As recently as 30 years ago, doctors and scientists questioned whether a baby’s nervous systems was mature enough to generate the experience of pain. Consequently, pain relieving medication was not always given to babies during surgical procedures.
‘There was a historical misconception that babies may not be able to feel pain because their nervous system was immature,’ explains Professor Rebeccah Slater. This practice was challenged in 1987 and now, although widely accepted that premature babies do feel pain, essential medical procedures such as intubation, injections and blood tests, are still often performed in babies without adequate pain medication.Established in 2013 the Paediatric Neuroimaging Group – a multidisciplinary team of 16, led by Professor of Paediatric Neuroimaging, Rebeccah Slater – brings together scientists, clinicians and engineers to further our understanding of early human brain development, specifically in infant pain. The group is based in the Department of Paediatrics at the University of Oxford, and is situated in the Women's Centre in the John Radcliffe Hospital.
The average baby in neonatal intensive care has around 10 medical procedures every day, and up to 50 if born extremely prematurely. Without language it’s difficult to know what causes pain and how medication helps. For example, applying a local anaesthetic cream may reduce pain, but the baby may still cry because they are distressed by the procedure.
Pain manifests in the brain, in adults this is normally associated with changes in cortical brain activity. Assuming this is also true for infants, the group hopes that measuring changes in pain-related brain activity will provide a better understanding of how pain experience develops in babies.
They also measure other behavioural and physiological changes, for example facial grimacing, limb reflex withdrawal and changes in heart and breathing rate. A core goal of the group is understanding the relationship between these different measures and how these responses develop in early life.
Parental bonding is a big concern for these infants who can spend weeks in incubators having regular daily tests. A recent study by the group focussed on gently stroking the babies before a blood test. Professor Slater explains that adults find having their skin stroked at about 3 cm/s is pleasurable and report that it can reduce their pain experience.When Deniz Gursul, a DPhil student in the group, stroked babies at this rate she found that it significantly reduced the amount of pain-related brain activity generated following a blood test. Professor Slater continues ‘better understanding of the neurobiological underpinnings of techniques like infant massage will allow us to improve advice to parents about comforting their babies.’
Engaging with parents goes beyond the neonatal unit for the group. The Wellcome Trust has funded a programme that allows the group the host five public engagement events each year, this covers anything from visiting schools and attending science festivals to presenting talks to lay audiences, specialist interest groups or parents with premature babies.
The team members also work with artists to create animations, brain models and graphical images to showcase their work to different audiences. They recently created a mother and child sculpture that shows the different parts of the brain that are activated when a child feels pain – and how an adult differs.
“The work carried out by the group is directly translational, the staff and students have a massive range of different skills and the team work together extremely closely. Every single person in the group is so dedicated and motivated because they care so much about the questions they are asking.”
The concept of teamwork goes further than this research team; support from charitable foundations, such as BLISS and the Wellcome Trust, creating a cohesive environment with the doctors and nurses in the hospital and making parents an integral part of their studies has provided a sturdy base for the group, which in turn has helped them to measure the pain-related brain activity in infants and to use these measures in clinical trials – ultimately helping to soothe pain for future generations of babies.
Find out more about the group at https://neuroimaging.paediatrics.ox.ac.uk/
Read the Hilary Term issue of Blueprint