| Sumario: | PURPOSE: To identify physiologic and behavioral responses of preterm infants to a routinely administered painful stimulus (heelstick) to determine how postconceptional age (PCA) may influence pain responses.SUBJECTS: Nonprobability convenience sample of I I preterm infants born at 24-26 weeks PCA.DESIGN: Quasi-experimental, repeated measures design.METHODS: The Neonatal Individualized Developmental Care Assessment Program (NIDCAP) method was used to assess infant responses before, during, and after a heelstick performed at weekly intervals between ages 27-32 weeks PCA.MAIN OUTCOME MEASURES: Univariate indicators of pain, including physiologic (heart rate, oxygen saturation, and respiratory rate) and behavioral (brow bulge, eye squeeze, and 4S NIDCAP variables) responses, were examined. Additionally, the Premature Infant Pain Profle (PIPP) was used as a composite measure to assess pain.PRINCIPAL RESULTS: Heart rate increased, whereas oxygen saturation and respiratory rate decreased during the most invasive phase of the procedure for infants between 27-32 weeks PCA. Increased PIPP scores and increased brow bulge and eye squeeze were also noted during the stick/squeeze phase. Finger splay increased significantly in magnitude of occurrence between 27-32 weeks PCA, whereas other NIDCAP variables, physiologic measures, facial variables, and PIPP scores were not sensitive to differences in PCA.CONCLUSIONS: Former 24- to 26-week preterm infants who are between 27-32 weeks PCA are capable of expressing pain through physiologic measures and facial actions in a manner similar to more mature preterm and healthy term infants. The PIPP is a valid instrument for assessing pain in infants as young as 27-32 weeks PCA.
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