[Rebecca Slater:] One of the most special memories I have
of doing research with children in neonatal intensive care
was looking at a baby who was in an incubator
and her mum was next to me
and I was touching the baby's foot
and every time I touched the foot,
we could see a little pattern of activity in the brain.
The mum said to me, "can I touch her foot?"
She was quite anxious about the fact
that she couldn't hold her baby in the way she was expected to
yet every time she touched the foot,
she could see that she was having some impact on her child.
A child who's born who requires intensive care
on average will have about 10 painful procedures a day
and given that their hospital stay is often 50 days or more
this is a huge burden in early life.
It's quite incredible, but it used to be thought that babies just don't feel pain
and the idea was that,
although you could see that they were responding
and moving,
that this was merely reflexive
and not to be then processed by the brain.
Oxford has been a really important place for work on pain in children.
Back in 1987, a really important piece of work was done
where children were randomised to be given pain relief during surgery
and in the other group, standard practice was used
where they were mainly given muscle relaxants.
The children who were given the pain relief
had better outcome measures after the surgery.
This really changed clinical practice
because it was then considered unacceptable
not to give them appropriate pain relief during surgery.
Now the Department of Paediatrics has made a priority
to look at Neuroscience during development.
[Fiona Moultrie:] The only tools that exist at the moment look at facial expression.
Anyone who's got a child can see that
they pull very much the same facial expressions for pain,
for 'I'm hungry', for 'I'm wet'
for all the things that they do.
[Rebecca Slater:] One of the options that we have
is to look at what's happening in their brain.
We've used a number of techniques.
One is called EEG,
where you can put some electrodes over the surface of the baby's head
and see whether there are any particular patterns of activity
that only occur when you do something painful.
We've also started to use an MRI scanner
and you can look at the whole network of activity following pain.
FMRI has been used to understand pain in many, many different studies
but it's never been used in babies.
[Rachel:] What they used on Amy today was one of these punctate stimuli.
As you can see it really doesn't hurt.
It looks like a little pin.
but it just bounces back inside the tube.
[ Fiona Moultrie:] I want to know that I'm able to give the appropriate drug
and know what effect that drug is having on the baby.
The number of clinical trials that have been done
in the neonatal population
is very small and mostly based on facial expression.
So until now there was no way of knowing
exactly what was going on in the nervous system,
whether we're having an appropriate effect.
It's very important to treat pain in this population
because they're a vulnerable population
which we want to have as little impact on as possible,
so they develop as normally as possible.
[Rachel:] Not many people get a chance to look inside their baby's head that early on
so I'm really pleased that we got the opportunity.