Validation of a neonatal pain scale adapted to the new practices in caring for preterm newborns.
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.
Milesi
Christophe
C
Neonatologie, Hopital de la Croix Rousse, Rousse, Lyon, France.
Cambonie
Gilles
G
Jacquot
Aurelien
A
Barbotte
Eric
E
Mesnage
Renaud
R
Masson
Florence
F
Pidoux
Odile
O
Ferragu
Felicie
F
Thevenot
Pierre
P
Mariette
Jean-Bernard
JB
Picaud
Jean-Charles
JC
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