Roué Jean-Michel, Rioualen Stéphane, Gendras Julie, Misery Laurent, Gouillou Maëlenn, Sizun Jacques
Department of Neonatal Medicine, Brest University Hospital, Brest, France,
Laboratory of Neurosciences of Brest, University of Western Britanny (EA 4685), Brest, France,
J Pain Res. 2018 Oct 11;11:2257-2267. doi: 10.2147/JPR.S165810. eCollection 2018.
Improving pain and stress assessments in neonates remains important in preventing the short- and long-term consequences. We aimed to identify the relationships between different pain assessment parameters by simultaneously measuring changes in cortical, autonomic, hormonal, physiological, and behavioral evoked responses to venepuncture in healthy, full-term neonates.
This observational, prospective study (ancillary to the ACTISUCROSE trial) included 113 healthy, 3-day old, full-term neonates who underwent venepuncture for systematic neonatal screening, from July to October 2013, in a tertiary-level maternity ward of a university hospital. During venepuncture, we simultaneously measured the cortical single-channel near-infrared spectroscopy (NIRS) signals, foot skin conductance, salivary cortisol, physiological responses, and behavioral (Neonatal Facial Coding System [NFCS]) evoked responses.
Regarding the NIRS analysis, the highest correlation was between the NFCS at venepuncture and the change in NIRS integrated values of total hemoglobin (=0.41, <0.001) or oxygenated hemoglobin (=0.27, <0.001). The NFCS at venepuncture was moderately positively correlated with changes in salivary cortisol (=0.42, <0.001) and skin conductance (=0.29, <0.001). Salivary cortisol and skin conductance changes were not correlated; the latter parameters were not correlated with heart rate, respiratory rate, or SpO2.
During venepuncture, NFCS was mildly or moderately correlated with salivary cortisol, skin conductance, and cortical NIRS changes.
改善新生儿疼痛和应激评估对于预防短期和长期后果仍然很重要。我们旨在通过同时测量健康足月儿在静脉穿刺时皮质、自主神经、激素、生理和行为诱发反应的变化，来确定不同疼痛评估参数之间的关系。
这项观察性前瞻性研究（ACTISUCROSE试验的辅助研究）纳入了113名健康的3日龄足月儿，于2013年7月至10月在一家大学医院的三级产科病房接受静脉穿刺进行系统性新生儿筛查。在静脉穿刺过程中，我们同时测量了皮质单通道近红外光谱（NIRS）信号、足部皮肤电导、唾液皮质醇、生理反应和行为（新生儿面部编码系统[NFCS]）诱发反应。
关于NIRS分析，静脉穿刺时的NFCS与总血红蛋白的NIRS积分值变化（=0.41，<0.001）或氧合血红蛋白的变化（=0.27，<0.001）之间的相关性最高。静脉穿刺时的NFCS与唾液皮质醇变化（=0.42，<0.001）和皮肤电导变化（=0.29，<0.001）呈中度正相关。唾液皮质醇和皮肤电导变化不相关；后两个参数与心率、呼吸频率或SpO2均不相关。
在静脉穿刺过程中，NFCS与唾液皮质醇、皮肤电导和皮质NIRS变化呈轻度或中度相关。
