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Venipuncture activates the cerebral cortex in children with intellectual disability
  1. Stefano Bembich1,
  2. Giuliana Morabito2,
  3. Valentina Simeon2,
  4. Tamara Strajn1,
  5. Rosaria Rutigliano1,
  6. Paola Di Rocco1,
  7. Gabriele Cont1,
  8. Francesco Maria Risso1,
  9. Francesca Peri2,
  10. Egidio Barbi1,3
  1. 1 IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
  2. 2 Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
  3. 3 Pediatrics, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
  1. Correspondence to Dr Francesca Peri, Pediatrics, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste 34127, Italy; francesca.peri{at}


Objective To evaluate the pattern of cortical activation during a painful procedure, such as a venipuncture, in children with intellectual disability and compare it with that of cognitively healthy children.

Study design and setting A cohort study was conducted and cortical activation was assessed by multichannel cerebral near-infrared spectroscopy to monitor variations in oxyhaemoglobin and deoxyhaemoglobin (Hbb) in children with and without intellectual disability during a venipuncture for blood sampling with topical anaesthesia. Pain and distress were assessed as well using different validated pain scales (visual analogue scale and Non-Communicating Children’s Pain Checklist-Postoperative Version for children with intellectual disability), and compared between groups.

Participants 16 children with severe to profound intellectual disability and 20 cognitively healthy peers (age range: 4–17 years).

Results When Hbb was analysed, children with intellectual disability exhibited a bilateral activation of the somatosensory (p<0.006) and right motor cortex (p=0.0045), whereas cognitively healthy peers never showed a cortical activation. Children with intellectual disability also showed more pain than controls (p=0.001).

Conclusions When subjected to a painful procedure, only children with intellectual disability show an activation of the cerebral cortex, even if topical anaesthesia is applied, and express more pain than cognitively healthy peers. The role of other issues in painful procedures, such as anxiety, fear or physical restraint, deserves further investigation.

  • neurodisability
  • pain
  • procedures

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  • Contributors SB and GM developed the paper proposal, wrote the original study protocol, carried out data analysis and wrote the manuscript. GC, FMR and EB contributed to development of the paper proposal and made edits to the manuscript. VS assisted with data analysis and made edits to the manuscript. PDR, RR and TS contributed to the design and execution of the cohort study and made edits to the manuscript. FP contributed to the interpretation of the findings and wrote the manuscript. EB conceptualised the cohort study and has overseen the conduct of the study since its inception. In addition, SB provided feedback on previous versions of the manuscript, and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Independent Committee for Bioethics approved the research, following the Declaration of the World Medical Association (registration number: RC 20/18). Informed consent was previously obtained from parents after full explanation regarding the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Our Excel database is available under request to the corresponding author (