This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (22) Citing Articles via Google Scholar Google Scholar Articles by Holsti, L. Articles by Whitfield, M. F. Search for Related Content PubMed PubMed Citation Articles by Holsti, L. Articles by Whitfield, M. F. Related Collections Office Practice Social Bookmarking                         What's this?

PEDIATRICS Vol. 114 No. 1 July 2004, pp. 65-72

Specific Newborn Individualized Developmental Care and Assessment Program Movements Are Associated With Acute Pain in Preterm Infants in the Neonatal Intensive Care Unit

Liisa Holsti, PhD^*, Ruth E. Grunau, PhD^*,,, Tim F. Oberlander, MD^*,, and Michael F. Whitfield, MD^,

^* Centre for Community Child Health Research, British Columbia Research Institute for Children’s and Women’s Health, Vancouver, British Columbia, Canada
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Children’s and Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada

Objective. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is widely used in neonatal intensive care units and comprises 85 discrete infant behaviors, some of which may communicate infant distress. The objective of this study was to identify developmentally relevant movements indicative of pain in preterm infants.

Methods. Forty-four preterm infants were assessed at 32 weeks’ gestational age (GA) during 3 phases (baseline, lance/squeeze, and recovery) of routine blood collection in the neonatal intensive care unit. The NIDCAP and Neonatal Facial Coding System (NFCS) were coded from separate continuous bedside video recordings; mean heart rate (mHR) was derived from digitally sampled continuous electrographic recordings. Analysis of variance (phase x gender) with Bonferroni corrections was used to compare differences in NIDCAP, NFCS, and mHR. Pearson correlations were used to examine relationships between the NIDCAP and infant background characteristics.

Results. NFCS and mHR increased significantly to lance/squeeze. Eight NIDCAP behaviors also increased significantly to lance/squeeze. Another 5 NIDCAP behaviors decreased significantly to lance/squeeze. Infants who had lower GA at birth, had been sicker, had experienced more painful procedures, or had greater morphine exposure showed increased hand movements indicative of increased distress.

Conclusions. Of the 85 NIDCAP behaviors, a subset of 8 NIDCAP movements were associated with pain. Particularly for infants who are born at early GAs, addition of these movements to commonly used measures may improve the accuracy of pain assessment.

---

Key Words: preterm infant • pain • NIDCAP • movement • NICU

Abbreviations: NIDCAP, Newborn Individualized Developmental Care and Assessment Program • NICU, neonatal intensive care unit • GA, gestational age • PCA, postconceptional age • NFCS, Neonatal Facial Coding System • SNAP-II, Score for Neonatal Acute Physiology II

---

Received for publication Mar 3, 2003; Accepted Jul 7, 2003.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. Ohlsson NIDCAP: New Controversial Evidence for Its Effectiveness Pediatrics, October 1, 2009; 124(4): 1213 - 1215. [Full Text] [PDF]

				A. Kleberg, I. Warren, E. Norman, E. Morelius, A.-C. Berg, E. Mat-Ali, K. Holm, A. Fielder, N. Nelson, and L. Hellstrom-Westas Lower Stress Responses After Newborn Individualized Developmental Care and Assessment Program Care During Eye Screening Examinations for Retinopathy of Prematurity: A Randomized Study Pediatrics, May 1, 2008; 121(5): e1267 - e1278. [Abstract] [Full Text] [PDF]

				Y. Ahn The Relationship between Behavioral States and Pain Responses to Various NICU Procedures in Premature Infants J Trop Pediatr, June 1, 2006; 52(3): 201 - 205. [Abstract] [Full Text] [PDF]

				B. Westrup Newborn Individualized Developmental Care and Assessment Program (NIDCAP): Family-centered Developmentally Supportive Care NeoReviews, March 1, 2005; 6(3): e115 - e122. [Full Text] [PDF]