*Faculty of Health Sciences §Epidemiology Department, Ben Gurion University of the Negev ∥Soroka Medical Center, Beer Sheva, Israel †Pediatrics Department, University of British Columbia ‡Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, BC, Canada ¶Orgil Medical Instruments, Or Akiva, Israel.
Clin J Pain. 2013 Dec;29(12):1044-9. doi: 10.1097/AJP.0b013e318284e525.
Preterm infants undergo frequent painful procedures in the neonatal intensive care unit. Electroencephalography (EEG) changes in reaction to invasive procedures have been reported in preterm and full-term neonates. Frontal EEG asymmetry as an index of emotion during tactile stimulation shows inconsistent findings in full-term infants, and has not been examined in the context of pain in preterm infants. Our aim was to examine whether heel lance for blood collection induces changes in right-left frontal asymmetry, suggesting negative emotional response, in preterm neonates at different gestational age (GA) at birth and different duration of stay in the neonatal intensive care unit.
Three groups of preterm infants were compared: set 1: group 1 (n=24), born and tested at 28 weeks GA; group 2 (n=22), born at 28 weeks GA and tested at 33 weeks; set 2: group 3 (n=25), born and tested at 33 weeks GA. EEG power was calculated for 30-second artifact-free periods, in standard frequency bandwidths, in 3 phases (baseline, up to 5 min after heel lance, 10 min after heel lance).
No significant differences were found in right-left frontal asymmetry, or in ipsilateral or contralateral somatosensory response, across phases. In contrast, the Behavioral Indicators of Infant Pain scores changed across phase (P<0.0001). Infants in group 1 showed lower Behavioral Indicators of Infant Pain scores (P=0.039).
There are technical challenges in recording EEG during procedures, as pain induces motor movements. More research is needed to determine the most sensitive approach to measure EEG signals within the context of pain in infancy.
早产儿在新生儿重症监护病房中经常接受有创性疼痛操作。已有研究报道，在早产儿和足月儿中，侵入性操作会引起脑电图（EEG）变化。在触觉刺激过程中，作为情绪的额部 EEG 不对称在足月儿中存在不一致的发现，而在早产儿的疼痛背景下尚未进行研究。我们的目的是研究足跟采血是否会导致早产儿左右额部不对称发生变化，提示存在负性情绪反应，同时考虑到早产儿的出生胎龄（GA）和在新生儿重症监护病房的停留时间不同。
比较了三组早产儿：第 1 组（n=24），出生时 GA 为 28 周，测试时 GA 为 33 周；第 2 组（n=22），出生时 GA 为 28 周，测试时 GA 为 33 周；第 2 组（n=25），出生时 GA 为 33 周，测试时 GA 为 33 周。在 3 个阶段（基线、足跟采血后 5 分钟、足跟采血后 10 分钟）计算 30 秒无伪迹期的标准频带脑电图功率。
在左右额部不对称或同侧或对侧体感反应方面，各阶段均无显著差异。相比之下，婴儿疼痛行为指标在各阶段均发生变化（P<0.0001）。第 1 组婴儿的婴儿疼痛行为指标评分较低（P=0.039）。
在操作过程中记录脑电图存在技术挑战，因为疼痛会引起运动。需要进一步研究，以确定在婴儿疼痛背景下测量脑电图信号的最敏感方法。
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