Johnston Celeste C, Stevens Bonnie, Craig Kenneth D, Grunau Ruth V E
McGill University School of Nursing, MontrealCanada Montreal Children's Hospital, MontrealCanada University of British Columbia, Department of Psychology, Vancouver B.C.Canada Children's Hospital of British Columbia, Vancouver B.C.Canada.
Pain. 1993 Feb;52(2):201-208. doi: 10.1016/0304-3959(93)90132-9.
The purpose of this study was to examine the behavioural responses of infants to pain stimuli across different developmental ages. Eighty infants were included in this cross-sectional design. Four subsamples of 20 infants each included: (1) premature infants between 32 and 34 weeks gestational age undergoing heel-stick procedure; (2) full-term infants receiving intramuscular vitamin K injection; (3) 2-month-old infants receiving subcutaneous injection for immunisation against DPT; and (4) 4-month-old infants receiving subcutaneous injection for immunisation against DPT. Audio and video recordings were made for 15 sec from stimulus. Cry analysis was conducted on the first full expiratory cry by FFT with time and frequency measures. Facial action was coded using the Neonatal Facial Action Coding System (NFCS). Results from multivariate analysis showed that premature infants were different from older infants, that full-term newborns were different from others, but that 2- and 4-month-olds were similar. The specific variables contributing to the significance were higher pitched cries and more horizontal mouth stretch in the premature group and more taut tongue in the full-term newborns. The results imply that the premature infant has the basis for communicating pain via facial actions but that these are not well developed. The full-term newborn is better equipped to interact with his caretakers and express his distress through specific facial actions. The cries of the premature infant, however, have more of the characteristics that are arousing to the listener which serve to alert the caregiver of the state of distress from pain.
本研究的目的是考察不同发育年龄的婴儿对疼痛刺激的行为反应。本横断面设计纳入了80名婴儿。四个各有20名婴儿的子样本包括：(1) 胎龄在32至34周之间接受足跟采血操作的早产儿；(2) 接受肌肉注射维生素K的足月儿；(3) 接受皮下注射白百破疫苗免疫的2个月大婴儿；以及(4) 接受皮下注射白百破疫苗免疫的4个月大婴儿。从刺激开始进行15秒的音频和视频记录。通过快速傅里叶变换对第一次完全呼气哭声进行时间和频率测量的哭声分析。使用新生儿面部动作编码系统（NFCS）对面部动作进行编码。多变量分析结果显示，早产儿与较大婴儿不同，足月儿与其他婴儿不同，但2个月和4个月大的婴儿相似。导致差异显著的具体变量是，早产组哭声音调更高、嘴巴横向张开更大，足月儿舌头更紧绷。结果表明，早产儿有通过面部动作传达疼痛的基础，但这些动作发育不完善。足月儿更有能力与照顾者互动，并通过特定的面部动作表达痛苦。然而，早产儿的哭声更具引起听众注意的特征，这有助于提醒照顾者其因疼痛而痛苦的状态。
