Functional near‐infrared spectroscopy to assess pain in neonatal circumcisions

Introduction Pain assessment is challenging in neonates. Behavioral and physiological pain scales do not assess neocortical nociception, essential to pain encoding and central pain pathway development. Functional near‐infrared spectroscopy (fNIRS) can assess neocortical activation to noxious stimuli...

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Published in:Pediatric anesthesia 2022-03, Vol.32 (3), p.404-412
Main Authors: Yuan, Ian, Nelson, Olivia, Barr, Gordon A., Zhang, Bingqing, Topjian, Alexis A., DiMaggio, Theresa J., Lang, Shih‐Shan, Christ, Lori A., Izzetoglu, Kurtulus, Greco, Christine C., Kurth, Charles D., Ganesh, Arjunan, Vutskits, Laszlo
Format: Article
Language:English
Subjects:
Anesthetics, Local
Circumcision
Circumcision, Male
functional near‐infrared spectroscopy
Humans
Infant
Infant, Newborn
Male
neonatal circumcision
Pain
pain assessment
Pain Measurement
Spectroscopy, Near-Infrared - methods
Spectrum analysis
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Summary:Introduction Pain assessment is challenging in neonates. Behavioral and physiological pain scales do not assess neocortical nociception, essential to pain encoding and central pain pathway development. Functional near‐infrared spectroscopy (fNIRS) can assess neocortical activation to noxious stimuli from changes in oxy‐(HbO) and total‐hemoglobin concentrations (HbT). This study aims to assess fNIRS nociceptive functional activation in the prefrontal cortex of neonates undergoing circumcision through changes in HbO and HbT, and the correlation between changes in fNIRS and Neonatal Infant Pain Scale (NIPS), a behavioral pain assessment scale. Methods In healthy term neonates, HbO, HbT, and NIPS were recorded during sequential circumcision events 1‐Prep before local anesthetic injection; 2‐Local anesthetic injection; 3‐Prep before incision; 4‐Oral sucrose; 5‐Incision; 6‐Gomco (hemostatic device) attached; 7‐Gomco twisted on; and 8‐Gomco removed. fNIRS and NIPS changes after each event were assessed with Wilcoxon signed‐rank test and summarized as median and interquartile range (IQR). Changes in fNIRS vs. NIPS were correlated with Spearman coefficient. Results In 31 neonates fNIRS increased (median [IQR] µmol/L) with noxious events: Local injection (HbO: 1.1 [0.5, 3.1], p 
ISSN:1155-5645
1460-9592
DOI:10.1111/pan.14326