Neonatal procedural pain exposure predicts lower cortisol and behavioral reactivity in preterm infants in the NICU
Neonatal procedural pain exposure predicts lower cortisol and behavioral reactivity in preterm infants in the NICU
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DOI：
10.1016/j.pain.2004.10.020
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发表时间：
2005-02-01
期刊：
影响因子：
7.4
通讯作者：
Yu, W
中科院分区：
文献类型：
--
作者：
Grunau, RE;Holsti, L;Yu, W
来自动物模型的数据表明，新生儿压力或疼痛可以永久性地改变随后对压力源的行为和/或生理反应。然而，在新生儿重症监护病房（NICU）的急性手术相关的疼痛对后期压力和/或疼痛反应的累积影响受到了有限的关注。本研究的目的是探讨新生儿疼痛暴露（皮肤破裂程序的数量），并随后在新生儿重症监护室的早产儿的压力和疼痛反应之间的关系。87名早产儿在32（+/-1周）的产后年龄（PCA）进行了研究。在每次研究前72小时内接受镇痛或镇静或任何产后地塞米松的婴儿。被排除在外。结果是婴儿对两种不同的压力源的反应，在不同的日子里进行了重复测量，随机交叉设计：（1）血浆皮质醇对一系列固定的护理程序的压力;（2）行为（新生儿面部编码系统：NFCS）和心脏对采血疼痛的反应。出生时胎龄小于或等于28周（GA），但不是29-32周GA的婴儿。在32周PCA时，较高的累积新生儿程序性疼痛暴露与较低的皮质醇应激反应和较低的面部（而非自主神经）疼痛反应有关，与早期疾病严重程度和出生后的吗啡暴露无关。神经发育不成熟的早产儿反复出现新生儿手术性疼痛与下丘脑-垂体-肾上腺轴的下调有关，而吗啡不能抵消这一作用。早期疼痛对行为、生理和激素系统发育的不同影响值得进一步研究。(C)2004年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
Data from animal models indicate that neonatal stress or pain can permanently alter subsequent behavioral and/or physiological reactivity to stressors. However, cumulative effects of pain related to acute procedures in the neonatal intensive care unit (NICU) on later stress and/or pain reactivity has received limited attention. The objective of this study is to examine relationships between prior neonatal pain exposure (number of skin breaking procedures), and subsequent stress and pain reactivity in preterm infants in the NICU. Eighty-seven preterm infants were studied at 32 (+/-1 weeks) postconceptional age (PCA). Infants who received analgesia or sedation in the 72 h prior to each study, or any postnatal dexamethasone. were excluded. Outcomes were infant responses to two different stressors studied on separate days in a repeated measures randomized crossover design: (1) plasma cortisol to stress of a fixed series of nursing procedures; (2) behavioral (Neonatal Facial Coding System: NFCS) and cardiac reactivity to pain of blood collection. Among infants born less than or equal to28 weeks gestational age (GA), but not 29-32 weeks GA. higher cumulative neonatal procedural pain exposure was related to lower cortisol response to stress and to lower facial (but not autonomic) reactivity to pain, at 32 weeks PCA, independent of early illness severity and morphine exposure since birth. Repeated neonatal procedural pain exposure among neurodevelopmentally immature preterm infants was associated with down-regulation of the hypothalamic-pituitary-adrenal axis, which was not counteracted with morphine. Differential effects of early pain on development of behavioral, physiologic and hormonal systems warrant further investigation. (C) 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.