RESUMO
BACKGROUND: Studies on acute-procedural pain in neonates have been based more on single behavioral scores than on response patterns. AIM: To assess the individual reactivity and recovery pattern to the painful procedure of blood collection. STUDY DESIGN: A cross-sectional, within-group comparison trial. SUBJECTS: Forty-eight preterm and very low birth weight neonates hospitalized in a Neonatal Intensive Care Unit. OUTCOME MEASURES: The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was recorded by video, and sleep-wake state was recorded at the bedside. The facial activity of the neonates was analyzed according to Neonatal Facial Coding System (NFCS). The pain reactivity pattern was analyzed using the measures of latency, magnitude, and duration of behavioral responses and by comparison between the different phases. RESULTS: In the Antisepsis phase, the neonates showed higher NFCS score and behavioral arousal than at Baseline. In the Puncture phase, the neonates showed higher NFCS score and behavioral activation than in Baseline and in Antisepsis. In Recovery-Dressing, 31% of neonates continued to show more behavioral activation than at Baseline. CONCLUSION: To better assess and manage pain in preterm neonates, it is relevant to analyze the individual patterns of changes, focusing on the reactivity and also the recovery, during painful stimuli.
Assuntos
Coleta de Amostras Sanguíneas/efeitos adversos , Medição da Dor/métodos , Dor/diagnóstico , Dor/fisiopatologia , Estudos Transversais , Expressão Facial , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Sono/fisiologiaRESUMO
The purpose of this study was to assess the behavioral and physiological reactivity of preterm neonates during different phases of a blood collection procedure involving arterial puncture. The sample consisted of 43 preterm and very low birth weight neonates with a postnatal age of 1 to 21 days who were hospitalized in the Neonatal Intensive Care Unit. The neonates were evaluated during the whole blood collection procedure. The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was videotaped and analyzed using the Neonatal Facial Coding System (NFCS). The sleep-wake state and heart rate were registered at the bedside. There was a significant increase in NFCS score and heart rate, and more active behavior during phases A, P, and RD relative to BL. Regarding the tactile stimulation of the infant in pre-puncture (A) and post-puncture (RD), it was observed increased NFCS score, heart rate, and active behavior in comparison to the BL and RR phases. There was evidence of distress responses immediately before and after a painful event, quite apart from the pain reaction to the puncture procedure.