Influence of pain on the development in preterm infants

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Introduction. The influence of uncontrolled exposure to pain in newborns in the first days of life on the long-term consequences for both the brain and the development of the nervous system as a whole is of interest.

The aim of the study was to assess the intensity of pain in preterm infants who need respiratory care in the early neonatal period and to determine its impact on the development of the child by the end of the first month of life.

Materials and methods. From December 2018 to December 2019, 92 preterm infants requiring respiratory support in the early neonatal period were examined. Pain intensity was assessed on the EDIN6 scale, and neuro-muscular maturity was assessed on the J. Ballard scale. The preterm infants were divided into 2 groups: Group I – 34 children who underwent invasive ventilation (body weight 1120 [865; 1390] g, gestational age 29 [26; 31] weeks); group II – 58 newborns who used non-invasive respiratory therapy (CPAP) (body weight 1160 [875; 1400] g, gestational age 29 [28; 31] weeks). Group I newborns had a lower Apgar score at 5 minutes (p = 0.001) and a higher Silverman score (p = 0.001).

Results and discussions. In all newborns, the maximum pain intensity score on the EDIN6 scale was registered on the 3rd day of life: in group I, it was 9, and in group II – points (p = 0.041), which corresponds to moderate pain. Group I children underwent more manipulations (20.8 ± 2.14 vs 17.7 ± 2.05; p = 0.016). An increase in the average airway pressure of ≥10 cm H2O in group I children and ≥6.5 cm H2O in group II patients is accompanied by an increase in the intensity of pain to severe and moderate, respectively. In both groups of children, an inverse correlation was found between the number of manipulations, head circumference (R = –0.64; p = 0.004) and the J. Ballard score on the 28th day of life (R = –0.57; p = 0.008). The number of painful manipulations in the early neonatal period, exceeding 21 procedures per day, increases the risk of delayed child development by more than 3.5 (p = 0.009; OR = 3.68; CI = 1.12–8.36).

Conclusion. The number of manipulations performed and the value of the average airway pressure are the main factors affecting the intensity of pain in preterm infants and determining their development in the neonatal period.

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About the authors

Artem V. Andreyev

V.N. Gorodkov Ivanovo Research Institute of Motherhood and Childhood

Author for correspondence.

Postgraduate Student, the Department of Obstetrics and Gynecology, Neonatology, Anesthesiology and Resuscitation

Russian Federation, Ivanovo

Natalya V. Kharlamova

V.N. Gorodkov Ivanovo Research Institute of Motherhood and Childhood


MD, PhD, Dr. Sci. (Med.), Professor, Head, the Department of Neonatology and Clinical Neurology of Children’s Age

Russian Federation, Ivanovo

Semen S. Mezhinskij

V.N. Gorodkov Ivanovo Research Institute of Motherhood and Childhood


MD, PhD, Cand. Sci. (Med.), Assistant Professor, the Department of Obstetrics and Gynecology, Neonatology, Anesthesiology and Resuscitation

Russian Federation, Ivanovo

Natalya A. Shilova

V.N. Gorodkov Ivanovo Research Institute of Motherhood and Childhood


MD, PhD, Cand. Sci. (Med.), Senior researcher, the Department of Neonatology and Clinical Neurology of Children’s Age

Russian Federation, Ivanovo


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Supplementary files

Supplementary Files
1. Fig. 1. Dynamics of neuromuscular and physical maturity in preterm infants according to the J. Ballard scale

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2. Fig. 2. Pain level on the EDIN6 scale in preterm infants in the early neonatal period

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3. Fig. 3. The level of pain in preterm infants with mechanical ventilation (group I) depending on the МАР

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4. Fig. 4. The level of pain in preterm infants with CPAP (group II) depending on the МАР

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Copyright (c) 2021 Andreyev A.V., Kharlamova N.V., Mezhinskij S.S., Shilova N.A.

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