Looking through Providers' Eyes: Pain in the Neonatal Intensive Care Unit

Julia B.L. Borten; Marina C.M. Barros; Erica S. Silva; Lucas P. Carlini; Rita C.X. Balda; Rafael N. Orsi; Tatiany M. Heiderich; Adriana Sanudo; Carlos E. Thomaz; Ruth Guinsburg

doi:10.1055/a-2212-0578

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(S 01): e3242-e3248
DOI: 10.1055/a-2212-0578

Original Article

Looking through Providers' Eyes: Pain in the Neonatal Intensive Care Unit

Autoren

Julia B.L. Borten

¹Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Marina C.M. Barros

¹Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Erica S. Silva

¹Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Lucas P. Carlini

²Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
Rita C.X. Balda

¹Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Rafael N. Orsi

³Epidemiology and Biostatistics, Department of Preventive Medicine at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Tatiany M. Heiderich

²Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
Adriana Sanudo

³Epidemiology and Biostatistics, Department of Preventive Medicine at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
Carlos E. Thomaz

²Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
Ruth Guinsburg

¹Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

Abstract

Objective Evaluate the pain of critically ill newborns is a challenge because of the devices for cardiorespiratory support. This study aim to verify the adults' gaze when assessing the critically ill neonates' pain at bedside.

Study Design Cross-sectional study in which pediatricians, nursing technicians, and parents evaluated critically ill neonates' pain at bedside, for 20 seconds with eye-tracking glasses. At the end, they answered whether the neonate was in pain or not. Visual tracking outcomes: number and time of visual fixations in four areas of interest (AOI) (face, trunk, and upper [UL] and lower [LL] limbs) were compared between groups and according to pain perception (present/absent).

Results A total of 62 adults (21 pediatricians, 23 nursing technicians, 18 parents) evaluated 27 neonates (gestational age: 31.8 ± 4.4 weeks; birth weight: 1,645 ± 1,234 g). More adults fixed their gaze on the face (96.8%) and trunk (96.8%), followed by UL (74.2%) and LL (66.1%). Parents performed a greater number of fixations on the trunk than nursing technicians (11.0 vs. 5.5 vs. 6.0; p = 0.023). Controlled for visual tracking variables, each second of eye fixation in AOI (1.21; 95% confidence interval [CI]: 1.03–1.42; p = 0.018) and UL (1.07; 95% CI: 1.03–1.10; p < 0.001) increased the chance of perceiving the presence of pain.

Conclusion Adults, when assessing at bedside critically ill newborns' pain, fixed their eyes mainly on the face and trunk. The time spent looking at the UL was associated with the perception of pain presence.

Key Points

Pain assessment in critically ill newborns is a challenge.
To assess critically ill neonates' pain, adults mainly look at the face and trunk.
Looking at the upper limbs also helps in assessing critically ill neonates' pain.

Keywords

infant - newborn - pain measurement - intensive care units - neonatal - eye-tracking technology - fixation - ocular

Volltext

Referenzen

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