Cortical pain responses in human infants. (360G-Wellcome-090245_Z_09_Z)

We propose to investigate the development and plasticity of pain processing in the infant human brain. Cortical pain activity in will be measured using nociceptive event related potentials (nERPs) triggered by routine heel lances and other clinically required noxious stimuli. The studies will be performed in preterm infants in intensive care (aged 25-45 postmenstrual weeks) and older infants (aged 3-18 months) in hospital clinics. First we will perform parallel recordings of nERPs and other c urrent physiological pain measures (cortical haemodynamic signals, spinal reflex EMGs and facial expression scores) to establish the accuracy and reliability of nERPs as a measure of infant pain. We will then study the developmental profile of nERPs and test whether they undergo distinct changes in morphology and topography from 25 weeks onwards, consistent with underlying cortical maturation. We also will test whether nERPs can be used more widely to measure pain evoked by other skin-breakin g clinical procedures, such as venepuncture, and in older infants returning to clinic for innoculation. Finally we will test whether nERPs can be used to explore differences in pain processing in children that have experienced repeated intensive care procedures. The results will directly improve pain control in vulnerable paediatric populations.