Developmental care decreases physiologic and behavioral pain expression in preterm neonates

Abstract

Pain expression in the neonate (NN) is affected by intrinsic and extrinsic factors (gestational and postconceptional age, states, and painful experiences). The impact of developmental care is discussed in relation to defined pain expression. The aim of this randomized crossover study was to determine the impact of developmental care on pain expression during a nursing intervention in preterm NNs. Nineteen preterm NNs (gestational age, 29 +/- 1.8 weeks body weight, 1212 +/- 255 g) were included. Each NN experienced 2 randomly ordered diaper changes (with and without developmental support). Physiologic responses (heart rate, oxygen saturation, hypoxic events with SaO(2) less than 80%, bradycardia less than 80 beats/min) were studied during 3 periods: baseline, diaper change (time 0), and recovery period. Pain expression was evaluated with 2 pain scales: chronic pain with Echelle Douleur et Inconfort ([EDIN] or Pain and discomfort scale for newborns) at time B60 minutes, 0, +30 minutes, and +60 minutes and procedural pain with the Preterm Infant Pain Profile (PIPP) at time 0. Statistical analysis was conducted with a Wilcoxon nonparametric test. PIPP, EDIN 0, EDIN + 30 minutes, and EDIN + 60 minutes scores were significantly decreased with developmental care versus without developmental care: 8.7 +/- 1.9 v 11.1 +/- 2.36 (P < .01) 0.6 +/- 0.5 v 3.2 +/- 2.9 (P < .01);0.33 +/- 0.5 v 3.9 +/- 2.5 (P < .001);0.3 +/- 3.4 v 3.4 +/- 3 (P < .001), respectively. Hypoxic events rate was decreased with developmental care during the baseline and diaper change periods. The lowest oxygen saturation observed during the PIPP measure was significantly higher with developmental care (88.8% +/- 3% v 81.8% +/- 4% P < .01). Developmental care significantly decreased the PIPP and EDIN pain scores and hypoxic events during a routine nursing intervention.