title: Validation of a neonatal pain scale adapted to the new practices in caring for preterm newborns.
abstract: BACKGROUND Neonatal pain assessment generally requires access to facial expression. Improved neonatology practices, such as greater protection against bright lights and non-invasive mask ventilation, have made facial observation more difficult.
  
  
  OBJECTIVE
  To validate a 'faceless' acute neonatal pain scale (FANS), which does not depend on facial expression.
  
  
  METHODS
  In a prospective, multicentre study, 24-40-week-old neonates were videotaped during a painful procedure (heel prick). Three investigators then scored the pain using FANS and a previously validated scale: DAN (Douleur aiguë du Nouveau-né). FANS is based on assessment of limb movement, cry and autonomic reaction. Reliability was assessed by inter-rater agreement and internal consistency (Cronbach's alpha). Validity was evaluated by agreement between scales (intraclass correlation coefficient (ICC)). The Wilcoxon test evaluated the FANS score differences between conditions. Results are expressed as medians (25th and 75th percentiles). Ranges are presented for outcome parameters.
  
  
  RESULTS
  From April 2006 to September 2007, 53 preterms of 32 (30-35) gestational weeks and 1500 (1000-2200) g were observed. Cronbach's alpha was 0.72. The ICC was 0.92 (0.9-0.98) for inter-rater agreement and 0.88 (0.76-0.93) for agreement between scales.
  
  
  CONCLUSIONS
  FANS, which is reliable and valid, is the first scale to score pain in preterm newborns when facial expression is not accessible.
authors.affiliation: Neonatologie, Hopital de la Croix Rousse, Rousse, Lyon, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Milesi
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
authors.forename: Aurelien
authors.initials: A
authors.lastname: Jacquot
authors.forename: Eric
authors.initials: E
authors.lastname: Barbotte
authors.forename: Renaud
authors.initials: R
authors.lastname: Mesnage
authors.forename: Florence
authors.initials: F
authors.lastname: Masson
authors.forename: Odile
authors.initials: O
authors.lastname: Pidoux
authors.forename: Felicie
authors.initials: F
authors.lastname: Ferragu
authors.forename: Pierre
authors.initials: P
authors.lastname: Thevenot
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Mariette
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Picaud
mesh_terms: D000208:Acute Disease; D001800:Blood Specimen Collection / Q000009:adverse effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000379:methods; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000209:etiology; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D014743:Videotape Recording