Relationship between acute procedural pain and immune status in newborn infants

2.50
Hdl Handle:
http://hdl.handle.net/10755/148314
Type:
Presentation
Title:
Relationship between acute procedural pain and immune status in newborn infants
Abstract:
Relationship between acute procedural pain and immune status in newborn infants
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Rasmussen, Lynn
P.I. Institution Name:University of Missouri-Kansas City
The ability of the infant to perceive pain has been demonstrated by behavioral, cardiorespiratory, and hormonal responses to surgical and acute procedures. However, the responses of the newborn’s immune system to pain have not been explored. Newborns are a vulnerable population and are prone to infection because of the immaturity and naïveté of their immune systems. The theoretical framework of psychoneuroimmunology (PNI), which postulates interactions among the central nervous system, the endocrine system, and the immune system, has been instrumental in uncovering relationships between different stressors and the immune system in adults and provided the theoretical framework for this study. The main purpose of this descriptive, correlational study was to determine if there were relationships among the pain scores, stress responses, and immune system status in newborn infants undergoing circumcision. The PNI framework guided the formation of the main hypothesis: acute procedural pain and stress are related to immune status in newborns surrounding circumcision. Specifically, it was hypothesized that acute procedural pain, as measured by the Premature Infant Pain Profile (PIPP) developed by Stevens, et al., (1996), and stress, as measured by changes in cortisol levels, are significantly correlated with changes in immune status, as measured by changes in levels of neutrophils, and the cytokines Interleukin-one beta (IL-1b), Tumor necrosis factor-alpha (TNF-a), and Interferon-gamma (IFN-g), in newborns surrounding circumcision. The relationship among PIPP scores and changes in cortisol levels was also investigated. The study was conducted with a convenience sample of 32 healthy male newborns in a large perinatal center in the Midwest. Each subject served as his own control. Blood and saliva samples were collected before and after circumcision; cytokine and cortisol levels were determined by ELISA assays and neutrophil counts were determined by microscopic examination using a modified Wright’s stain. The findings of this study supported the theory of PNI with significant relationships found among the central nervous system, the endocrine system, and the immune system of newborn infants. The pain and stress of circumcision appeared to impact the percentage of neutrophils and the proportion of immature to total neutrophils seen in the circulation of newborns after the procedure. The mean PIPP score during circumcision had a significant negative correlation with percentage of neutrophils after circumcision (rho = -.46, p = .008). Thus, the higher the PIPP score, the more pain felt by the infant and the lower the neutrophil percentage was after circumcision. Stress also was related to immune status as the level of cortisol before circumcision was significantly correlated with the change in neutrophils seen in circulation surrounding circumcision (r = .60, p = .007). Cytokines IL-1b and TNF-a also appeared to influence these findings, with significant associations demonstrated despite a small sample size, assay limitations, and individual variability among the subjects. Since pain appears to be related to the immune status in infants, this knowledge will be of interest to those who care for newborns and those who study the development of the immune and nervous systems. The findings of this study advance the understanding of the immune system of newborn, and are essential in order to enhance the development of immunocompetence in this vulnerable population through pain prevention. Further research is needed to replicate these findings and to further explore the influence of pain and stress upon the immune system of infants.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleRelationship between acute procedural pain and immune status in newborn infantsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/148314-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Relationship between acute procedural pain and immune status in newborn infants</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Rasmussen, Lynn</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Missouri-Kansas City</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">rasmussenl@umkc.edu</td></tr><tr><td colspan="2" class="item-abstract">The ability of the infant to perceive pain has been demonstrated by behavioral, cardiorespiratory, and hormonal responses to surgical and acute procedures. However, the responses of the newborn&rsquo;s immune system to pain have not been explored. Newborns are a vulnerable population and are prone to infection because of the immaturity and na&iuml;vet&eacute; of their immune systems. The theoretical framework of psychoneuroimmunology (PNI), which postulates interactions among the central nervous system, the endocrine system, and the immune system, has been instrumental in uncovering relationships between different stressors and the immune system in adults and provided the theoretical framework for this study. The main purpose of this descriptive, correlational study was to determine if there were relationships among the pain scores, stress responses, and immune system status in newborn infants undergoing circumcision. The PNI framework guided the formation of the main hypothesis: acute procedural pain and stress are related to immune status in newborns surrounding circumcision. Specifically, it was hypothesized that acute procedural pain, as measured by the Premature Infant Pain Profile (PIPP) developed by Stevens, et al., (1996), and stress, as measured by changes in cortisol levels, are significantly correlated with changes in immune status, as measured by changes in levels of neutrophils, and the cytokines Interleukin-one beta (IL-1b), Tumor necrosis factor-alpha (TNF-a), and Interferon-gamma (IFN-g), in newborns surrounding circumcision. The relationship among PIPP scores and changes in cortisol levels was also investigated. The study was conducted with a convenience sample of 32 healthy male newborns in a large perinatal center in the Midwest. Each subject served as his own control. Blood and saliva samples were collected before and after circumcision; cytokine and cortisol levels were determined by ELISA assays and neutrophil counts were determined by microscopic examination using a modified Wright&rsquo;s stain. The findings of this study supported the theory of PNI with significant relationships found among the central nervous system, the endocrine system, and the immune system of newborn infants. The pain and stress of circumcision appeared to impact the percentage of neutrophils and the proportion of immature to total neutrophils seen in the circulation of newborns after the procedure. The mean PIPP score during circumcision had a significant negative correlation with percentage of neutrophils after circumcision (rho = -.46, p = .008). Thus, the higher the PIPP score, the more pain felt by the infant and the lower the neutrophil percentage was after circumcision. Stress also was related to immune status as the level of cortisol before circumcision was significantly correlated with the change in neutrophils seen in circulation surrounding circumcision (r = .60, p = .007). Cytokines IL-1b and TNF-a also appeared to influence these findings, with significant associations demonstrated despite a small sample size, assay limitations, and individual variability among the subjects. Since pain appears to be related to the immune status in infants, this knowledge will be of interest to those who care for newborns and those who study the development of the immune and nervous systems. The findings of this study advance the understanding of the immune system of newborn, and are essential in order to enhance the development of immunocompetence in this vulnerable population through pain prevention. Further research is needed to replicate these findings and to further explore the influence of pain and stress upon the immune system of infants.</td></tr></table>en_GB
dc.date.available2011-10-26T09:43:22Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:43:22Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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