• Neta Maimon, Ruth E Grunau, Ivan L Cepeda, Michael Friger, Leonel Selnovik, Shlomo Gilat, and Eilon Shany.
• *Faculty of Health Sciences §Epidemiology Department, Ben Gurion University of the Negev ∥Soroka Medical Center, Beer Sheva, Israel †Pediatrics Department, University of British Columbia ‡Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, BC, Canada ¶Orgil Medical Instruments, Or Akiva, Israel.
• Clin J Pain. 2013 Dec 1;29(12):1044-9.

ObjectivesPreterm infants undergo frequent painful procedures in the neonatal intensive care unit. Electroencephalography (EEG) changes in reaction to invasive procedures have been reported in preterm and full-term neonates. Frontal EEG asymmetry as an index of emotion during tactile stimulation shows inconsistent findings in full-term infants, and has not been examined in the context of pain in preterm infants. Our aim was to examine whether heel lance for blood collection induces changes in right-left frontal asymmetry, suggesting negative emotional response, in preterm neonates at different gestational age (GA) at birth and different duration of stay in the neonatal intensive care unit.Materials And MethodsThree groups of preterm infants were compared: set 1: group 1 (n=24), born and tested at 28 weeks GA; group 2 (n=22), born at 28 weeks GA and tested at 33 weeks; set 2: group 3 (n=25), born and tested at 33 weeks GA. EEG power was calculated for 30-second artifact-free periods, in standard frequency bandwidths, in 3 phases (baseline, up to 5 min after heel lance, 10 min after heel lance).ResultsNo significant differences were found in right-left frontal asymmetry, or in ipsilateral or contralateral somatosensory response, across phases. In contrast, the Behavioral Indicators of Infant Pain scores changed across phase (P<0.0001). Infants in group 1 showed lower Behavioral Indicators of Infant Pain scores (P=0.039).DiscussionThere are technical challenges in recording EEG during procedures, as pain induces motor movements. More research is needed to determine the most sensitive approach to measure EEG signals within the context of pain in infancy.

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