Calmer: a robot for managing acute pain effectively in preterm infants in the neonatal intensive care unit

Liisa Holsti, Karon MacLean, Timothy Oberlander, Anne Synnes, Rollin Brant, Liisa Holsti, Karon MacLean, Timothy Oberlander, Anne Synnes, Rollin Brant

Abstract

Introduction: For preterm infants in the neonatal intensive care unit, early exposure to repeated procedural pain is associated with negative effects on the brain. Skin-to-skin contact with parents has pain-mitigating properties, but parents may not always be available during procedures. Calmer, a robotic device that simulates key pain-reducing components of skin-to-skin contact, including heart beat sounds, breathing motion, and touch, was developed to augment clinical pain management.

Objective: Our objective was to evaluate the initial efficacy of Calmer for mitigating pain in preterm infants. We hypothesized that, compared to babies who received a human touch-based treatment, facilitated tucking, infants on Calmer would have lower behavioural and physiological pain indices during a single blood test required for clinical care.

Methods: Forty-nine preterm infants, born between 27 and 36 weeks of gestational age, were randomized either to facilitated tucking or Calmer treatment. Differences between groups in changes across 4 procedure phases (baseline 1, baseline 2, poke, and recovery) were evaluated using (1) the Behavioral Indicators of Infant Pain scored by blind coders from bedside videotape and (2) heart rate and heart rate variability continuously recorded from a single-lead surface ECG (lead II) (Biopac, Canada) sampled at 1000 Hz using a specially adapted portable computer system and processed using Mindware.

Results: No significant differences were found between groups on any outcome measures.

Conclusion: Calmer provided similar treatment efficacy to a human touch-based treatment. More research is needed to determine effects of Calmer for stress reduction in preterm infants in the neonatal intensive care unit over longer periods.

Keywords: NICU; Pain; Preterm infant.

Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Premature infant lying on Calmer.
Figure 2.
Figure 2.
Patient flow diagram.
Figure 3.
Figure 3.
Main outcomes (medians, ranges). BIIP, Behavioral Indicators of Infant Pain; HF, high frequency; HR, heart rate; LF, low frequency.

