Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK.
Colegio de Ciencias Biologicas y Ambientales, Universidad San Francisco de Quito USFQ, Quito EC170901, Ecuador.
Cereb Cortex. 2022 Aug 22;32(17):3799-3815. doi: 10.1093/cercor/bhab449.
Pain assessment in preterm infants is challenging as behavioral, autonomic, and neurophysiological measures of pain are reported to be less sensitive and specific than in term infants. Understanding the pattern of preterm infants' noxious-evoked responses is vital to improve pain assessment in this group. This study investigated the discriminability and development of multimodal noxious-evoked responses in infants aged 28-40 weeks postmenstrual age. A classifier was trained to discriminate responses to a noxious heel lance from a nonnoxious control in 47 infants, using measures of facial expression, brain activity, heart rate, and limb withdrawal, and tested in two independent cohorts with a total of 97 infants. The model discriminates responses to the noxious from the nonnoxious procedure with an overall accuracy of 0.76-0.84 and an accuracy of 0.78-0.79 in the 28-31-week group. Noxious-evoked responses have distinct developmental patterns. Heart rate responses increase in magnitude with age, while noxious-evoked brain activity undergoes three distinct developmental stages, including a previously unreported transitory stage consisting of a negative event-related potential between 30 and 33 weeks postmenstrual age. These findings demonstrate that while noxious-evoked responses change across early development, infant responses to noxious and nonnoxious stimuli are discriminable in prematurity.
早产儿的疼痛评估具有挑战性，因为行为、自主和神经生理疼痛测量被报道不如足月儿敏感和特异。了解早产儿伤害性诱发反应的模式对于改善该人群的疼痛评估至关重要。本研究旨在调查 28-40 孕周早产儿多模态伤害性诱发反应的可区分性和发育情况。使用面部表情、脑活动、心率和肢体退缩等指标，对 47 名婴儿进行了训练，以区分疼痛性足跟穿刺和非疼痛性对照反应，然后在两个独立的队列中对总共 97 名婴儿进行了测试。该模型对伤害性和非伤害性操作的反应具有 0.76-0.84 的总体准确性，在 28-31 周组中的准确性为 0.78-0.79。伤害性诱发反应具有独特的发育模式。心率反应随年龄增长而增加，而伤害性诱发脑活动则经历三个不同的发育阶段，包括在 30-33 孕周之前未报道的暂态阶段，其特征是负事件相关电位。这些发现表明，虽然伤害性诱发反应在早期发育过程中发生变化，但早产儿对伤害性和非伤害性刺激的反应是可区分的。
