Modern-Day Crystal Ball Could Revolutionize Neonatal Care

    • April 4, 2013

In the eyes of many Americans, neonatologists are real-world superheroes. There is good reason for that view; every day, they save the lives of babies who would not otherwise survive.

But there is a dark side to the miracle of modern-day neonatal care. For some premature infants, neonatal care can involve intense, sometimes untreated pain. Pushed too soon into an alien world, preemies are pricked, prodded and probed throughout their first weeks or months of life. The bright, cold and dry hospital environment can overwhelm their underdeveloped sensory capacities and, making matters worse, they can’t express themselves.

But hope is on the horizon, thanks to Martin Schiavenato, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar who has invented a revolutionary machine to assess pain in premature infants and potentially protect them from its negative developmental effects.

“Technology is advancing to the point that we’re saving infants at much younger gestational ages,” says Schiavenato, a former Army medic who is now an assistant professor at the University of Miami School of Nursing and Health Studies. “But in order to do that, we’re exposing them to a tremendous number of invasive procedures. We know that this changes developing infants in profound ways.”

To better understand, assess, and treat this pain and protect infants from its harmful effects, Schiavenato has invented a tool that translates behavioral and physiological signs of pain in infants—such as body gestures and physiological signals like heart rate metrics—into a “real time” visual display of pain levels. The tool’s display is a glass orb that changes color depending on the subject’s pain levels. It will give clinicians immediate, objective readouts of infant pain.

It is, in essence, a modern-day crystal ball. And it may revolutionize the way health care providers care for premature infants and others who cannot articulate pain and discomfort, such as full-term babies, young children, critically ill adults, and those with dementia.

Such a device would have been unimaginable just a few decades ago. For years, conventional wisdom held that infants were not able to experience pain because of their immature neurological systems. Consequently, clinicians routinely performed procedures on newborns, including operations as intensive as open-heart surgery, without anesthesia or other pain medication. Even today, some health care providers do not provide adequate pain relief for routine painful procedures like circumcision.

But studies show that infants do in fact experience pain, Schiavenato says. And untreated pain has potentially profound implications for babies, and for premature infants in particular, whose brains and bodies are not fully developed, he adds. The average premature infant undergoes 12 painful procedures in his or her first 13 days of life. Many undergo hundreds over their first several months—a critical period of cognitive growth, Schiavenato says.

“The premature infant is developing rapidly during those first few weeks of life after birth. Their brains are still being constructed, and any and all offenses that they suffer to their nervous systems have the potential to have negative effects, and sometimes tremendous negative effects, such as lifelong disabilities like hyper- or hypo-sensitivity to pain, and possibly contributions to cerebral palsy, mental retardation, and other profound lifelong disabilities.”

Clinicians are often reluctant to treat pain in preemies because it is difficult to finely assess, Schiavenato says. Over-treating infant pain, meanwhile, carries its own set of risks: Many pain medications are derived from opium—the base ingredient in morphine and heroin—and are potentially harmful and even lethal to premature infants.

"We’re treating premature infant pain with a blindfold on."

“The way it is now, we’re treating premature infant pain with a blindfold on,” Schiavenato says. “We need to be able to assess their degree of pain. If we can keep track of that, then we can better adjust opioid dosages so as to treat pain safely in a way that will prevent long-term, profound, lifelong ailments that follow the experience of pain after birth.”

A Searing Early Experience

Schiavenato developed a passion for infant care in 1992 while working as a nurse in a neonatal intensive care unit in Tallahassee, Fla. He was caring for a full-term baby who had a rare—and extremely painful—genetic disease that caused her skin to blister and slough off. The baby died several days after birth from a massive infection, and the tragedy left an indelible impression on him. “It was just terrible,” Schiavenato recalls. “It seared me. When it came time for me to pick a specialty, I decided to work to help alleviate pain in infants.”

After earning his masters at Florida State University, Schiavenato pursued a PhD in nursing and innovative technologies at the University of Central Florida. He joined the faculty at the University of Rochester in New York, where he tried to identify “the primal face of pain”—the universal expressions of pain among all people of all ages. He used his findings to develop a more sophisticated scale that enables providers to better assess pain in preschool-aged children.

In 2009, Schiavenato was awarded an RWJF Nurse Faculty Scholars award to support the invention of a new medical tool to assess pain in premature infants. A self-described “Trekkie,” he likens his invention to the tricorder, a kind of “magic iPhone” used in Star Trek to diagnose patients and collect physiological data. “You pass it over patients and it lights up and tells you what’s wrong with them,” he says.

In Schiavenato’s real-life version of the tricorder, a computer receives data from a node placed over a subject’s heart that measures heart-rate variability in response to stress. Another sensor in the palm of the hand records an instinctive finger-splaying response to pain; a third sensor monitors facial grimacing for key facial expressions signaling pain. The computer then calculates the subject’s pain levels and displays the findings on a glass orb that turns various colors to reflect premature infant pain levels.

Schiavenato has demonstrated the effectiveness of the machine among adult students in a laboratory setting and is now researching ways to perfect its use among premature infants. To understand how to do that, he and his colleagues studied infant responses to stimuli such as eating, sleeping, diaper changes, and injections. They are now analyzing data to ensure the machine accurately reads infant pain levels, which differ not only from adult pain but from the pain experienced by infants of different gestational ages.

In the meantime, Schiavenato, along with the University of Rochester, has filed for a patent for his orb. He is presenting his research to stakeholders, and exploring when and how to bring the machine to market. That may be a long time off, but if and when the machine becomes available, the blindfold will come off the teams treating premature infants, and those who benefit from Schiavenato’s work may one day grow up to thank him.

Learn more about the RWJF Nurse Faculty Scholars program.
For an overview of RWJF scholar and fellow opportunities, visit