• Developmental Care Program
• Assessing and treating stress and pain responses in preterm infants in the neonatal intensive care nursery

The Developmental Care Program centers on finding ways to accurately assess and effectively treat stress and pain responses in preterm infants in the Neonatal Intensive Care Unit. We are conducting a comprehensive program of research that includes studies which are descriptive, mechanistic and interventionist; outcome measures ranging from cellular to behavioural levels; and mothers, fathers and infants born from the earliest gestational ages to term.

Feeding analgesia studies
Converging evidence from animal and preterm infant studies suggests that chronic exposure to pain may alter brain development. Preterm infants are at risk for enhanced pain sensitivity because their developing nervous systems differ from those of adults. Currently, caregivers of preterm infants lack pain treatments that are effective and that are free from adverse effects. In term born infants, breast-feeding reduces biobehavioural pain responses by 80-90%, effects that are opioid and non-opioid mediated. Breast-feeding analgesia has not been studied in preterm infants. In our first multicenter randomized trial, we are comparing the effects of mothers' breast-feeding with the effects of non-nutritive sucking on preterm infant biobehavioural responses during and immediately after acute procedural pain. In our second study, we will evaluate the analgesic effects of a simulated model of breastfeeding for preterm infants not mature enough to breastfeed.

Fathers of preterm infants
Few studies describe the unique experiences of fathers whose infants are admitted to the Special Care Nursery. Following a qualitative study examining fathers’ experiences, we have developed a support scale for fathers. Now, in collaboration with neonatologists and others in nurseries in BC and in Nova Scotia, we are establishing the psychometric properties this scale.

The impact of procedural stress in infants born extremely preterm
Infants born extremely preterm are at risk for altered cortisol production which can lead to acute and chronic disease states (e.g. adrenal insufficiency and bronchopulmonary dysplasia).  Little is known about how routine procedures, such as suctioning, affect cortisol levels and inflammation in these infants.  In set of studies we are describing cortisol, immune, and behavioral responses to endotracheal suctioning in infants born < 31 weeks gestational age and examining the interaction between the stress and immune responses to suctioning.  These studies will also establish the validity of the Behavioral Indicators of Infant Pain, our new pain scale, for assessing acute pain responses in very early born infants.

Holsti L, Grunau RE, Oberlander TF, Osiovich H.  Is it painful or not?  Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) Scale. Clin J Pain. 2008;24:83-88.

Sherlock R, Synnes A, Grunau RE, Holsti L, Hubber-Richard P, Johanessen D.  Long term outcome after neonatal intraparenchymal echodensities with porencephaly.  Arch Dis Childhood Fetal/Neonatal Ed.  2008;93:F127-F131.

Arockiasamy V, Holsti L, Albersheim SG.  Fathers’ experiences in response to the stress of the neonatal intensive care unit. Pediatrics. 2008;121:e215-e222

Holsti L, Grunau RE. Initial validation of the Behavioral Indicators of Infant Pain (BIIP). Pain.  2007;132:264-272.

Holsti L, Weinberg J, Whitfield MF, Grunau RE. Relationships between adrenocorticotropic hormone and cortisol are altered in preterm infants born at extremely low gestational age. Early Hum Devel. 2007;83(5):341-348.

Tier 2 Canada Research Chair in Neonatal Health and Development - 2010-2015

Canadian Child Health Clinician Scientist Program Career Award - 2005-2009

BCRICWH Postdoctoral Fellowship - 2004-2005

CIHR/COTF Post Doctoral Fellowship - 2001-2004

Colleen Jantzen, BA - Research Coordinator
Rochelle Stokes, MSc Student - Rehabilitation Sciences
Karen Sauve, MSc Student - Rehabilitation Sciences
Chandra Pham, Research Nurse