title: Does the neonatal clinical risk for illness severity influence pain reactivity and recovery in preterm infants?
abstract: BACKGROUND
  The biobehavioural pain reactivity and recovery of preterm infants in the neonatal period may reflect the capacity of the central nervous system to regulate neurobiological development.
  
  
  OBJECTIVE
  The aim of the present study was to analyse the influence of the neonatal clinical risk for illness severity on biobehavioural pain reactivity in preterm infants.
  
  
  METHODS
  Fifty-two preterm infants were allocated into two groups according to neonatal severity of illness, as measured by the Clinical Risk Index for Babies (CRIB). The low clinical risk (LCr) group included 30 neonates with CRIB scores <4, and the high clinical risk (HCr) group included 22 neonates with CRIB scores ≥4. Pain reactivity was assessed during a blood collection, which was divided into five phases (baseline, antisepsis, puncture, recovery-dressing and recovery-resting). Behavioral pain reactivity was measured using the scores, and magnitude of responses in Neonatal Facial Coding System (NFCS) and Sleep-Wake States Scale (SWS). The heart rate was continuously recorded.
  
  
  RESULTS
  The HCr demonstrated a higher magnitude of response on the SWS score from the baseline to the puncture phase than the LCr. Also, the HCr exhibited a higher mean heart rate and minimum heart rate than the LCr in the recovery-resting phase. In addition, the HCr exhibited a higher minimum heart rate from the baseline to the recovery-resting phase than the LCr.
  
  
  CONCLUSIONS
  The infants exhibiting a high neonatal clinical risk showed high arousal during the puncture procedure and higher physiological reactivity in the recovery phase.
authors.affiliation: Department of Neurosciences and Behavior, University of São Paulo, São Paulo, Brazil.
authors.forename: B O
authors.initials: BO
authors.lastname: Valeri
authors.forename: C M
authors.initials: CM
authors.lastname: Gaspardo
authors.forename: F E
authors.initials: FE
authors.lastname: Martinez
authors.forename: M B M
authors.initials: MB
authors.lastname: Linhares
mesh_terms: D001143:Arousal / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D018730:Infant Behavior / Q000502:physiology*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000503:physiopathology; D008297:Male; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D012306:Risk