Jiale Hu1, Shokoufeh Modanloo1, Janet Squires1, JoAnn Harrold1, Denise Harrison1
1) Canada
Sick infants in hospitals undergo large numbers of painful procedures, making early assessment and treatment of acute pain in infants critical. However, there is no gold standard for assessing pain in infants. Moreover, using behavioral indicators and vital signs in clinical practice for critically ill infants, especially those who are receiving neuromuscular relaxants and deep sedation, is challenging. Skin conductance (SC) is one of the physiological approaches to measuring pain. SC represents sympathetic nerve activity, measuring the electrodermal activity at an infant’s plantar region. The objective of this study was to conduct a scoping review on SC for assessing acute pain in infants.
Arksey and O’Malley’s five-stage framework for scoping reviews was followed. The following databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO. ProQuest Dissertation & Theses Global and different clinical trials registry platforms were also searched. Key words used were “pain*, nocicept*, stress*; cutaneous, skin, electrodermal, galvanic; conduct*, response*, resistan*”. Included studies are primary studies of full-term or pre-term infants and SC for measuring acute pain.
5718 records were screened, 529 full text papers assessed and 18 studies included and analyzed. Sixteen analyzed correlations with behavioral pain indicators. The most commonly studied clinical settings were spontaneously breathing infants in neonatal intensive care units (NICU) (9 articles). No study tested sensitivity, specificity, positive/negative predictive value or other diagnostic test accuracy of SC in ventilated infants. One study indicated that neuromuscular blockers blocked SC activity during intubation in preterm infants. Studies were eligible if published in English.
Further studies evaluating the validity of SC for measuring acute pain in ventilated infants in the NICU are warranted. In particular, studies exploring the effect of SC in relation to neuromuscular blockers, especially in preterm infants are needed.
We acknowledge Ontario Trillium Scholarship for supporting Hu’s Ph.D. study at University of Ottawa.
