Preterm infants stress responses to an invasive NICU event: Endotracheal suctioning

Abstract

The pain, distress and emotional upset associated with the administration of neonatal intensive care is being increasingly recognized. We studied preterm infants' response patterns to endotracheal suctioning, one of the most distressing procedures performed during neonatal intensive care. The neurobehavioural and physiological responses of 15 preterm infants were examined. The study parameters were infant body movement responses (distal limb, proximal limb, truncal), heart rate and oxygen saturation values. The infants' movements were recorded with a video camera. Heart rate and oxygen saturation were recorded with an Ivy monitor. Observations were made before (for 2 minutes), throughout and after (for 2 minutes), endotracheal suctioning. During endotracheal suctioning the infants displayed a significant alteration in neurobehaviour with increased distal limb, proximal limb and truncal movements. There was a significant change in the median heart rate, heart rate variability, median oxygen saturation and minimum oxygen saturation. Preterm infants display both neurobehavioural and physiological responses to invasive procedures like endotracheal suctioning. Ventilated infants can communicate their distress to their caregiver in a number of demonstrable ways. Recognition of these response patterns is helpful in identifying those who are distressed and require sedation, analgesia and postponement or modification of the procedure.