References

    1. Anand KJS, Bergqvist L, Hall W, Carbajal R. Acute pain management in newborn infants. PAIN (Clinical Updates) 2011;19:1–6.
    1. Cignacco EL, Sellam G, Stoffel L, Gerull R, Nelle M, Anand KJS, Engberg S. Oral sucrose and “facilitated tucking” for repeated pain relief in preterms: a randomized controlled trial. Pediatrics 2012;129:299–308.
    1. Committee on Fetus and Newborn and Section on Anesthesiology and pain Medicine. Prevention and management of procedural pain in the neonate: an update. Pediatrics 2016;137:e20154271–4271.
    1. Doesburg SM, Chau CM, Cheung TP, Moiseev A, Ribary U, Herdman AT, Miller SP, Cepeda IL, Synnes A, Grunau RE. Neonatal pain-related stress, functional cortical activity and visual-perceptual abilities in school-age children born at extremely low gestational age. PAIN 2013;154:1946–52.
    1. Hartley KA, Miller CS, Gephart SM. Facilitated tucking to reduce pain in neonates: evidence for best practice. Ad Neonatal Care 2015;15:201–8.
    1. Holsti L, Grunau RE. Considerations for using sucrose to reduce procedural pain in preterm infants. Pediatrics 2010;125:1042–7.
    1. Holsti L, Grunau RE. Initial validation of the Behavioral Indicators of Infant Pain (BIIP). PAIN 2007;132:264–72.
    1. Holsti L, Grunau RE, Oberlander TF, Osiovich H. Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) Scale. Clin J Pain 2008;24:83–8.
    1. Holsti L, Grunau RE, Oberlander TF, Whitfield MF, Weinberg J. Body movements, an important additional factor in discriminating pain from stress in preterm infants. Clin J Pain 2005;21:491–8.
    1. Johnston C, Campbell Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, Inglis D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2017;2:CD008435.
    1. Johnston CC, Filion F, Campbell-Yeo M, Goulet C, Bell L, McNaughton K, Byron J, Aita M, Finley GA, Walker CD. Kangaroo mother care diminished pain from heel lance in very preterm infants: a cross-over trial. BMC Pediatr 2008;8:13.
    1. Kommers D, Joshi R, Pul CV, Feijs L, Oei G, Oetomo SB, Andriessen P. Unlike kangaroo care, mechanically simulated kangaroo care does not change heart rate variability in preterm neonates. Early Hum Devel 2018;121:27–32.
    1. Ludington-Hoe SM, Hosseini RB. Skin-to-skin contact analgesia for preterm infant heel stick. AACN Clin Issues 2005;16:373–3887.
    1. Lundeburg T, Unväs-Moberg K, Ägren G, Bruzelius G. Anti-nociceptive effects of oxytocin in rats and mice. Neurosci Lett 1994;170:153–7.
    1. Maksimovic S, Baba Y, Lumpkin EA. Neurotransmitters and synaptic components in the Merkel cell-neurite complex, a gentle touch receptor. Ann N Y Acad Sci 2013;1279:13–21.
    1. McKechnie L, Levene M. Procedural pain guidelines for the newborn in the United Kingdom. J Perinatol 2008;28:107–11.
    1. Oberlander TF, Grunau RE, Pitfield S, Whitfield MF, Saul JP. The developmental character of cardiac autonomic responses to an acute noxious event in 4- and 8-month old healthy infants. Pediatr Res 1999;45:519–25.
    1. Oberlander T, Saul JP. Methodological considerations for the use of heart rate variability as a measure of pain reactivity in vulnerable infants. Clin Perinatol 2002;29:427–43.
    1. Ranger M, Chau CM, Garg A, Woodward TS, Beg MF, Bjornson B, Poskitt K, Fitzpatrick K, Synnes AR, Miller SP, Grunau RE. Neonatal pain-related stress predicts cortical thickness at age 7 years in children born very preterm. PLoS One 2013;8:e76702.
    1. Ranger M, Zwicker JG, Chau CM, Park MTM, Chakravarthy MM, Poskitt K, Miller SP, Bjornson B, Tam EWY, Chau V, Synnes AR, Grunau RE. Neonatal pain and infection relate to smaller cerebellum in very preterm children at school age. J Pediatr 2015;167:292–8.e1.
    1. Rosner BS, Doherty NE. The response of neonates to intra-uterine sounds. Devel Med Child Neurol 1979;21:723–9.
    1. Salk L. The effects of the normal heartbeat sound on the behavior of newborn infant: implications for mental health. World Ment Health 1960;12:1–8.
    1. Schneider J, Duerdena EG, Ting G, Ng K, Hagmann P, Bickle GM, Grunau RE, Chakravarty MM, Hüppi PS, Truttmann AC, Miller SP. Procedural pain and oral glucose in preterm neonates: brain development and sex-specific effects. PAIN 2018;159:515–25.
    1. Stevens B, Gibbins S. Clinical utility and clinical significance in the assessment and management of pain in vulnerable infants. Clin Perinatol 2002;29:459–68.
    1. Stevens B, Yamada J, Promislow S, Barwick M, Pinard M; the CIHR Team in Children's Pain. Pain assessment and management after a knowledge translation booster intervention. Pediatrics 2016;138:e20153468.
    1. Trembley S, Ranger M, Chau CMY, Ellegood J, Lerch J, Holsti L, Goldowitz D, Grunau RE. Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations. PAIN 2017;158:1586–98.
    1. Törnhage CJ, Serenius F, Unväs-Moberg K, Lindberg T. Plasma somatostatin and cholecystokinin levels in preterm infants during kangaroo care with and without nasogastric feeding. J Ped Endocrinol Metab 1998;11:645–51.
    1. Williams N, MacLean K, Guan L, Collet JP, Holsti L. Pilot testing a robot for reducing pain in hospitalized preterm infants. OTJR: Occupation, Participation and Health; 2019:1–8. 10.1177/153944921882543

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren