Grant: DRA : Canada Graduate Research Scholarship - Doctoral Program (CGRS D)

About 1 in 12 Canadian children are born preterm (<37 weeks gestational age) each year and require specialized care in the Neonatal Intensive Care Unit (NICU). During their hospital stay, these infants undergo an average of 7-17 painful procedures per day. Repeated exposure to pain so early in life can affect brain development and the stress response system, leading to cognitive, behavioural, and emotional difficulties later in childhood. Research suggests that these painful procedures early in life may create a cumulative "burden of pain," where new painful experiences occur before recovery from previous ones, leaving infants in a persistent state of distress. This dissertation will examine how repeated painful experiences shape the way preterm infants' brains respond to pain, and how caregiver stress and the caregiving environment (e.g., being held skin-to-skin versus placed in a cot) influence these responses. The first study will review existing research to clarify how cumulative pain is measured in infancy and its effects on brain activity. The second will test whether the number and severity of painful procedures an infant has experienced predict their brain response to a routine blood test, and whether this varies by gestational age at birth and postnatal age. The third will compare brain responses of infants undergoing a painful procedure in skin-to-skin contact with their caregiver versus in a cot, and assess whether caregiver stress modifies these effects. Data will be collected from preterm infants (24-36 weeks' gestational age) at hospitals in Toronto and London, UK. Given the prevalence of preterm birth and the lasting consequences of early pain exposure, this research will provide critical evidence on the burden of pain in infancy. The findings will inform family-centred pain management strategies in the NICU, supporting healthier development and long-term outcomes for preterm children.