title: Comparative heel stick study showed that newborn infants who had undergone repeated painful procedures showed increased short-term pain responses.
abstract: OBJECTIVE
  We evaluated the short-term effect of repeated pain exposure on the pain responses of newborn infants using different pain assessment methods, as this area had been under-researched.
  
  
  METHODS
  We compared 20 term, large for gestational age infants and 40 term, appropriate for gestational age controls. All had undergone a heel stick for a newborn screening test just before discharge, but the larger babies had also undergone at least other five painful stimuli prior to that. A pulse oximeter and a skin conductance algesimeter (SCA) were connected to the babies during the heel prick, and video recordings were made. Crying time, the Neonatal Infant Pain Scale (NIPS), heart rate, peripheral oxygen saturation (SpO2) and SCA measurements were compared within and between the groups.
  
  
  RESULTS
  After the heel prick, the crying time (p = 0.021) and NIPS (p = 0.013) scores were significantly higher in the study group and the SpO2levels were significantly lower (p = 0.009), but the heart rate (p = 0.981) was not significantly different between the groups. SCA measurements did not differ significantly between the groups.
  
  
  CONCLUSIONS
  Babies who received more painful stimuli during the first few days of life showed greater pain responses during a subsequent heel prick.
authors.affiliation: Department of Paediatrics, Marmara University Medical School, Istanbul, Turkey. gamzeuzuncibuk@hotmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Gokulu
authors.affiliation: Division of Neonatology, Department of Paediatrics, Marmara University Medical School, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Bilgen
authors.affiliation: Division of Neonatology, Department of Paediatrics, Marmara University Medical School, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Ozdemir
authors.affiliation: Department of Public Health, Marmara University Medical School, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Sarioz
authors.affiliation: Division of Neonatology, Department of Paediatrics, Marmara University Medical School, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Memisoglu
authors.affiliation: Division of Neurology, Department of Paediatrics, Gazi University Medical School, Ankara, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Gucuyener
authors.affiliation: Division of Neonatology, Department of Paediatrics, Marmara University Medical School, Istanbul, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Ozek
mesh_terms: D001800:Blood Specimen Collection / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D005320:Fetal Macrosomia; D005712:Galvanic Skin Response / Q000502:physiology; D006365:Heel; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000009:adverse effects* / Q000379:methods; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods; D018709:Statistics, Nonparametric; D047929:Term Birth
keywords: Neonatal Infant Pain Scale; Newborn; Pain; Recurrent pain; Skin conductance algesimeter