Changes in electrical conductivity of the skin due to painful stimuli in newborns of different gestational categories and comparison with changes in selected physiological parameters
Authors:
J. Macko 1; P. Humpolíček 2; D. Moravčíková 3; L. Kantor 4; M. Kotíková 1
Authors place of work:
Novorozenecké oddělení, Krajská nemocnice Tomáše Bati, Zlín
primář MUDr. J. Macko
1; Institut zdravotnických studií, Univerzita Tomáše Bati, Zlín
vedoucí Mgr. M. Cichá, Ph. D.
2; Ústav porodní asistence, Institut zdravotnických studií, Univerzita Tomáše Bati, Zlín
vedoucí Mgr. L. Reslerová, Ph. D.
3; Novorozenecké oddělení, Fakultní nemocnice, Olomouc
primář MUDr. L. Kantor
4
Published in the journal:
Čes-slov Pediat 2011; 66 (6): 363-371.
Category:
Original Papers
Summary
Pain in neonates is globally regarded as a highly undesirable phenomenon. Many studies have been confirmed that the pain feels as mature newborns and premature babies born. So far, however, there is no objective method of assessing pain in these patients who cannot yet verbalize their pain. One of the objectives of this study was to explore the use of measuring changes in electrical skin conductance as an objective criterion for evaluating the perception of pain in neonates. Given the experience of pain affects the physiological functions of the organism, the next objective was to ascertain the relationship between changes in skin conductance and changes in selected physiological parameters.
Patients:
The study included a total of 57 babies born in KNTB in Zlín in the first half of 2010. Infants were divided according to gestational age in the following 3 groups: group A: 41+6–36+0 (19 neonates), group B: 35+6–32+0 (25 neonates), group C: 31+6–25+0 (13 newborns).
Results:
As the most sensitive parameter for changes in skin conductance rating of pain seems to be the peak per second (PPS), other parameters of skin conductance and selected physiological parameters measured do not correlate with each other. The results could not determine basal skin conductance levels. A comparison of gestational age and parameters of skin conductance weren´t also demonstrate significant correlation. Gestational age also doesn´t affect the electrical parameters of skin conductance changes.
Conclusion:
We can conclude that the evaluation of pain in both mature and premature newborns requires individual assessment. Changes in skin conductance are probably influenced by other factors, not just the emergence of painful stimulus. The present study suggests, that pain assessment in neonates only measured by changes in electrical skin conductivity cannot replace the full range of established practices and vice versa is necessary to take into account the complexity of the perception of pain using a combination of several methods.
Key words:
electrical conductivity of the skin, infants, Prechtl, saturation, heart rate, gestational age
Zdroje
1. Storm H. Changes in skin conductance as a tool to monitor nociceptive stimulation and pain. Curr Opin Anaesth 2008; 21: 796–804.
2. Hulletee B, Chambers N, Preuss J, et al. Monitoring electrical skin conductance: A tool for the assessment of postoperative pain in children. Anestesiology 2009; 3: 513–517.
3. Storm H. Skin conductance and the stress response from heel stisk in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 83: F143–F147.
4. Gjerstad AN, Wagner K, Henrichsen T, Storm H. Skin conductance versus the modified comfort sedation score as a measure of discomfort in artificially ventilated children. Pediatrics 2008; 122: e848–e853.
5. Edelberg R. Electrical properities of the skin. In: Brown CC, ed. Methods in Psychophysiology. Baltimore, MD: Williams&Wilkins, 1967: 1–53.
6. Hagbarth KE, Halin RG, Hongell A, et. al. General characteristics of sympatethic activity in human skin nerves. Acta Physiol Scand 1972; 84(2): 164–176.
7. Wallin BG, Sundlöf G, Delius W. The effect of karotid sinus nerve stimulations on muscle and skin nerve sympathetic activity in man. Pflugers Arch 1975; 358(2): 101–110.
8. Storm H, Shafiei M, Myre K, Raeder J. Palmar skin conductance compared to a developed stress score and to noxious and awakeness stimuli on patiens in anaesthesia to study the sensitivity and specificity of skin conductance. Acta Anaesth Scand 2005; 49: 798–804.
