIDCAP and Neonatal Facial Coding System (NFCS) were coded from separate continuous bedside video recordings; mean heart rate (mHR) was derived from digitally sampled continuous electrographic recordings. Analysis of variance (phase x gender) with Bonferroni corrections was used to compare differences in NIDCAP, NFCS, and mHR. Pearson correlations were used to examine relationships between the NIDCAP and infant background characteristics.
  
  
  RESULTS
  NFCS and mHR increased significantly to lance/squeeze. Eight NIDCAP behaviors also increased significantly to lance/squeeze. Another 5 NIDCAP behaviors decreased significantly to lance/squeeze. Infants who had lower GA at birth, had been sicker, had experienced more painful procedures, or had greater morphine exposure showed increased hand movements indicative of increased distress.
  
  
  CONCLUSIONS
  Of the 85 NIDCAP behaviors, a subset of 8 NIDCAP movements were associated with pain. Particularly for infants who are born at early GAs, addition of these movements to commonly used measures may improve the accuracy of pain assessment.
authors.affiliation: Centre for Community Child Health Research, British Columbia Research Institute for Children's and Women's Health, Vancouver, British Columbia, Canada. lholsti@cw.bc.ca
authors.forename: Liisa
authors.initials: L
authors.lastname: Holsti
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Grunau
authors.forename: Tim F
authors.initials: TF
authors.lastname: Oberlander
authors.forename: Michael F
authors.initials: MF
authors.lastname: Whitfield
mesh_terms: D000208:Acute Disease; D000704:Analysis of Variance; D005149:Facial Expression; D005260:Female; D006339:Heart Rate; D006801:Humans; D018730:Infant Behavior / Q000145:classification; D007224:Infant Care; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology* / Q000523:psychology; D007363:Intensive Care Units, Neonatal; D008297:Male; D009068:Movement; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D012890:Sleep; D014851:Wakefulness