Body Movements: An Important Additional Factor in Discriminating Pain From Stress in Preterm Infants
Body Movements: An Important Additional Factor in Discriminating Pain From Stress in Preterm Infants
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DOI：
10.1097/01.ajp.0000146163.30776.44
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发表时间：
2005-11
期刊：
影响因子：
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通讯作者：
L. Holsti;R. Grunau;T. Oberlander;M. Whitfield;J. Weinberg
中科院分区：
文献类型：
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作者：
L. Holsti;R. Grunau;T. Oberlander;M. Whitfield;J. Weinberg
目的：描述早产儿对一组常规护理任务（特殊护理）的发育适当的、特定的身体运动和其他生物行为反应，并比较急性疼痛与特殊护理的反应。方法：在一项随机设计中，在新生儿重症监护室对54例胎龄32周的早产儿进行了3个阶段的血液收集（基线，Lance/挤压，恢复）和尿布更换，测量腹围和腋温，以及口腔护理（基线，护理，恢复）。新生儿个体化发育护理和评估计划和新生儿面部编码系统的1个面部动作，眉膨出，从单独的连续床边视频记录中编码。心率和血氧饱和度也连续采集。结果：与基线相比，Lance/挤压时，眉毛隆起、心率和9个新生儿个体化发育护理和评估计划运动的子集增加，血氧饱和度显著降低。类似的面部和生理变化发生在护理期间，但强度较低。然而，婴儿表现出更大的频率和多样性的新生儿个性化发展护理和评估计划的压力线索，在监护期间比在长矛/挤压。压力线索持续后，护理，而婴儿返回到基线后长矛/挤压。讨论：面部活动和心率的变化仍然是早产儿疼痛的最敏感标志。触觉程序，如换尿布，产生较低强度的面部和生理反应比疼痛程序，但更大的身体反应。此外，触觉程序的效果似乎持续时间更长。在疼痛和压力的评估中增加对少量特定身体运动的观察，可以提供补充信息，特别是对于那些由于反复疼痛暴露而可能表现出面部反应减弱的婴儿。
Objectives:To describe developmentally appropriate, specific body movements and other biobehavioral responses of preterm infants to a group of routine care giving tasks (Clustered Care), and to compare responses to acute pain with those of Clustered Care. Methods:In a randomized design, 54 preterm infants were assessed at 32 weeks gestational age during 3 phases of blood collection (Baseline, Lance/squeeze, Recovery) and of diaper changing, measuring abdominal girth and axillary temperature, and mouth care (Baseline, Clustered Care, Recovery) in a neonatal intensive care unit. The Newborn Individualized Developmental Care and Assessment Program and 1 facial action from the Neonatal Facial Coding System, Brow Bulge, were coded from separate continuous bedside video recordings. Heart rate and oxygen saturation were also acquired continuously. Results:Brow Bulge, heart rate, and a subset of 9 Newborn Individualized Developmental Care and Assessment Program movements increased and oxygen saturation decreased significantly to Lance/squeeze compared to Baseline. Similar facial and physiological changes occurred during Clustered Care, but with less intensity. However, infants showed greater frequencies and variety of Newborn Individualized Developmental Care and Assessment Program stress cues during Clustered Care than during Lance/squeeze. Stress cues persisted after Clustered Care, whereas the infants returned to Baseline following Lance/squeeze. Discussion:Changes in facial activity and heart rate remain the most sensitive markers of pain in preterm infants. Tactile procedures, such as diaper changing, produce lower intensity facial and physiological responses than pain procedures, but greater body reactions. Also, the effects from tactile procedures appear to last longer. Adding observations of a small number of specific body movements to the assessment of pain and stress provides complementary information particularly for those infants who may show dampened facial reactivity as a result of repeated pain exposure.