9. Storm H, Skorpen F, Klepstad P, et. al. Genetic variations influence the skin conductance response to nociceptive pain in anesthetized patients. Abstract accepted ISAP, Orlando; 2008.
10. Gjerstad AC, Storm H, Wallin G. Evaluation of the skin conductance method by using microneurographi [abstract]. Chicago: ISAP; 2006.
11. Prechtl HFR. The behavioural states of the newborn infant (a review). Brain Res 1974 August; 76(2): 185–212.
12. Gladman G, Chiswick ML. Skin conductance and arousal in the newborn infant. Arch Dis Child 1990; 65: 1063–1066.
13. Macefield VG, Wallin BG. The change in behavior of single sympathetic outflow in normotensive human sweat glands. J Auton Nerv Syst 1996; 14: 277–286.
14. Lindberg L, Wallin G. Sympathetic skin nerve discharges in relation to amplitude of skin resistence response. Psychophys 1981; 18(3): 268–270.
15. Kim EJ, Buschmann MBT. Reliability and validity of the faces pain scale with older adults. Intern J Nurs Stud 2006; 43: 456–477.
16. Porter FL, Wolf CM, Miller JP. The effect of handling and immobilization on the response to acute pain in newborn infants. Pediatrics 1998 Dezember; 102(6): 1383–1389.
17. Thompson DG. Utilizing an oral sucrose solution to minimize neonatal pain. J Spec Pediat Nurs 2005; 10(1): 3–10.
18. Mc Kechnie L, Levene M. Procedural pain guidelines for the newborn i the United Kingdom. J Perinatol 2008; 28: 107–111.
19. Macko J. Procedurální bolest novorozence – možnosti prevence a tišení. Čes-slov Pediat 2010; 65(10): 584–591.
20. Grunau RE, Oberlander TF, Whitfield MF, Fitzgerald C, Lee SK. Demographis and therapeutic determinantns of pain reactivity in very low birth weight neonates at 32 weeks postconceptional age. Pediatrics 2001; 107: 105–112.
21. Holsti L, Grunau RE, Whitfield MF. Behavioural responsiveness to pain are heightened after clustered care in preterm infants born between 30 and 32 weeks gestational age. Clin J Pain 2006; 22(9): 757–764.
22. Morison SJ, Grunau RE, Tim F, Oberlander MF. Whitfield-relations between behavoural and cardiac autonomic reactivity to acute pain in preterm infants. Clin J Pain 2001 December; 17(4): 350–358.
23. O´ Rourke D. The measurement of pain in infants, children and adolescents: from policy to practice. Phys Ther 2004 Jun; 84(6): 560–570.
24. Lindh V, Wicklund U, Hakansson S. Heel lancing in term newborn infants: an evaluation of pain by frequency domain analysis of heart rate variability. Pain 1999; 80: 143–148.
25. Hummel P, van Dijk M. Pain assessment, current status and challenges. Semin Foetal Neonatal Med 2006; 11: 237–245.
26. Stevens B, Gibbins S, Franck LS. Treatment of pain in the neonatal intensive care unit. Pediatr Clin North Am 2000 Jun; 47(3): 633–650.
27. Harrison D, Boyce S, Loughnan P, Dargaville P, Storm H, Johnston L. Skin conductance as a measure of pain and stress in hospitalised infants. Early Hum Dev 2006; 82(9): 603–608.
28. Hellerud BC, Storm H. Skin condutance and behaviour during sensory stimulation of preterm and term infants. Early Hum Dev 2002; 70(1–2): 35–46.
29. Bellieni C. Pain definitions revised : newborns not only feel pain, they also suffer. Eth and Med Spring 2005; 21(1): 5–9.
30. Ranger M, Johnston CC, Anand KJS. Current controversie regarding pain in neonates. Semin Perinatol 2007; Sep 07. pp 283-28.
31. Stevens BJ, Johnston CC. Physiological responses of premature infantns to a painful stimulus. Nurs Res 1994; 43(4): 226–231.
Štítky
Neonatology Paediatrics General practitioner for children and adolescentsČlánok vyšiel v časopise
Czech-Slovak Pediatrics
2011 Číslo 6
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