Cardiovascular Indices development in acute pain responding in infants
Improper management of infant acute pain has been associated with various short- and long-term negative physiological and psychological consequences. The major challenge with infant pain assessment is that neonates cannot self-report their subjective experience of pain. Moreover, there is a lack of agreement on the best proxy modality of assessing infant pain, whether it is cortical, biochemical, physiological, or behavioral.
Despite the above-mentioned disputes, cardio-physiological indices of pain, such as heart rate (HR) and HR variability (HRV), are pervasive in the hospital setting. No prospective research has examined the development of cardiac responses to acutely painful procedures in the first year of life of infants. To synthesize the existing evidence regarding the development of cardiovascular responses to acutely painful medical procedures over the first year of life in preterm and term born infants, a study was conducted.
A systematic search retrieved 6994 articles to review against inclusion criteria. A total of 41 studies were included in the review. Observational or descriptive studies of individuals equal to or under 3 years of age undergoing an acutely painful procedures were monitored using a cardiovascular measure. A controlled group data from pain manipulation studies and prospective randomized controlled trials were also added that investigated the effectiveness of pain management strategies using cardiovascular measures.
After the analysis of acute painful procedures, it was observed that most infants had an increase in mean heart rate(HR) that varied in magnitude both in consistent. A total of 180 articles were then reviewed by full-text review, and of these, 41 articles (involving 1552 participants) fulfilled the inclusion criteria. These studies underwent quality assessment and data extraction and were included in the final review.
From the evaluated data, it was concluded that longitudinal research is needed to further understand the inherent variability of cardiovascular pain responses across and within gestational and post-natal ages and the causes for the variability. It was difficult to draw conclusions across development and GA groups for cardiovascular responses to acute medical procedure pain as the majority of studies did not included the co-variation in their analyses that could impact an infant’s cardiovascular response to acute pain.