[Impact of the instrumental vaginal delivery on pain perception at two months].
BACKGROUND
Although instrumental vaginal delivery reduces the risk of neonatal mortality, it increases the risk of specific morbidity including prolonged neonatal discomfort. Previous studies suggest that neonatal exposure to acute pain could have long-term effects on the pain response later in life. The aim of the study was to investigate whether instrumental vaginal delivery may alter the response to a noxious stimulus at the age of two months.


METHODS
Newborn infants were enrolled in this prospective observational study after parental consent. A group of children born by instrumental vaginal delivery (group 2) were compared to matched controls born by vaginal delivery (group 1). Pain was assessed in each newborn infant between two and four hours after birth using the scale of pain and discomfort of the newborn baby (EDIN). These children were reassessed for pain response to immunizations (Infanrix(®) and Prevenar(®)) at two months of age using the DAN scale.


RESULTS
Thirteen children were enrolled in this study, six in group 1 and seven in group 2. Gestational age, birth weight, Apgar score, and umbilical arterial blood were similar in both groups. The EDIN measured between H2 and H4 was significantly higher in group 2 (median, 4 [IQ, 3] versus 0 [3.25], P<0.05). While the DAN score before and during immunization was similar in the two groups, it was statistically higher in group 2 than in group 1 (4 [3] versus 2 [2.25], P<0.01) within the15 min following the injections.


CONCLUSIONS
These results indicate that birth by instrumental vaginal delivery causes discomfort after birth and increases the pain response to immunization at the age of two months. This study supports the hypothesis that instrumental vaginal delivery may alter pain perception later in life.
Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France.
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Weslinck
Inserm CIC-IT 807, institut Hippocrate, CHRU de Lille, 59038 Lille, France; UPRES-EA4489, environnement périnatal et croissance, faculté de médecine, université Lille I et Lille II, 1, place de Verdun, 59000 Lille, France.
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De Jonckheere
Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France; UPRES-EA4489, environnement périnatal et croissance, faculté de médecine, université Lille I et Lille II, 1, place de Verdun, 59000 Lille, France.
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Storme
Inserm CIC-IT 807, institut Hippocrate, CHRU de Lille, 59038 Lille, France.
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Logier
Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France.
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Appel
Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France.
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Thomas
Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France; UPRES-EA4489, environnement périnatal et croissance, faculté de médecine, université Lille I et Lille II, 1, place de Verdun, 59000 Lille, France. Electronic address: t-rakza@chru-lille.fr.
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Rakza
D000328:Adult; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009772:Obstetrical Forceps / Q000009:adverse effects*; D010147:Pain Measurement; D058748:Pain Perception; D011247:Pregnancy; D011446:Prospective Studies; D014611:Vaccination; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*