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Developmental Biology - Infant Skin-on-Skin Contact

Parental Touch Reduces Pain Perception in Babies

A newborn baby's brain response to a painful medical jab is reduced by parental touch...


Infants held by a parent in skin-to-skin contact, showed reduced response to a painful needle jab blood test, finds a new study led by researchers at University College Hospitals (UCL), London, England and York University, Toronto, Canada.

Scientists report in the European Journal of Pain that there is more activity in the brain of a newborn baby in reaction to pain when a parent was holding that baby through clothing, than without clothing - or skin to skin.
"We have found when a baby is held by their parent, with skin-on-skin contact, the higher-level brain processing in response to pain is somewhat dampened. The baby's brain is also using a different pathway to process its response to pain.

"While we cannot confirm whether the baby actually feels less pain, our findings reinforce the important role of touch between parents and their newborn babies."


Lorenzo Fabrizi PhD, Department of Neuroscience, Physiology and Pharmacology, University College London, England.

The study involved 27 infants, 0-96 days old, both premature and full term, at University College Hospitals in London, England. Researchers measured each infants' response to a painful but clinically required heel lancing (a blood test). Brain activity was recorded via EEG (electroencephalography) electrodes taped to each newborn's scalp.
Some mothers held their diapered babies skin-to-skin, against mom's bare chest. Other fully clothed babies were also held by their clothed mothers. And some babies simply lay in a cot or incubator, most wrapped in blankets, prior to being lanced.

Researchers found that initial brain responses to lancing pain were the same. But, as heel lancing elicits a series of four to five brain wave responses, later brain waves reflected differences between babies held skin-to-skin or those fully covered.

Joint senior author, Professor Rebecca Pillai Riddell explains: "The slightly delayed response was dampened if there was skin contact with their mother, which suggests that parental touch impacts the brain's higher level processing. The pain might be the same, but how the baby's brain processes and reacts to that pain depends on their contact with a parent.
"Our findings support the notion that holding a newborn baby against your skin is important to their development."

Rebecca Pillai Riddell PhD, Professor, Department of Psychology, York University, Toronto, Canada
Brains of babies that remained in a cot or incubator also reacted less strongly to heel lance pain than fully clothed babies held by their own parents. But, researchers think this may be the result of less disruption to these babies before their procedure. Or, may be the result of sensitive, individualized care each baby received from staff.

Infant behaviour was not significantly different between each group, although the skin-to-skin group did exhibit slightly reduced responses in terms of facial expression and heart rate. Other studies have found skin-to-skin contact with a parent does affect baby behaviour and may reduce how strongly a baby reacts to pain, but those studies did not investigate brain response using EEG.

In the current study, babies' brain responses were not only dampened in the skin-to-skin group, but also followed a different neural pathway.
"Newborn babies' brains have a high degree of plasticity, particularly those born preterm, and their development is highly dependent on interactions with their parents. Our findings may lend new insights into how babies learn to process threats, as they are particularly sensitive to maternal cues."

Laura Jones PhD, University College Hospitals, Departments of Neuroscience, Physiology, Pharmacology, London, England and first author.

"Parents and clinicians have known for many years how important skin to skin care is for babies in NICU. Now we have been able to demonstrate that this has a solid neurophysiological basis, which is an exciting discovery."

Co-author Judith Meek PhD, University College Hospitals, London, England.

Abstract
Background
Neonates display strong behavioural, physiological and cortical responses to tissue-damaging procedures. Parental contact can successfully regulate general behavioural and physiological reactivity of the infant, but it is not known whether it can influence noxious-related activity in the brain. Brain activity is highly dependent upon maternal presence in animal models, and therefore this could be an important contextual factor in human infant pain-related brain activity.

Methods
Global topographic analysis was used to identify the presence and inter-group differences in noxious-related activity in three separate parental contexts. EEG was recorded during a clinically required heel lance in three age and sex-matched groups of neonates (a) while held by a parent in skin-to-skin (n = 9), (b) while held by a parent with clothing (n = 9) or (c) not held at all, but in individualized care (n = 9).

Results
The lance elicited a sequence of 45 event-related potentials (ERPs), including the noxious ERP (nERP), which was smallest for infants held skin-to-skin and largest for infants held with clothing (p=0.016). The nERP was then followed by additional and divergent long-latency ERPs (> 750 ms post-lance), not previously described, in each of the groups, suggesting the engagement of different higher level cortical processes depending on parental contact.

Conclusions
These results show the importance of considering contextual factors in determining infant brain activity and reveal the powerful influence of parental contact upon noxious-related activity across the developing human brain.

Significance
This observational study found that the way in which the neonatal brain processes a noxious stimulus is altered by the type of contact the infant has with their mother. Specifically, being held in skin-to-skin reduces the magnitude of noxious-related cortical activity. This work has also shown that different neural mechanisms are engaged depending on the mother/infant context, suggesting maternal contact can change how a baby's brain processes a noxious stimulus.

Authors
Laura Jones, Maria Pureza Laudiano-Dray, Kimberley Whitehead, Judith Meek, Maria Fitzgerald, Lorenzo Fabrizi and Rebecca Pillai Riddell.

AcknowledgementsScience
This work was funded by the Medical Research Council UK (MR/M006468/1, MR/L019248/1, and MR/S003207/1) and an International Association for the Study of Pain Collaborative Research Grant. The authors have no conflict of interest to declare.

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Sep 30 2020   Fetal Timeline   Maternal Timeline   News



Various studies have found skin-to-skin contact with a parent has a positive affect on infant behaviour. The current study verified results using infant brain EEG testing. CREDIT Public Domain.


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