Neonatal Pain Behaviour and Perinatal Events: Implications for Research Observations

Abstract

Pain in early infancy has only recently been recognized as an area requiring systematic study in nursing (Owens, 1984; Roberts, 1988). This has emerged in part because of recognition of the need for an empirical base for pédiatrie pain management (Russo & Varni, 1982), but also reflects changes in views regarding neonatal functional capacity in other modalities (Emde & Robinson, 1979; Stratton, 1982). In the past, there have been widespread erroneous beliefs held that neonates were relatively insensitive to pain, perhaps as part of a system of protection during the birth process (Bondy, 1980). Studies of healthy neonates during circumcision (Dixon, Snyder, Holve & Bromberger, 1984; Gunnar & Malone, 1985; Marshall, Stratton, Moore & Boxerman, 1980) and heel lance for blood collection (Grunau & Craig, 1987; McKeel & Sanders, 1984; Owens & Todt, 1984) have now demonstrated vigorous and dramatic behavioral responses to noxious stimulation which adults would interpret as pain in response to tissue damage (Craig & Grunau, in press). The possibility that variations in pain behavior in the first few days of life may reflect perinatal variables, such as mode of delivery and maternal obstetric medication, was raised 30 years ago by Lipsett and Levy (1959), and again by Fisichelli, Karelitz, Fisichelli and Cooper (1974). However, to our knowledge, this issue has never been addressed empirically. Other concomitant factors, such as time from last feeding prior to the invasive procedure, and type of feeding (breast vs. bottle) at a time when breast milk supply may not yet be well established, may also affect pain behavior. Difficulties inherent in attempting to determine causal relations between obstetric drugs or other perinatal variables and neonatal behavior, in the light of confounding of maternal and obstetric factors, have recently been described (Kraemer, Korner, Anders, Jacklin & Dimiceli, 1985).