الفهرس 
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Abstract
Infants in NICU are exposed to a series of repeated, randomly occurring invasive investigations and treatments resulting in acute or chronic pain and prolonged stress. This pain and stress occurs during a critical period of brain growth predisposing to the development of significant clinical, physiologic and psychologic sequelae.
There is now evidence that neonates not only respond to painful stimuli, but may be even more sensitive to these stimuli than adults and vulnerable to long term effects.
Although there are many measures available to assist clinicians and researchers in assessing pain, emphasis is on the health care provider to choose the “best” measure for his/her infant patient. A multidimensional or composite pain measure seems to offer the most comprehensive assessment of infant pain.
The present study aimed to assess pain in the newborns after two painful procedures (endotracheal intubation and umbilical vein catheterization) using multidimensional measurements (physiological, behavioral and hormonal) and to apply the clinical usefulness of the existing pain measures and find out the simplest and reliable measure.
This study was conducted on seventy five preterm and term newborns of both sexes. The population of the study was classified into 3 groups: group A (N=30) which included newborns with respiratory distress who needed intubation and mechanical ventilation, group B (N=15) which included newborns with indirect hyperbilirubinemia that reached a level that necessitated insertion of umbilical vein catheterization and exchange transfusion and group C (N=30) which included healthy newborns of matched age and sex that were taken as a control group.
Neonates included in the study were subjected to detailed history taking including maternal & obstetric history, perinatal history and thorough clinical examination with special emphasis on Ballard score to determine gestational age. Close observation prior to and 10 minutes after performing the painful procedures for recording of: heart rate (HR), respiratory rate (RR), blood pressure (BP), oxygen saturation (SaO2), palmar sweating, facial responses (grimace, brow bulge, eye squeeze, nasolabial furrows, and mouth opening), limb and body movements and crying.
Plasma renin activity (PRA) was measured by radioimmunoassay randomly to group C (control group) and it was measured 10 minutes after the painful procedures (intubation for group A and umbilical vein catheterization for group B).
Regarding group A There was statistical significant increase of HR, MAP, SaO2 and PRA and significant decline of RR after intubation.
There was significant increase of HR, RR, MAP, SaO2 and PRA in post-intubated patients when compared to control group. Also there was statistical significant difference as regard post-intubation palmar sweating, grimace, brow bulge, eye squeeze, nasolabial furrows, mouth opening, body movements and crying.
As regard group B there was no statistical significant difference of HR, RR, MAP and SaO2 after catheterization. however, there was significant increase of PRA after umbilical vein catheterization.
There was significant increase of HR, RR, MAP, SaO2 and PRA in post-catheterization patients when compared to control group. Also there was statistically significant difference as regard post-catheterization palmar sweating, grimace, brow bulge, eye squeeze, nasolabial furrows, mouth opening, body movements and crying.
We found a statistical significant positive correlation between post-intubation PRA and MAP
Plasma rennin activity was found to be the single indicator of pain in group A (after exclusion of RR, SaO2 and crying). On the other hand, we did not find any reliable indicator of pain group B