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Latency to facial expression change following noxious stimulation in infants is dependent on postmenstrual age

Slater, R; Cantarella, A; Yoxen, J; Patten, D; Potts, H; Meek, J; Fitzgerald, M; (2009) Latency to facial expression change following noxious stimulation in infants is dependent on postmenstrual age. PAIN , 146 (1-2) 177 - 182. 10.1016/j.pain.2009.07.022.

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Abstract

Change in facial expression over a fixed time after a noxious stimulus is the key measure used to calculate pain scores in preterm and newborn infants. We hypothesised that the latency of facial motor responses Would be longer in the youngest premature infants and that behavioural scoring methods of pain may need to take this into account. One hundred and seventy-two clinically required heel lances were performed in 95 infants from 25 to 44 weeks postmenstrual age (PMA). Sixty-four percentage of the heel lances evoked a change in facial expression. Change in facial expression was observed in infants across the whole age range from 25 weeks PMA and the latency to the facial expression response ranged from I to 17 s. Latency to facial expression change was dependent on the infants' PMA at the time of the heel lance. Infants below 32 weeks PMA had a significantly longer latency to change in facial expression than older infants (54% increase in infants below 32 weeks: p < 0.001). Sleep state and presence of brain damage (IVH grades 1-4) did not significantly increase the latency (p > 0.05 for each variable). Intravenous morphine at the time of the heel lance significantly increased the latency to facial expression response (p < 0.001) but the analysis shows that latency is highly dependent on PMA independent of morphine administration. These findings highlight developmental changes underlying infant behaviour that are critically important if pain scores are to be correctly interpreted. (C) 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Type:Article
Title:Latency to facial expression change following noxious stimulation in infants is dependent on postmenstrual age
DOI:10.1016/j.pain.2009.07.022
Keywords:Neonate (newborn), Facial expression, Development, Pain, PAIN RESPONSES, MORPHINE PHARMACOKINETICS, POSTNATAL-DEVELOPMENT, PRETERM, MATURATION, REFLEX, TRANSMISSION, PLACEMENT, TRIAL, LIMB
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Life Sciences > Biosciences (Division of) > Neuroscience, Physiology and Pharmacology
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > CHIME

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