Looking at neonatal facial features of pain: do health and non-health professionals differ?

OBJECTIVE: To analyze the regions that trigger the attention of adults' gaze when assessing pain in newborn infants' pictures and to verify if there are differences between health and non-health professionals. METHOD: Experimental study with 84 health professionals and 59 non-health professionals, who evaluated two images of 10 neonates, one at rest and the other during a painful procedure. Each image was shown for 7 seconds on a computer screen, while eye movements were tracked by the Tobii TX300 EyeTracker. After evaluating each image, participants gave a score from 0 (absent pain) to 10 (maximum pain), according to their perception of neonatal pain. For each image, the number and total time of gaze fixations in the forehead, eyes, nasolabial furrow, and mouth were studied. Comparisons between both groups of adults were made by an intraclass correlation coefficient, Student's t-test, and Bland Altman graphic. RESULTS: Health professionals (93% female; 34 ± 9 years old), compared to non-health professionals (64% female; 35 ± 11 years old), gave lower scores for images at rest (0.81 ± 0.50 vs. 1.59 ± 0.76; p = 0.010), with no difference for those obtained during the painful procedure (6.98 ± 1.08 vs. 6.73 ± 0.82). There was a strong or almost perfect correlation for the number of fixations in the mouth, eyes, forehead, and for the total fixation time in the eyes and forehead. CONCLUSIONS: Adults, irrespective of their profession, showed a homogeneous gaze pattern when evaluating pictures of neonates at rest or during a painful procedures.

Identification of pain in neonates: the adults' visual perception of neonatal facial features.

OBJECTIVE: To verify the visual attention of adults when assessing neonatal pain. STUDY DESIGN: 143 adults (59% health professionals) evaluated 20 pictures (2 pictures of 10 neonates' faces: at rest; during a painful procedure). Tobii-TX300 tracked the participants' eyes movement. For each picture, adults scored pain intensity (0 = no pain; 10 = maximum). Latent classes analysis was applied by cognitive diagnosis models-GDINA with two attributes (knowledge of pain presence/absence). Variables associated with belonging to the class of adults that correctly identified pictures of newborns with/without pain were identified by logistic regression. RESULTS: To identify neonatal pain, adults look at the mouth, eyes, and forehead in facial pictures. The latent class analysis identified four classes of adults: those that identify painful/painless neonates (YY-Class; n = 80); only painful neonates (n = 28); only painless neonates (n = 34) and none (n = 1). Being a health professional (OR: 2.29; 95% CI: 1.16-4.51), and each look at the nasolabial furrow (2.07; 1.19-3.62) increased the chance of belonging to the YY-class. CONCLUSIONS: Being a health professional and the visual fixation at the nasolabial furrow helped to identify the presence/absence of neonatal pain.