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Learning About Pain in Preterm Newborns


Journal of Developmental & Behavioral Pediatrics: December 2001 - Volume 22 - Issue 6 - p 418-424
Original Articles

The first goal of the study was to explore whether preterm newborns can learn to predict painful stimulation. The second goal was to provide a description of physiological and behavioral responses to repeated heel-sticks over days. Preterm newborns, born between 28 and 32 weeks gestational age, were observed five times over a period of 2 weeks while undergoing heel-sticks. Infants' facial expressions, cardiac reactions, and movement durations were recorded before, during, and after the heel-stick procedure. On Tests 1, 3, and 5, the phlebotomist picked up the baby's leg and held it for 10 seconds before proceeding to the heel-stick. Infants showed significantly greater increase in heart rate during the leg pickup on Test 5 compared with Test 1. This increase in heart rate after 2 weeks of experience suggests that newborn infants learned to anticipate the painful stimulus. Infants also demonstrated reliable behavioral and cardiac reactions to the invasive part of the heel-stick, but no change was observed in reactivity over days. However, greater post-conceptional age (PCA) was associated with increased behavioral reactivity during heel-stick on Tests 4 and 5. The anticipatory heart rate increase during leg pickup highlights the preterm infant's early capacity to learn and react to experience in the neonatal intensive care unit. The lack of global change in reactivity to the invasive procedure over days illustrates the need to take into account specific factors such as PCA when investigating sensitivity to repeated pain experiences.

Department of Psychology, Gettysburg College, Gettysburg, Pennsylvania (GOUBET)

Department of Psychology, University of Massachusetts, Amherst, Massachusetts (CLIFTON)

Tufts University School of Medicine, Boston, and Division of Newborn Medicine, Baystate Medical Center Children's Hospital, Springfield, Massachusetts (SHAH)

Address for reprints: Nathalie Goubet, Ph.D., Department of Psychology, Gettysburg College, Gettysburg, PA 17325; e-mail:

Portions of this research were part of Nathalie Goubet's doctoral dissertation, and a portion was presented at the biennial conference of the Society for Research in Child Development, Albuquerque, NM, April 1999.

Acknowledgments. The authors thank Patricia Conlin for her assistance in recruiting babies, Neil E. Berthier for his valuable help on heart rate data collection, Kristen Kavanaugh and Tory Field for data scoring, the phlebotomists and nurses at Baystate Medical Center in Springfield, MA, and the parents and infants who participated in the study. Support for this project was primarily provided by March of Dimes Grant 12-FY96-1015. Additional support came from Johnson & Johnson, a National Institute of Child Health and Human Development Grant HD 27714, a Research Scientist Award MH 00332 to R.K.C., and from the Swiss National Science Foundation, No. 1114-52573.97. This work is dedicated to the memory of Stephen J. Shraison.

© 2001 Lippincott Williams & Wilkins, Inc.