TY - JOUR T1 - Cry presence and amplitude do not reflect cortical processing of painful stimuli in newborns with distinct responses to touch or cold JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed DO - 10.1136/archdischild-2016-312279 SP - fetalneonatal-2016-312279 AU - Nathalie L Maitre AU - Ann R Stark AU - Carrie C McCoy Menser AU - Olena D Chorna AU - Daniel J France AU - Alexandra F Key AU - Ken Wilkens AU - Melissa Moore-Clingenpeel AU - Don M Wilkes AU - Stephen Bruehl Y1 - 2017/05/12 UR - http://fn.bmj.com/content/early/2017/05/12/archdischild-2016-312279.abstract N2 - Objective Newborns requiring hospitalisation frequently undergo painful procedures. Prevention of pain in infants is of prime concern because of adverse associations with physiological and neurological development. However, pain mitigation is currently guided by behavioural observation assessments that have not been validated against direct evidence of pain processing in the brain. The aim of this study was to determine whether cry presence or amplitude is a valid indicator of pain processing in newborns.Design Prospective observational cohort.Setting Newborn nursery.Patients Healthy infants born at >37 weeks and <42 weeks gestation.Interventions We prospectively studied newborn cortical responses to light touch, cold and heel stick, and the amplitude of associated infant vocalisations using our previously published paradigms of time-locked electroencephalogram (EEG) with simultaneous audio recordings.Results Latencies of cortical peak responses to each of the three stimuli type were significantly different from each other. Of 54 infants, 13 (24%), 19 (35%) and 35 (65%) had cries in response to light touch, cold and heel stick, respectively. Cry in response to non-painful stimuli did not predict cry in response to heel stick. All infants with EEG data had measurable pain responses to heel stick, whether they cried or not. There was no association between presence or amplitude of cries and cortical nociceptive amplitudes.Conclusions In newborns with distinct brain responses to light touch, cold and pain, cry presence or amplitude characteristics do not provide adequate behavioural markers of pain signalling in the brain. New bedside assessments of newborn pain may need to be developed using brain-based methodologies as benchmarks in order to provide optimal pain mitigation. ER -