Pediatricians’ focus of sight at pain assessment during a neonatal heel puncture

Silva, Erica Souza; Barros, Marina Carvalho de Moraes; Borten, Julia Baptista Lopes; Carlini, Lucas Pereira; Balda, Rita de Cássia Xavier; Orsi, Rafael Nobre; Heiderich, Tatiany Marcondes; Thomaz, Carlos Eduardo; Guinsburg, Ruth

doi:10.1590/1984-0462/2024/42/2023089

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Brasil

Revista Paulista de Pediatria

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ORIGINAL ARTICLE • Rev. paul. pediatr. 42 • 2024 • https://doi.org/10.1590/1984-0462/2024/42/2023089 copy

Pediatricians’ focus of sight at pain assessment during a neonatal heel puncture

Foco do olhar do pediatra na avaliação da dor neonatal durante uma punção de calcanhar

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the focus of pediatricians’ gaze during the heel prick of neonates.

Methods:

Prospective study in which pediatricians wearing eye tracker glasses evaluated neonatal pain before/after a heel prtick. Pediatricians scored the pain they perceived in the neonate in a verbal analogue numerical scale (0=no pain; 10=maximum pain). The outcomes measured were number and time of visual fixations in upper face, lower face, and hands, in two 10-second periods, before (pre) and after the puncture (post). These outcomes were compared between the periods, and according to pediatricians’ pain perception: absent/mild (score: 0–5) and moderate/intense (score: 6–10).

Results:

24 pediatricians (31 years old, 92% female) evaluated 24 neonates. The median score attributed to neonatal pain during the heel prick was 7.0 (Interquartile range: 5–8). Compared to pre-, in the post-periods, more pediatricians fixed their gaze on the lower face (63 vs. 92%; p=0.036) and the number of visual fixations was greater on the lower face (2.0 vs. 5.0; p=0.018). There was no difference in the number and time of visual fixations according to the intensity of pain.

Conclusions:

At bedside, pediatricians change their focus of attention on the neonatal face after a painful procedure, focusing mainly on the lower part of the face.

Keywords:
Infant, newborn; Pain measurement; Facial expression; Eye-tracking technology; Fixation, ocular; Analog pain scale

	Upper face	Lower face	Hands^† * ꭓ2 test; †Hands were not visible in five assessments in the pre-puncture period and in four assessments in the post-puncture period.
Pre-Puncture	21/24 (87.5%)	15/24 (62.5%)	5/19 (26.3%)
Post-Puncture	19/24 (79.2%)	22/24 (91.7%)	8/20 (40.0%)
p-value^* * ꭓ2 test; †Hands were not visible in five assessments in the pre-puncture period and in four assessments in the post-puncture period.	0.701	0.036	0.501

	Upper face	Lower face	Hands
Number of visual fixations
Pre-puncture period	5.50 (2.80–10.30)	2.00 (0.00–6.00)	0.00 (0.00–1.00)
Post-puncture period	7.00 (1.00–10.30)	5.00 (1.80–10.0)	0.00 (0.00–1.30)
p-value^* Data expressed in median (interquartile range). *Wilcoxon-Rank test for related samples	0.493	0.018	0.833
Total time of visual fixations (seconds)
Pre-puncture period	4.30 (1.05–7.55)	1.34 (0.00–4.96)	0.00 (0.00–0.22)
Post-puncture period	3.42 (0.14–5.53)	2.19 (1.28–5.02)	0.00 (0.00–0.23)
p-value^* Data expressed in median (interquartile range). *Wilcoxon-Rank test for related samples	0.121	0.107	0.859

	Upper face	Lower face
Number of visual fixations
Pre-puncture period	7.17±5.72	3.50±4.09
Post-puncture period	7.04±7.40	6.46±5.53
Total time of visual fixations
Pre-puncture period	4.55±3.49	2.76±3.34
Post-puncture period	3.27±3.02	3.52±3.22

	Pain intensity perception		p-value^* Data expressed as median and interquartile range. *Mann-Whitney test.
	Absent/mild (n=9)	Moderate/intense(n=15)
Upper face
Number of visual fixations	1.00 (0.00–10.00)	8.00 (3.00–10.00)	0.423
Total time of visual fixations (seconds)	0.46 (0.00–3.86)	5.18 (0.99–5.56)	0.400
Lower face
Number of visual fixations	10.00 (1.00–10.00)	5.00 (3.50–7.50)	0.675
Total time of visual fixations (seconds)	3.24 (0.16–9.22)	1.98 (1.50–3.70)	1.000
Hands
Number of visual fixations	0.00 (0.00–0.50)	0.00 (0.00–3.00)	0.642
Total time of visual fixations (seconds)	0.00 (0.00–0.09)	0.00 (0.00–0.46)	0.642

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[1] *Corresponding author. E-mail: marinamoraesbarros@uol.com.br (M. C. M. Barros)