title: Pain reactivity and recovery in preterm neonates: latency, magnitude, and duration of behavioral responses.
abstract: BACKGROUND
  Studies on acute-procedural pain in neonates have been based more on single behavioral scores than on response patterns.
  
  
  OBJECTIVE
  To assess the individual reactivity and recovery pattern to the painful procedure of blood collection.
  
  
  METHODS
  A cross-sectional, within-group comparison trial.
  
  
  METHODS
  Forty-eight preterm and very low birth weight neonates hospitalized in a Neonatal Intensive Care Unit.
  
  
  METHODS
  The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was recorded by video, and sleep-wake state was recorded at the bedside. The facial activity of the neonates was analyzed according to Neonatal Facial Coding System (NFCS). The pain reactivity pattern was analyzed using the measures of latency, magnitude, and duration of behavioral responses and by comparison between the different phases.
  
  
  RESULTS
  In the Antisepsis phase, the neonates showed higher NFCS score and behavioral arousal than at Baseline. In the Puncture phase, the neonates showed higher NFCS score and behavioral activation than in Baseline and in Antisepsis. In Recovery-Dressing, 31% of neonates continued to show more behavioral activation than at Baseline.
  
  
  CONCLUSIONS
  To better assess and manage pain in preterm neonates, it is relevant to analyze the individual patterns of changes, focusing on the reactivity and also the recovery, during painful stimuli.
authors.affiliation: Department of Neurology, Psychiatry and Medical Psychology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Juliana Thomazatti
authors.initials: JT
authors.lastname: Chimello
authors.forename: Cláudia Maria
authors.initials: CM
authors.lastname: Gaspardo
authors.forename: Thaís Souza
authors.initials: TS
authors.lastname: Cugler
authors.forename: Francisco Eulógio
authors.initials: FE
authors.lastname: Martinez
authors.forename: Maria Beatriz Martins
authors.initials: MB
authors.lastname: Linhares
mesh_terms: D001800:Blood Specimen Collection / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005149:Facial Expression; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods*; D012890:Sleep / Q000502:physiology