Neonatal Facial and Cry Responses to Invasive and Non-invasive Procedures

Seo, Seon Hwa; Chang, Young Pyo

Abstract

PURPOSE
The evaluation of pain in neonates is difficult due to their limited means of communication. The aim of this study was to determine whether the behavioral reactions of facial action and cry provoked by an invasive pain-induced procedure could be discriminated from the reactions to a noninvasive pain-induced procedure in normal full-term neonates.
METHODS
Thirty-six healthy full-term neonates received three pain-induced procedures in counterbalanced order:intramuscular injection, tactile stimulus, and rubbing thigh with alcohol. The facial actions to the pain-induced procedures were measured and analysed by Neonatal Facial Action Coding System (NFACS) and the cry measures were analysed by the speech analysis after recording.
RESULTS
1) A cluster of facial actions comprised of brow bulging, eye squeezing, deepening of nasolabial furrow and open mouth was associated most frequently with the invasive procedure and the total facial action was the highest score in intramuscular injection. 2) Acoustic analysis of cry showed the shortest latency to the first cry and the lonegst duration of the first cry in intramuscular injection. 3) Two variables, total facial action and duration of the first cry, were most statistically significant in discriminating the invasive pain-induced procedure from the noninvasve pain-induced procedure.
CONCLUSION
The facial actions and cry responses to the invasive pain-induced procedure were significantly different from the responses to the noninvasive pain-induced procedure in healthy full-term neonates.