This application concerns two related topics. One deals with identifying the relative effectiveness of soothing interventions for infants who need to undergo painful but medically necessitated procedures. The second is to identify the consequences for the infant of repeated administration of painful medical procedures. In order to achieve the first aim, of comparing the effectiveness of interventions for comforting infants during procedural pain, an experimental study is proposed with four conditions: Group A (Pacifier and Touch), Group B (Pacifier and Swaddling), Group C (Pacifier and Sucrose), and Group D (no treatment control). The prediction is that infants given each intervention will react less to the painful heelstick and soothe more quickly after it, than will infants given the normal no-treatment hospital condition. To achieve the second aim, of studying the effects of repeated stressful stimulation, a population of newborn infants at risk for infection and receiving multiple heelsticks (six within the first 24 hours) will be studied. Two predictions are made: 1) Group A infants receiving multiple heelsticks) will respond more intensely at 24 hours of age to the neonatal screening heelstick, and take longer to calm down spontaneously after the heelstick, than will group B (infants of the same age who are given their first or second heelstick); 2) Group A infants receiving multiple heelsticks will be less socially reactive, as measured by the orientation items of the Brazelton Newborn Assessment Scale (1973) than Group B. Intensity of response will be measured by higher levels of HR and vocalization, and reduced frequency of quiet-alert state. These studies are designed to provide the beginnings of a systematic data base on behavioral interventions effective in reducing procedural pain in infants. The research also has implications for alleviating stress in groups of chronically ill infants hospitalized for AIDS, crack addiction, or other conditions that subject the infant to repeated procedural pain. The proposed research will also provide pilot data for a more systematic investigation of combinations of non-pharmacological interventions for other types of procedural pain in infants.
