NEOTHERM is a multicenter, prospective, observational pilot study examining whether infrared thermal imaging (ITI) can contribute to the assessment of prolonged pain in infants with excessive crying. Thermal measurements of the face and body will be compared with scores obtained using the EDIN behavioral pain and discomfort scale. The study will also examine associations between ITI measures, EDIN scores, and hair cortisol concentrations as a biomarker of prolonged stress, and will describe early motor organization and psychomotor development using General Movements Assessment and Bayley-4. Eighty infants will be enrolled in two comparison groups based on daily crying duration and assessed longitudinally at two standardized visits. The main hypothesis is that ITI will identify cutaneous thermal changes associated with prolonged pain and that these measures will be associated with EDIN scores.
Infants aged 2 to 6 weeks post-term in corrected age at the first assessment.
Born at or after 32 weeks' gestational age.
No known neurological or gastrointestinal disease.
Written informed consent from the holder(s) of parental authority.
Confirmed cerebral lesions identified by ultrasound or magnetic resonance imaging.
Major congenital or chromosomal abnormalities.
Growth faltering.
Birth before 32 weeks' gestational age.
Experimental group: excessive crying duration The study population will comprise 80 infants recruited prospectively from three participating centers. Infants will be enrolled at 2 to 6 weeks post-term in corrected age and reassessed at 10 to 14 weeks post-term in corrected age. Based on the 7-day parental crying diary completed before the first assessment, infants will be classified into two predefined cohorts: an excessive-crying (EC) cohort and a typical-crying (TC) cohort, with 40 infants planned in each cohort. Participants in the TC cohort will be matched to participants in the EC cohort according to corrected age at assessment (±1 week), sex when possible, gestational age at birth (±1 week), feeding modality, and maternal parity.
Cohort
Prospective
Not listed
Association Between Infrared Thermal Imaging Indices and EDIN Total Score
Mean skin temperatures will be extracted from predefined body and facial regions of interest. Infrared thermal imaging indices will include absolute bilateral body temperature differences, central-to-peripheral temperature gradients, and intra-facial temperature gradients calculated relative to the forehead. An absolute temperature difference greater than 0.5°C will be considered an abnormal thermal asymmetry. The EDIN is a behavioral scale assessing facial expression, body movements, sleep, interaction, and consolability. Each item is scored from 0 to 3. Higher scores indicate greater pain- or discomfort-related behaviors; a total score of 5 or higher indicates probable prolonged pain. Concordance between infrared thermal imaging indices and EDIN total scores will be quantified using Spearman rank correlation coefficients at each assessment. Thermal images will be analyzed by an external assessor blinded to the EDIN score and cohort classification.
Associations Between Hair Cortisol Concentration, Infrared Thermal Imaging Indices, and EDIN Total Score
Hair cortisol concentration will be measured in pg/mg of hair from a small sample collected from the occipital region. Cortisol will be quantified using high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-MS/MS). Hair cortisol concentration will be investigated as a biomarker of prolonged stress. Spearman correlation coefficients will be calculated between hair cortisol concentration, infrared thermal imaging indices, and EDIN total scores
General Movements Assessment Scores and Motor Patterns
Spontaneous general movements will be recorded with the infant lying supine, wearing only a diaper or onesie, during 2 to 5 minutes of active wakefulness without crying, interaction, a pacifier, or hiccups. Recordings will be independently evaluated by two assessors trained in General Movements Assessment and blinded to cohort classification, EDIN scores, and infrared thermal imaging results. The General Movement Optimality Score-Revised (GMOS-R; maximum score 38) will be used at Visit 1. The Motor Optimality Score- Revised (MOS-R) will be used at Visit 2; scores of 25 to 28 are considered optimal, whereas lower scores indicate less optimal motor organization. Qualitative motor characteristics, including movement quality, variability, fluency, symmetry, posture, and atypical movement patterns, will also be described and compared between cohorts.
Psychomotor Development Assessed Using the Bayley Scales of Infant and Toddler Development, Fourth Edition
Psychomotor development will be assessed using the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4). Five subtests will be administered: cognitive development, receptive communication, expressive communication, fine motor development, and gross motor development. Raw subtest scores will be converted to scalar and composite scores using the normative tables of the Bayley-4. Higher scores indicate better performance in the assessed developmental domain. Scores will be compared between the EC and TC cohorts. Scoring will be performed by an assessor blinded to cohort classification.
Associations Between Early Motor Organization and Prolonged Pain or Stress Indicators
Associations between General Movements characteristics, GMOS-R or MOS scores, Bayley-4 scores, infrared thermal imaging indices, EDIN total scores, and hair cortisol concentrations will be examined using Spearman correlations and exploratory regression analyses.
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Centre Hospitalier de Saint-Denis
Lead sponsor
Ecole Pratique des Hautes Etudes
Collaborator
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