Poster #53 - Effects of Neonatal Pain on Internalizing Behavior Problems in Toddlers Born Preterm

• In Event: 2-163 - Poster Session 08
  In Poster Session: PS 08 Section - Developmental Psychopathology

Integrative Statement

Commonly, the first developmental context of a preterm infant is the neonatal intensive care unit (NICU) because they require special care for survival. However, several events characterize the NICU as a high-risk context for human development, because of many procedures that cause pain, stress, and discomfort for the vulnerable infants (Cong et al., 2017). The neonatal pain-related stress events have the potential to alter brain microstructure and functions (Grunau, 2013), and they present association with negative alterations in both early and later developmental outcomes (Valeri, Holsti, & Linhares, 2015). The neonatal pain was associated with internalizing behavior in toddlers born very preterm at 18 months of age (Vinall, Miller, Synnes, & Grunau, 2013). The aim of the present study was to examine the effects of infant’s neonatal biobehavioral reactivity to pain, and the pain-related stress in the NICU, on internalizing behavior problems in toddlers born preterm. The sample included 24 toddlers born preterm (gestational age mean = 29 weeks [± 3]) with low birthweight (mean = 1,030 grams [± 269]), who were admitted after birth in a NICU with a developmental care protocol, including a non-pharmacological management for pain relief using oral sucrose prior to acute painful procedures. The toddlers were assessed in two moments: at neonatal phase (postnatal age mean = 5 days [± 3]), and at toddlerhood (age mean = 25 months of age [± 5]). At the neonatal phase, the infants’ biobehavioral pain reactivity was assessed during a painful blood collection procedure in NICU. The facial activity was videotaped and analyzed using the Neonatal Facial Coding System - NFCS (Grunau & Craig, 1987), and the sleep-wake state (Nijhuis & Pas, 1992) was recorded at the bedside. The Neonatal Infant Stressor Scale - NISS (Newnham, Inder, & Milgrom, 2009) analyzed the number of pain-related stress events during the NICU hospitalization, based on the clinical procedures recorded in the medical chart. At the toddlerhood, the mothers were interviewed using the Child Behavior Checklist - CBCL1.5-5 (Achenbach & Rescorla, 2000), for toddlers’ behavior problems assessment. Statistical descriptive, correlation, and multiple linear regression analyses were performed (SPSS, version 25.0). The level of significance of the study was p ≤ 0.05. The results showed that high neonatal pain-related stress index, associated with high infant’s biobehavioral pain reactivity and more activated sleep-wake state during a blood collection procedure in NICU explained 37% variability of the internalizing behavior problems at toddlerhood (p ≤ 0.03). Only 9% of the toddlers born preterm presented clinical internalizing behavior problems. In despite of this, the findings of the present study showed the negative effects of neonatal pain on behavior in this vulnerable population. The follow-up program for toddlers born preterm and their families should be offered positive parenting educational practices, strengthening the developmental process of these toddlers, aiming to prevent behavior problems.

Authors

• Claudia Maria Gaspardo, University of Sao Paulo
  Presenting Author

• Rafaela Cassiano, University of Sao Paulo
  Non-Presenting Author

• Guilherme Furini, University of Sao Paulo
  Non-Presenting Author

• Maria Beatriz Martins Linhares, University of São Paulo
  Non-Presenting Author