Title: The Measurement of pain in premature infants
Funder: BLISS

Abstract: Despite an increased awareness of the short and long-term consequences of pain in infancy, it remains under-treated and poorly understood. Hospitalised infants routinely require frequent invasive painful clinical procedures, but with very few evidence-based treatment options available, pain relief is consequently rarely and inconsistently provided. The assessment of pain in premature infants presents a considerable challenge considering their lack of verbal communication and the rapid development of their maturing nervous system. Our vision is to undertake a series of mechanistic studies in human infants to improve the understanding and treatment of pain in prematurely-born infants. In this proposal, we will measure how premature infants respond to painful procedures by measuring changes in pain-related brain activity, behaviour and physiology (including respiratory rate, heart rate and oxygen saturation). We will develop and validate an EEG-based measure of pain-related brain activity that is developmentally sensitive and suitable for use in premature infants from 24 – 37 weeks’ gestation. We will aim for it to be useful across a range of painful clinical procedures (e.g. cannulation, eye examinations for retinopathy of prematurity and injections). We will also establish the best approach to objectively quantify how the physiology of premature infants is altered by painful events (e.g. episodes of bradycardia, tachycardia, apnoea and oxygen desaturation). The measures we develop in this work could be used to test the effects of a variety of treatment strategies for painful procedures for neonates. In this project, the measures will be used to test whether a parental affective touch intervention, optimised to activate C-tactile afferents, can reduce the impact of pain on infant brain activity, physiology and behaviour. Overall, this comprehensive programme of work will provide new multimodal approaches to the measurement and treatment of infant pain and will test whether a parent-led intervention can reduce infant pain.

Lay abstract: Over 30 years ago surgical procedures were routinely performed in infants without the provision of adequate pain relief. In part, this was due to the misconception that the infant nervous system may be too immature to process pain and concerns about the side-effects of pain relieving drugs. It is now widely accepted that infants feel pain and pain-relief is routinely provided during surgery. Nevertheless, even today, essential medical procedures, such as intubations, injections and blood tests, are performed in premature and sick babies without adequate pain relief, which is stressful for both infants and their parents. Pain in early life can have considerable long-term consequences, such as reduced growth, altered brain development and reduced school-age academic performance. Pain-relieving drugs have the potential to reduce these consequences, as do other approaches to pain relief, such as affective parental touch during painful procedures. Crucial to improving the way we treat pain in babies in neonatal care is to understand how best to accurately measure it. Pain is a complex sensory and emotional experience, which babies cannot communicate verbally. To improve the treatment of pain in babies, it is necessary to develop and validate alternative measures of their pain experience. Recent scientific and technological advances have provided us with the opportunity to measure many biological changes that occur when a baby undergoes a painful clinical procedure. This project aims to measure the effects of medically-essential painful procedures on breathing, heart rate, oxygen saturation, facial expression and brain activity in premature infants, in order to identify the best age-appropriate ways to assess and treat pain in premature babies. We will then use these pain assessments to test whether parental touch prior to a painful procedure, optimised to activate specialised nerve fibres, can reduce pain in infants. This will ultimately lead to better pain management and treatment in babies who require neonatal care.

Research activity codes: 4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: NEUROLOGICAL;REPRODUCTIVE HEALTH AND CHILDBIRTH