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Monitoring of Pain and Stress in an Infant With Asphyxia During Induced Hypothermia: A Case Report

Hoffman, Karin MSc, RN; Bromster, Therése MSc, RN; Hakansson, Stellan MD; van den Berg, Johannes PhD, RN

Section Editor(s): Heaberlin, Pamela

doi: 10.1097/ANC.0b013e31829d8baf
Case of the Month

The purpose of this article was to study an infant who suffered from asphyxia undergoing induced hypothermia with regard to (1) describe the pain and stress as measured by physiological variables skin conductance algesimeter (SCA) and pain rating scales, (2) the correlation between SCA and pain rating scales, and (3) how temperature cycles in the cooling blanket affect the response of the sympathetic nervous system as measured by the SCA and physiological variables. A single prospective case study was used for this article. Data were recorded every 15 minutes for 96 hours. Each observation was categorized according to treatment phase: cooling 0 to 72 hours, rewarming, and controlled normal temperature up to 96 hours. Structured observations were carried out and all nursing care was documented. In addition, 5 periods with no other nursing interventions were identified in which data were recorded every minute for analysis. Skin conductance algimetry showed a variable response during treatment. During cooling, 68% of the 15-minute periods, signs of stress and pain were recorded. During rewarming, the corresponding figure was 83%. During the time sequences with normal temperature, 89% of the periods were associated with stress and pain. During 80% of the nursing procedures, the SCA showed stress and pain. There was no correlation between the pain-rating scales and SCA. When the cooling blanket temperature was lower than core temperature, the infant had more stress and pain according to SCA (P < .001) and an increase in heart rate and blood pressure (P < .001). In infants during induced hypothermia, SCA seem to detect pain and stress. Future evaluation of SCA for the detection of pain and stress during hypothermia treatment is necessary. Pain-rating scales do not appear reliable in this case report.

Department of Clinical Sciences, Pediatrics, Umeå University, Sweden.

Correspondence: Karin Hoffman, MSc, RN, Barnavdelning 4 NICU, Department of Clinical Sciences, Pediatrics, Umeå University, S-901 87, Umeå, Sweden (

This study was conducted at the neonatal intensive care unit of University Hospital Umeå, Sweden.

The authors thank Markus Lindkvist and Markus Karlsson Department of Biological Engineering and Informatics, University Hospital, Umea, for their technical support, technical setup, data sampling, and data processing.

The authors declare no funding or conflict of interest.

© 2013 by The National Association of Neonatal Nurses