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Cited by 262Pediatric Pain Management TechniquesInfant Development and Preterm CareNeonatal and fetal brain pathology

Neonatal procedural pain and preterm infant cortisol response to novelty at 8 months

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Grunau, Ruth E., Weinberg, Joanne, Whitfield, Michael F.·2004·PEDIATRICS
DOI 10.1542/peds.114.1.e77PMC PMC1351380
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Abstract

OBJECTIVES: Stress systems may be altered in the long term in preterm infants for multiple reasons, including early exposure to procedural pain in neonatal intensive care. This question has received little attention beyond hospital discharge. Stress responses (cortisol) to visual novelty in preterm infants who were born at extremely low gestational age (ELGA; < or =28 weeks), very low gestational age (VLGA; 29-32 weeks), and term were compared at 8 months of age corrected for prematurity (corrected chronological age [CCA]). In addition, among the preterm infants, we evaluated whether cortisol levels at 8 months were related to neonatal exposure to procedural pain and morphine in the neonatal intensive care unit. METHODS: Seventy-six infants, 54 preterm (< or =32 weeks' GA at birth) and 22 term-born infants who were seen at 8 months CCA composed the study sample, after excluding those with major sensory, motor, or cognitive impairment. Salivary cortisol was measured before (basal) and 20 minutes after introduction of novel toys (post 1) and after developmental assessment (post 2). RESULTS: Salivary cortisol was significantly higher in ELGA infants at 8 months, compared with the VLGA and term groups before and after introduction of visual novelty. Term-born and VLGA infants showed a slight decrease in cortisol when playing with novel toys, whereas the ELGA group showed higher basal and sustained levels of cortisol. After controlling for early illness severity and duration of supplemental oxygen, higher basal cortisol levels in preterm infants at 8 months' CCA were associated with higher number of neonatal skin-breaking procedures. In contrast, cortisol responses to novelty were predicted equally well by neonatal pain or GA at birth. No relationship between morphine dosing and cortisol response was demonstrated in these infants. CONCLUSIONS: ELGA preterm infants show a different pattern of cortisol levels before and after positive stimulation of visual novelty than more maturely born, VLGA preterm and term-born infants. Exposure to high numbers of skin-breaking procedures may contribute to "resetting" basal arousal systems in preterm infants.

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Research works printed but not linked: 6

  1. [4]Grunau RE. Long-term consequences of pain in human neonates. In: Anand KJ, Stevens BJ, McGrath PJ, editors. Pain in Neonates. Elsevier; New York, NY: 2000. pp. 55–76. [Google Scholar]
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Authors
Grunau, R. E., Weinberg, J., & Whitfield, M. F.
Affiliations
University of British Columbia (CA)
ORCID
Venue
PEDIATRICS
Publisher
American Academy of Pediatrics (AAP)
Published
2004-07-01
Volume
114
Issue
1
Pages
e77-e84
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.114.1.e77
PMC
PMC1351380
OpenAlex
W2159543686
Cited by
262
References
62
Citations by year
2026: 6 · 2025: 3 · 2024: 2 · 2023: 4 · 2022: 9 · 2021: 7 · 2020: 42 · 2019: 7 · 2018: 5 · 2017: 8 · 2016: 13 · 2015: 11 · 2014: 16 · 2013: 24 · 2012: 16
FWCI
10.59
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Research Portal (Queen's University Belfast) (submittedVersion)
Funders
  • National Institute on Alcohol Abuse and Alcoholism (R01AA007789)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD039783, HD39783)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
Keywords
preterm infants, neonatal procedural pain, salivary cortisol, extremely low gestational age, very low gestational age, neonatal intensive care, stress response, basal cortisol, arousal system, term infants
MeSH terms
Analgesics, Opioid, Attention, Exploratory Behavior, Female, Gestational Age, Humans, Hydrocortisone, Infant, Infant, Newborn, Infant, Premature, Intensive Care Units, Neonatal, Male, Morphine, Pain, Saliva, Stress, Physiological, Infant Behavior

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