A simultaneous comparison of three neonatal pain scales during common NICU procedures.
OBJECTIVE
This study evaluated neonatal pain scales during procedures commonly performed in a neonatal intensive care unit.


METHODS
Evaluated were the Neonatal Infant Pain Scale (NIPS), the Comfort scale, and a new scale known as the Scale for Use in Newborns (SUN). Four procedures were scored: intubation, intravenous catheter insertion, endotracheal tube suctioning, and diaper changes. Scoring was done before, during, and after each procedure. Thirty-three patients were tested during 68 procedures with 1,428 scale scores.


RESULTS
All scales demonstrated significant changes. In before-versus-during for each procedure, the increase in pain scale score was significant for the NIPS, Comfort scale, and SUN. All three scales also demonstrated a return to baseline (before-vs.-after) for the four procedures, except for the Comfort scale, which remained elevated (p < .05) following diaper change. The NIPS had a significantly larger coefficient of variation (CV, 188% +/- 99%), whereas the Comfort scale and SUN had small CVs (27% +/- 5% and 33% +/- 8%, respectively). In evaluating potential confounding influences, it was found that infants > 2.5 kg on sedative or analgesic medications appeared to have procedure-related accentuation and sustained elevation in scale scores, whereas swaddling seemed to provide little added benefit.


CONCLUSIONS
The pain scale scores identify changes in an infant's behavior/physiologic state. It is unclear whether these changes are totally "pain specific." In comparing the three scales, the SUN overall was a preferable tool because of its ease of use, scale symmetry, and scoring consistency.
Blauer
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Division of Neonatology, Utah Valley Regional Medical Center, Provo 84604, USA.
Gerstmann
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D
D001724:Birth Weight; D002404:Catheterization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007224:Infant Care; D007231:Infant, Newborn / Q000502:physiology*; D015931:Intensive Care, Neonatal; D007442:Intubation, Intratracheal; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods*; D013396:Suction; D013997:Time Factors; D014680:Veins
D006993:Hypnotics and Sedatives