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86 Poster Session III, Monday, 5/3 (poster 361) Pain experienced at times of neurobiologic vulnerability in premature infants may influence subsequent pain response in infancy and childhood. The purpose of this study was to determine whether early and prolonged exposure to pain in former preterm infants alters pain response at 4 months corrected age. Measures of facial behavior (Neonatal Facial Coding System) and cardiac autonomic reactivity derived from the relationship between respiratory activity and short term variations of heart rate, (respiratory sinus arrhythmia) in 21 former extremely low birth weight infants (ELBW, birthweight < 801 grams) were compared with 24 term-born infants during baseline, lance and recovery periods of a finger lance blood collection. Experiences of painful procedures and treatment received during neonatal intensive care were also quantified. Overall behavioral and cardiac autonomic measures increased in response to the lance similarly in both groups. However, among the ELBW group, using transfer relationship between heart rate and respiration, there appeared to be a less intense parasympathetic withdrawal in the lance period and a more sustained sympathetic response during recovery. Further, in the recovery period, two behavioral patterns (early recovery and late recovery) were observed among the ELBW group. There were no associations between the number of previous painful procedures and subsequent pain reactivity, however infants in the early recovery group had received significantly more morphine (p<0.01; 0.50 vs. 0.27 mg/kg/day) during the course of their NICU care. It remains unclear whether subtle differences in cardiac autonomic responses or recovery behavior represent long term effects of early pain experience, a developmental lag in pain response or a lasting consequence of pharmacologic treatment received in the NICU. The lack of an overall difference between ELBW and term born control infants runs counter to previous findings of reduced or altered pain responses in former low birthweight infants.

Biobehavioral Pain Responses in Former Extremely Low Birthweight Infants at 4 Months Corrected Age