title: Skin conductance measurements as pain assessment in newborn infants born at 22-27 weeks gestational age at different postnatal age.
abstract: BACKGROUND
  To assess pain or stress in newborn infants submitted to intensive care is important but difficult, as different observational pain scales are not always reliable in premature infants. As an indicator of pain, skin conductance (SC) measurements have detected increased sweating in newborn infants >28 gestational age (GA) submitted to heel lancing.
  
  
  OBJECTIVE
  To measure SC during heel lancing and routine care in newborn infants, born at 22 to 27 GA, with special relation to postnatal age (PNA).
  
  
  METHODS
  In six infants <28+0 GA and 4 infants ≥28+0 GA spontaneous SC activity and behavioural state (Neonatal Pain Agitation and Sedation Scale (N-PASS)) was measured before, during and after each intervention. Measurements were repeated in each patient at different PNA.
  
  
  RESULTS
  Baseline SC prior to intervention took longer time to stabilise and was higher in <28 than in ≥28+0 PNA. The combination of heel lancing and squeezing gave an increased SC in <28 PNA, whereas heel lancing alone gave the same SC response in ≥28+0 PNA. A possibly continued immature response in SC measurements was not observed. Oral glucose admission prior to heel lancing increased SC. Routine care did not give any changes in SC. Except during orogastric tube placement no signs of discomfort or pain could be detected by the neonatal pain, agitation and sedation scale (N-PASS) in <28 PNA.
  
  
  CONCLUSIONS
  Changes in SC could be detected in infants at <28+0 PNA and related to the combination of heel lancing and squeezing. A maturational development of the SC was observed in infants born <28 GA. SC seems to be able to differentiate between pain and discomfort.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Josanne
authors.initials: J
authors.lastname: Munsters
authors.forename: Linda
authors.initials: L
authors.lastname: Wallström
authors.forename: Johan
authors.initials: J
authors.lastname: Agren
authors.forename: Torgny
authors.initials: T
authors.lastname: Norsted
authors.forename: Richard
authors.initials: R
authors.lastname: Sindelar
mesh_terms: D005260:Female; D005712:Galvanic Skin Response; D005865:Gestational Age; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology; D006365:Heel / Q000502:physiology; D006801:Humans; D018730:Infant Behavior / Q000502:physiology; D007231:Infant, Newborn / Q000502:physiology; D007234:Infant, Premature / Q000502:physiology; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D011181:Postnatal Care; D013312:Stress, Physiological
chemical_list: D005947:Glucose