Neonatal Perinatal Medicine Fellow University of Kentucky College of Medicine Lexington, Kentucky, United States
Background: Neonates have adverse responses to painful events and untreated pain can lead to hyperalgesia and neurodevelopmental impairments. NIRS can be applied to investigate the cortical response to painful stimuli by detecting changes in cerebral regional saturation (rSO2). Circumcision is a unique procedure involving sharp pain, pressure pain and non-noxious stimuli. Gaps exist in knowledge, evidence, and practice in neonatal pain assessment and management, which leads to challenges in managing pain. This study aims to assess the cortical responses over pre-frontal and somatosensory cortex by studying changes in cerebral rSO2 during circumcision and comparing these results with physiological parameters of pain. Objective: 1. To understand cortical brain response to pain in neonates undergoing circumcision by studying changes in cerebral rSO2 using NIRS. 2.To assess correlation of cortisol levels, heart rate variability and Neonatal Infant Pain Scale (NIPS) scores with NIRS changes during circumcision. Design/Methods: Male infants >36 weeks of gestational age undergoing circumcision were enrolled in this prospective observational study between 2023-2024. Critically ill, drug exposed and those with congenital anomalies were excluded. Parents provided informed consent, and study protocol was approved by University of Kentucky IRB.
Cerebral rSO2 were recorded using NIRS using four probes: placed over somatosensory and prefrontal cortex. rSO2 was recorded at baseline and at eight steps of circumcision: Sucrose> Alcohol prep>Lidocaine injection> Betadine prep>Incision>Attachment of Gomco clamp> Clamp on>Clamp off.
Salivary cortisol was sent at baseline and after 30min of Gomco attachment. Heart rates were recorded through cardiorespiratory monitoring. NIPS scoring was done from video recordings of procedure.
Prenatal and postnatal clinical data was collected. Multivariate logistic regression and Spearman’s correlation coefficient for clinical variables and change in rSO2 were performed.
We expect to complete patient enrollment by 03/01/24 with final results by 03/31/24.
