Original Article
Journal of Perinatology (2009) 29, 44–50; doi:10.1038/jp.2008.129; published online 4 September 2008
Mode of delivery modulates physiological and behavioral responses to neonatal pain
L L Bergqvist1,2, M Katz-Salamon1, S Hertegård3, K J S Anand4 and H Lagercrantz1
- 1Department of Woman and Child Health, Neonatal Research Unit Q2:07, Astrid Lindgren Children Hospital, Karolinska Institutet, Stockholm, Sweden
- 2Department of Medicine, Östersund Hospital, Östersund, Sweden
- 3Department of Logopedics and Phonations, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden
- 4Department of Pediatrics, College of Medicine, Arkansas Children Hospital Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Correspondence: Dr LL Bergqvist, Department of Woman and Child Health, Neonatal Research Unit Q2:07, Astrid Lindgren Children Hospital, Karolinska Institutet, SE-171 76 Stockholm, Sweden. E-mail: lena.bergqvist@ki.se
Received 18 December 2007; Revised 13 July 2008; Accepted 19 July 2008; Published online 4 September 2008.
Abstract
Objective:
To study whether the mode of delivery alters pain expression.
Study Design:
Full-term infants born by vaginal delivery or elective caesarean section were observed following high- and low-intensity pain stimuli, with recording of electrocardiogram, facial expression and vocalization.
Result:
Graded physiological and behavioral responses occurred, with greater responses to higher than lower intensity pain stimuli. Elevation in heart rate following both stimuli increased with time after vaginal delivery. Infants delivered by elective caesarean section showed stronger facial expressions and briefer time in vocalizations response to both interventions.
Conclusion:
Diminished responses following vaginal delivery suggest that physiological events associated with a normal delivery reduce the physiologic and sympathoadrenal activation by nociceptive mechanisms. Pain and stress reactivity appear to be inhibited during fetal life and sensory inputs during vaginal delivery may reverse this inhibition. To minimize neonatal pain, we recommend that postnatal invasive procedures to be performed shortly after vaginal birth.
Keywords:
assessment, facial expression, heart rate, infant-newborn, pain, phonation
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