title: Prior pain induces heightened motor responses during clustered care in preterm infants in the NICU.
abstract: BACKGROUND
  Acute pain is a significant stressor for preterm infants in neonatal intensive care units (NICU); however, little is known about the effects of acute pain on subsequent motor responses during clusters of tactile handling.
  
  
  OBJECTIVE
  (1) To compare facial, body and heart rate reactivity in preterm infants at 32 weeks gestational age (GA) during routine care-giving tasks following a rest period (RCC: diapering, measuring abdominal girth and axillary temperature, mouth care) with their responses to Clustered Care following blood collection (PCC). (2) To examine how GA at birth affects patterns of stress and self-regulatory behaviors during RCC and PCC.
  
  
  METHODS
  Within-group crossover design (random order).
  
  
  METHODS
  Preterm infants, N=54 (mean GA at birth 29.3 +/- 2.2 weeks; mean birth weight 1257 +/- 423 g) were assessed at 32 weeks GA in the NICU.
  
  
  METHODS
  The Newborn Developmental Care and Assessment Program (NIDCAP) and Neonatal Facial Coding System (NFCS) were coded from continuous bedside video recordings. Changes in mean heart rate (HR) were computed using custom physiologic software.
  
  
  RESULTS
  All infants had heightened facial, body and HR responses when CC followed a painful procedure compared to when they had not been handled prior to CC. Infants born at earlier GA (<30 weeks) had equal numbers of stress cues during RCC and PCC, but dampened self-regulatory behaviors during PCC.
  
  
  CONCLUSIONS
  Prior pain induces heightened biobehavioral reactivity in preterm infants during subsequent tactile procedures. In addition, clustering care is particularly stressful for infants born at earlier GA.
authors.affiliation: Centre for Community Child Health Research, Room F6, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4. 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: D018592:Cross-Over Studies; D005149:Facial Expression; D005260:Female; D005865:Gestational Age; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology* / Q000523:psychology; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D010146:Pain / Q000503:physiopathology*; D013312:Stress, Physiological / Q000209:etiology / Q000503:physiopathology; D014743:Videotape Recording