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INTRODUCTION: Children born very preterm display altered pain thresholds. Little is known about neonatal clinical and psychosocial factors associated with their later pain perception.

OBJECTIVE: We aimed to examine whether the number of neonatal invasive procedures, adjusted for other clinical and psychosocial factors, was associated with self-ratings of pain during a blood collection procedure in children born very preterm at school age.

METHODS: 56 children born very preterm (24-32 wk gestational age) at age 7.5 years, followed longitudinally from birth, and free of major neurodevelopmental impairments, underwent a blood collection by venipuncture. The children’s pain was self-reported using the Coloured Analog Scale and Facial Affective Scale. Parents completed the Child Behavior Checklist and State-Trait Anxiety Inventory. Pain exposure (number of invasive procedures) and clinical factors from birth to term-equivalent age were obtained prospectively. Multiple linear regression was used to predict children’s pain self-ratings from neonatal pain exposure after adjusting for neonatal clinical and concurrent psychosocial factors.

RESULTS: Greater number of neonatal invasive procedures and higher parent trait-anxiety were associated with higher pain intensity ratings during venipuncture at age 7.5 years. Fewer surgeries and lower concurrent child externalizing behaviors were associated with higher pain intensity.

In very preterm children, exposure to neonatal pain was related to altered pain self-ratings at school age, independent of other neonatal factors. Neonatal surgeries and concurrent psychosocial factors were also associated with pain ratings.


Valeri, B.O., Ranger, M., Chau, C.M., Cepeda, I.L., Synnes, A., Linhares, M.B. and Grunau, R.E. (2016) Neonatal Invasive Procedures Predict Pain Intensity at School Age in Children Born Very Preterm. The Clinical Journal of Pain. January 18th. .

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