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Stress and pain response of neonates after spontaneous birth and vacuum-assisted and cesarean delivery

Published:August 20, 2012DOI:https://doi.org/10.1016/j.ajog.2012.08.024

      Objective

      The objective of the study was to compare the stress response and pain expression of newborns (NBs) in the early postpartum period.

      Study Design

      This was a prospective study with 280 NBs enclosed at 3 Swiss university hospitals. Stress response and pain reaction were analyzed according to the mode of delivery: elective cesarean section (ELCS), spontaneous vaginal delivery, and assisted vaginal delivery by vacuum extraction (VE). Saliva cortisol and clinical pain expression were evaluated after delivery and before and after heel prick for metabolic screening.

      Results

      Significant differences were evident during the first 72 hours postpartum with highest nominations in the VE group. Meconium-stained amniotic fluid was the only intrapartum stress factor with an impact on clinical pain expression.

      Conclusion

      NBs delivered vaginally show a higher incidence of stress response and pain expression than infants of the ELCS group. The long-term impact of these findings remains to be determined.

      Key words

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      References

        • Fletcher A.B.
        Pain in the neonate.
        N Engl J Med. 1987; 317: 1347-1348
        • Anand K.J.
        • Hickey P.R.
        Pain and its effects in the human neonate and fetus.
        N Engl J Med. 1987; 317: 1321-1329
        • Wolf A.R.
        Pain, nociception and the developing infant.
        Paediatr Anaesth. 1999; 9: 7-17
        • Stevens B.
        • Johnston C.
        • Petryshen P.
        • Taddio A.
        Premature Infant Pain Profile: development and initial validation.
        Clin J Pain. 1996; 12: 13-22
        • Grunau R.V.
        • Craig K.D.
        Pain expression in neonates: facial action and cry.
        Pain. 1987; 28: 395-410
        • Glover V.
        • Fisk N.M.
        Fetal pain: implications for research and practice.
        Br J Obstet Gynaecol. 1999; 106: 881-886
        • Cignacco E.
        • Mueller R.
        • Hamers J.P.
        • Gessler P.
        Pain assessment in the neonate using the Bernese Pain Scale for Neonates.
        Early Hum Dev. 2004; 78: 125-131
        • Debillon T.
        • Zupan V.
        • Ravault N.
        • Magny J.F.
        • Dehan M.
        Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants.
        Arch Dis Child Fetal Neonatal Ed. 2001; 85: F36-F41
        • Runefors P.
        • Arnbjörnsson E.
        • Elander G.
        • Michelsson K.
        Newborn infants' cry after heel-prick: analysis with sound spectrogram.
        Acta Paediatr. 2000; 89: 68-72
        • Kapoor A.
        • Dunn E.
        • Kostaki A.
        • Andrews M.H.
        • Matthews S.G.
        Fetal programming of hypothalamo-pituitary-adrenal function: prenatal stress and glucocorticoids.
        J Physiol. 2006; 572: 31-44
        • Henry C.
        • Kabbaj M.
        • Simon H.
        • Le Moal M.
        • Maccari S.
        Prenatal stress increases the hypothalamo-pituitary-adrenal axis response in young and adult rats.
        J Neuroendocrinol. 1994; 6: 341-345
        • Clarke A.S.
        • Wittwer D.J.
        • Abbott D.H.
        • Schneider M.L.
        Long-term effects of prenatal stress on HPA axis activity in juvenile rhesus monkeys.
        Dev Psychobiol. 1994; 27: 257-269
        • Meaney M.J.
        • Szyf M.
        • Seckl J.R.
        Epigenetic mechanisms of perinatal programming of hypothalamic-pituitary-adrenal function and health.
        Trends Mol Med. 2007; 13: 269-277
        • Welberg L.A.
        • Seckl J.R.
        • Holmes M.C.
        Prenatal glucocorticoid programming of brain corticosteroid receptors and corticotrophin-releasing hormone: possible implications for behaviour.
        Neuroscience. 2001; 104: 71-79
        • Gitau R.
        • Menson E.
        • Pickles V.
        • Fisk N.M.
        • Glover V.
        • MacLachlan N.
        Umbilical cortisol levels as an indicator of the fetal stress response to assisted vaginal delivery.
        Eur J Obstet Gynecol Reprod Biol. 2001; 98: 14-17
        • Mears K.
        • McAuliffe F.
        • Grimes H.
        • Morrison J.J.
        Fetal cortisol in relation to labour, intrapartum events and mode of delivery.
        J Obstet Gynaecol. 2004; 24: 129-132
        • Vogl S.E.
        • Worda C.
        • Egarter C.
        • et al.
        Mode of delivery is associated with maternal and fetal endocrine stress response.
        BJOG. 2006; 113: 441-445
        • Miller N.M.
        • Fisk N.M.
        • Modi N.
        • Glover V.
        Stress responses at birth: determinants of cord arterial cortisol and links with cortisol response in infancy.
        BJOG. 2005; 112: 921-926
        • Bird J.A.
        • Spencer J.A.
        • Mould T.
        • Symonds M.E.
        Endocrine and metabolic adaptation following caesarean section or vaginal delivery.
        Arch Dis Child Fetal Neonatal Ed. 1996; 74: F132-F134
        • Taylor A.
        • Fisk N.M.
        • Glover V.
        Mode of delivery and subsequent stress response.
        Lancet. 2000; 355: 120
        • Bergqvist L.L.
        • Katz-Salamon M.
        • Hertegård S.
        • Anand K.J.
        • Lagercrantz H.
        Mode of delivery modulates physiological and behavioral responses to neonatal pain.
        J Perinatol. 2009; 29: 44-50
        • Nelson N.
        • Arbring K.
        • Theodorsson E.
        Neonatal salivary cortisol in response to heelstick: method modifications enable analysis of low concentrations and small sample volumes.
        Scand J Clin Lab Invest. 2001; 61: 287-291
        • Lidow M.S.
        Long-term effects of neonatal pain on nociceptive systems.
        Pain. 2002; 99: 377-383
        • Loizzo A.
        • Loizzo S.
        • Capasso A.
        Neurobiology of pain in children: an overview.
        Open Biochem J. 2009; 3: 18-25
        • Taddio A.
        • Katz J.
        • Ilersich A.L.
        • Koren G.
        Effect of neonatal circumcision on pain response during subsequent routine vaccination.
        Lancet. 1997; 349: 599-603
        • Lewis M.
        • Thomas D.
        Cortisol release in infants in resonse to inoculation Child Dev. 1990; 61: 50-59
        • Owens M.E.
        • Todt E.H.
        Pain in infancy: neonatal reaction to a heel lance.
        Pain. 1984; 20: 77-86
        • Lindsay R.S.
        • Lindsay R.M.
        • Waddell B.J.
        • Seckl J.R.
        Prenatal clucocorticoid exposure leads to offspring hyperglycaemia in the rat: studies with the 11 beta-hydroxysteroid dehydrogenase inhibitor carbenoxolone.
        Diabetologia. 1996; 39: 1299-1305
        • Lindsay RS Lindsay R.M.
        • Edwards C.R.W.
        • Seckl J.R.
        Inhibition of 11 beta-hydroxysteroid dehydrogenase in pregnant rats and the programming of blood pressure in the offspring.
        Hypertension. 1996; 27: 1200-1204
        • Levitt N.S.
        • Lindsay R.S.
        • Holmes M.C.
        • Seckl J.R.
        Dexamethasone in the last week of pregnancy attenuates hippocampal glucocorticoid receptor gene expression and elevates blood pressure in the adult offspring in the rat.
        Neuroendocrinology. 1996; 64: 412-418