According to a study conducted by experts at UCL (University College London), premature babies do not suffer as much as full-term babies, children and adults do.
According to the authors of a recent Current Biology article, medical operations in the first few weeks of life can affect the development of premature infants if they have not yet acquired mechanisms that allow humans to become accustomed to mild pain.
Lead author Dr Lorenzo Fabrizi (UCL Neuroscience, Physiology and Pharmacology) said: “The way we habituate to things can be seen as a simple example of behavioral and brain plasticity, and is a fundamental part of memory and learning. Habituation is important because it allows us to physically, emotionally and , and enables cognitive resources to be conserved without overreacting to unavoidable or life-threatening pain.
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“Our findings suggest that the ability to habituate to repeated pain may develop during the third trimester of pregnancy so that preterm infants may not develop the ability that full-term infants do from birth.”
Twenty newborns at University College London Hospital (UCLH) were studied. Half of them were preterm (and tested at less than 35 weeks’ gestational age*), while the other half were either full term (seven infants) or premature but tested at term age (three infants). The two groups were comparable in terms of their actual postnatal age, as the mean age of the preterm infants was 14 days, compared with 10 days in the full-term (or term age) group.
The researchers measured the infants’ response to a painful but medically necessary heel lance (blood test), which was conducted twice (three to 18 minutes apart) for each infant (sometimes two lancets are needed to collect enough blood; this is not necessary). (for most infants therefore only those requiring a second lance were included in the study).
Heel lances can elicit substantial pain responses in infants, but it was not previously known that this was reduced by repeated injections. To understand this, the researchers recorded the children’s brain activity using EEG (electroencephalography) electrodes placed on the skull and ECG (electrocardiography), as well as monitored their facial expressions and reflexes as they retracted their legs.
The researchers found that brain activity was not as strong immediately after the second heel lance, compared to the first, suggesting a habituation response, but this was only for full-term infants. They found a similar pattern for heart rate and facial expression, as premature infants showed a strong response to both heel spurs, while full-term infants showed a pain habit.
The team says this habitual response may be due to full-term infants anticipating impending pain when they receive a second heel lance, so their response is less pronounced, or instead may be due to their brains modifying their reflexive survival responses.
They add that pain habituation may protect full-term infants, but not preterm ones, from potential consequences for their development.
First author Dr Mohammed Rupawala (UCL Neuroscience, Physiology and Pharmacology) said: “Although unpleasant and painful clinical procedures for many young infants are necessary, they have the potential to affect their development, such as changes in pain perception, or potentially less gray matter or in the brain. White matter disruption.”
Co-author Dr. Judith Meek, consultant neonatologist at UCLH, said: “This work raises awareness of the additional risk of pain to premature babies. Clinicians should do everything possible to protect them from repeated painful experiences. This should be considered an essential component of brain-centred neonatal care.”
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