Neonatal Facial and Cry Responses to Invasive and Non-invasive Procedures

PURPOSE: The evaluation of pain in neonates is difficult due to their limited means of communication. The aim of this study was to determine whether the behavioral reactions of facial action and cry provoked by an invasive pain-induced procedure could be discriminated from the reactions to a noninvasive pain-induced procedure in normal full-term neonates. METHODS: Thirty-six healthy full-term neonates received three pain-induced procedures in counterbalanced order:intramuscular injection, tactile stimulus, and rubbing thigh with alcohol. The facial actions to the pain-induced procedures were measured and analysed by Neonatal Facial Action Coding System (NFACS) and the cry measures were analysed by the speech analysis after recording. RESULTS: 1) A cluster of facial actions comprised of brow bulging, eye squeezing, deepening of nasolabial furrow and open mouth was associated most frequently with the invasive procedure and the total facial action was the highest score in intramuscular injection. 2) Acoustic analysis of cry showed the shortest latency to the first cry and the lonegst duration of the first cry in intramuscular injection. 3) Two variables, total facial action and duration of the first cry, were most statistically significant in discriminating the invasive pain-induced procedure from the noninvasve pain-induced procedure. CONCLUSION: The facial actions and cry responses to the invasive pain-induced procedure were significantly different from the responses to the noninvasive pain-induced procedure in healthy full-term neonates.

A Case of Harlequin Baby

Harlequin baby may represent the extreme form of lamellar ichthyosis or may be a distinct entity. It is inherited as an autosomal recessive trait, but it's cause is unknown, although the abnormalities of keratinization and epidermal lipid metabolism have been suggested. We recently experienced a case of harlequin baby in a male neonate who showed the typical skin appearance at birth. His skin was markedly thickened and cracked, and large horny plates were formed over the entire body. His face was disfigured, and the nose and ear were flattened by the thickened skin. The chemosis and severe ectropion obscured the orbits, and his lips were everted and gaping. The inelastic skin resulted in flexion of all joints, and hands and feet appeared fixed and ischemic. The pathologic findings of skin biopsy were compatible to the lamellar ichthyosis and his family history was nonspecific. We managed the patient with supportive care for his special skin lesion, along with the trial of retinoic acid. However, the treatment was withheld and the baby was discharged against medical advice as the parents wised, and the baby died 5 days after discharge.