Premature babies can feel pain, scans show

Premature babies experience real pain rather than just displaying reflex reactions, scientists said yesterday.

Brain scans carried out on premature babies during blood tests showed surges of blood and oxygen in the sensory areas of their brains - demonstrating that pain was being processed.

Previous research had shown that even the youngest newborns are capable of showing the behavioural signs of pain but it had been unclear whether these were simply bodily reflexes.

Prof Maria Fitzgerald, from the department of anatomy and developmental biology at University College London, who led the team, said: "We have shown for the first time that the information about pain reaches the brain in premature babies.

"While previous research shows that even the youngest newborn infants are capable of displaying behavioural, physiological and metabolic signs of pain and distress, the measures are all indirect and could be dismissed as bodily reflex reactions rather than measures of true pain.

"These babies' brains are so immature it was difficult to genuinely know that the pain was going to their brain."

Prof Fitzgerald said that there was a "lack of basic information" about dealing with pain in premature babies and she hoped the research would lead to better control of pain in premature baby units.

"Nursing staff are not callous in dealing with these babies, but now we know for sure that pain information goes to the brain.

"As a result, while considerable effort is made to provide clinical pain control in babies undergoing invasive procedures, this remains suboptimal in many units."

The study, published in The Journal of Neuroscience, involved scans on 18 babies born at between 24 weeks and 37 weeks in the neonatal unit at the Elizabeth Garrett Anderson and Obstetric Hospital in west London.

The scientists registered the brain activity in the premature babies before, during and after nurses performed blood tests using a heel lance.

This showed surges of blood and oxygen in the somatosensory cortex, the part of the brain that processes sensations from the body's surface and is known to be linked to feelings of pain in adults.

Britain has the highest rate of low birth-weight babies in Western Europe, with about 12 per cent of all babies needing some special care at birth and about 2.5 per cent needing neonatal intensive care - some 17,000 babies per year.

Babies in intensive care undergo an average of 14 procedures per day, many of which are considered by clinical staff to be painful, such as inserting chest tubes.

The research also suggested that babies "remember" the painful experience and this could lead to an increased sensitivity to other, non-painful, procedures.

Prof Fitzgerald added: "Since pain information is transmitted to the pre-term infant cortex from 25 weeks, there is the potential for pain experience to influence brain development from a very early age as the brain is highly malleable at this stage."

A spokesman for Bliss, a premature baby charity, said the findings confirmed the need for a pain protocol for premature babies. "Only 20 per cent of neonatal units in the UK regularly use a pain tool to assess chronic pain," said the spokesman.

"We strongly believe there is no justification for babies to be in pain and that more attention should be paid to providing comfort and relief when painful procedures are undertaken whilst they are in neonatal care."

If you haven't seen this account you may enjoy reading it: Smell Of Rain: The story of Danae comforted on God's chest

A cold March wind danced around the dead of night in Dallas as the Doctor walked into the small hospital room of Diana Blessing. Still groggy from surgery, her husband David held her hand as they braced themselves for the latest news. That afternoon of March 10, 1991, complications had forced Diana, only 24-weeks pregnant, to undergo an emergency cesarean to deliver the couple's new daughter, Danae Lu Blessing.

At 12 inches long and weighing only one pound and nine ounces, they already knew she was perilously premature. Still, the doctor's soft words dropped like bombs. 'I don't think she's going to make it', he said, as kindly as he could. "There's only a 10-percent chance she will live through the night, and even then, if by some slim chance she does make it, her future could be a very cruel one".

Numb with disbelief, David and Diana listened as the doctor described the devastating problems Danae would likely face if she survived. She would never walk, she would never talk, she would probably be blind, and she would certainly be prone to other catastrophic conditions from cerebral palsy to complete mental retardation, and on and on.

"No! No!" was all Diana could say. She and David, with their 5-year-old son Dustin, had long dreamed of the day they would have a daughter to become a family of four. Now, within a matter of hours, that dream was slipping away.

Through the dark hours of morning as Danae held onto life by the thinnest thread, Diana slipped in and out of sleep, growing more and more determined that their tiny daughter would live-and live to be a healthy, happy young girl. But David, fully awake and listening to additional dire details of their daughter's chances of ever leaving the hospital alive, much less healthy, knew he must confront his wife with the inevitable.

David walked in and said that we needed to talk about making funeral arrangements. Diana remembers 'I felt so bad for him because he was doing everything, trying to include me in what was going on, but I just wouldn't listen, I couldn't listen.' I said, "No, that is not going to happen, no way! I don't care what the doctors say; Danae is not going to die! One day she will be just fine, and she will be coming home with us!" As if willed to live by Diana's determination, Danae clung to life hour after hour, with the help of every medical machine and marvel her miniature body could endure.

But as those first days passed, a new agony set in for David and Diana. Because Danae's underdeveloped nervous system was essentially 'raw,' the lightest kiss or caress only intensified her discomfort, so they couldn't even cradle their tiny baby girl against their chests to offer the strength of their love. All they could do, as Danae struggled alone beneath the ultraviolet light in the tangle of tubes and wires, was to pray that God would stay close to their precious little girl. There was never a moment when Danae suddenly grew stronger. But as the weeks went by, she did slowly gain an ounce of weight here and an ounce of strength there.

At last, when Danae turned two months old, her parents were able to hold her in their arms for the very first time. And two months later, though doctors continued to gently but grimly warn that her chances of surviving, much less living any kind of normal life, were next to zero, Danae went home from the hospital--just as her mother had predicted.

Today, five years later, Danae is a petite but feisty young girl with glittering gray eyes and an unquenchable zest for life. She shows no signs, what so ever, of any mental or physical impairment. Simply, she is everything a little girl can be and more-but that happy ending is far from the end of her story.

One blistering afternoon in the summer of 1996 near her home in Irving, Texas, Danae was sitting in her mother's lap in the bleachers of a local ballpark where her brother Dustin's baseball team was practicing.

As always, Danae was chattering nonstop with her mother and several other adults sitting nearby when she suddenly fell silent. Hugging her arms across her chest, Danae asked, "Do you smell that?"

Smelling the air and detecting the approach of a thunderstorm, Diana replied, "Yes, it smells like rain."

Danae closed her eyes and again asked, "Do you smell that?"

Once again, her mother replied, "Yes, I think we're about to get wet, it smells like rain.

Still caught in the moment, Danae shook her head, patted her thin shoulders with her small hands and loudly announced, "No, it smells like Him. It smells like God when you lay your head on His chest."

Tears blurred Diana's eyes as Danae then happily hopped down to play with the other children. Before the rains came, her daughter's words confirmed what Diana and all the members of the extended Blessing family had known, at least in their hearts, all along. During those long days and nights of her first two months of her life, when her nerves were too sensitive for them to touch her, God was holding Danae on His chest and it is His loving scent that she remembers so well.

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