Preterm infants do not become used to repeated pain: Study

LONDON: A study led by UCL (University College London) researchers discovered that preterm infants do not become accustomed to repeated pain in the same way that full-term infants, children, and adults do.

According to the authors of the new Current Biology paper, if preterm infants have not yet developed the mechanism that allows people to become accustomed to moderate pain, medical procedures in their first few weeks of life may have an impact on their development.

Lead author Dr Lorenzo Fabrizi (UCL Neuroscience, Physiology & Pharmacology) said: “The way that we can get used to things can be seen as the simplest example of behavioural and brain plasticity, and it is a basic part of memory and learning. Pain habituation is important because it enables us to preserve physical, emotional, and cognitive resources by not overreacting to pain that is unavoidable or not life-threatening.

“Our findings suggest that the ability to get used to repeated pain might develop during the third trimester of pregnancy, so that babies born prematurely have not yet developed this ability that full-term babies have right from birth.”

The study involved 20 infants at University College London Hospitals (UCLH). Half of them were preterm (and tested while still younger than 35 weeks gestational age*), while the other half were either born at full term (seven infants) or preterm but tested at term age (three infants). The two groups were comparable in terms of their actual postnatal age, as the preterm babies had a median age of 14 days, compared to 10 days among the full-term (or term age) group.

The researchers were measuring the infants’ responses to a painful but clinically required heel lance (blood test), which was conducted twice (three to 18 minutes apart) for each infant (two lances are sometimes required to collect enough blood; this is not needed for most infants so only those that needed a second lance were included in the study).

Heel lances can elicit substantial pain responses in infants, but it was not previously known whether this decreases on repeated lances. To understand this, the researchers recorded the infants’ brain activity with EEG (electroencephalography) electrodes placed on the scalp, and their heart rates using ECG (electrocardiography), while also monitoring their facial expressions and reflexes in withdrawing the leg.

The researchers found that the brain activity was not as strong immediately after the second heel lance, compared to the first, suggesting a habituation response, but this was only the case for full-term infants. They found a similar pattern for heart rate and facial expressions, as preterm infants reacted just as strongly to both heel lances, while the full-term infants appeared to habituate to the pain.