Objective: To evaluate the effectiveness of cerebral regional oxygen saturation (crSO) values, measured using near-infrared spectroscopy (NIRS), in assessing pain associated with the peripherally inserted central catheter (PICC) in premature infants.
Methods: NIRS was used to measure the crSO levels of 48 premature infants with gestational age (GA) of < 32 weeks or a birth weight of < 1500 g. Premature infant pain profile (PIPP) scores, vital signs, transcutaneous oxygen tension (TcpO), transcutaneous carbon dioxide tension (TcpCO), and crSO values were monitored. One-way repeated measure analysis of variance was used to compare heart rate (HR), respiratory rate (RR), blood pressure (BP), peripheral oxygen saturation (SpO), TcpO, TcpCO, and crSO values before (Time 1), during (Time 2), and after (Time 3) PICC insertion. The correlation between the PIPP scores at Time 2 and the fluctuations (values detected at Time 2 minus those at Time 1) of SpO TcpO and crSO were also analyzed.
Results: The PIPP score at Time 2 was significantly higher than those at Times 1 and 3. HR, RR, and BP values increased ( < .05), and SpO and crSO levels decreased at Time 2 ( < .05) compared with those at Time 1. Stratified analysis based on GA revealed significant differences in HR, RR, and crSO values between Times 1 and 2 in infants with a GA of ≥ 32 weeks. In infants with a GA < 32 weeks, significant differences were observed in HR, RR, SpO, BP, and crSO values between Times 1 and 2. The fluctuation of the crSO level was strongly correlated with the PIPP score at Time 2 ( = -0.829, < .001). A weak correlation was observed between the PIPP score at Time 2 and TcpO level fluctuation ( = 0.375, = .009). No correlation was observed between the PIPP score at Time 2 and SpO level fluctuation ( = 0.242, = .097).
Conclusion: The fluctuation of crSO levels strongly correlates with PICC procedural pain. Hence, crSO levels measured using NIRS may be used as an indicator for pain assessment in premature infants.
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