title: A simultaneous comparison of four neonatal pain scales in clinical settings.
abstract: OBJECTIVE
  To evaluate the usefulness of four neonatal pain scales (DAN, NIPS, PIPP, and NPAS) in describing newborn's response to a painful event in clinical settings.
  
  
  METHODS
  Prospective observational study at university-affiliated neonatal unit. Three hundred-sixty newborns were observed during venepuncture and heel lancing as a part of routine blood workout. Values of pain scales were determined in three time frames (start of procedure - T₀, maximal response - T₁, end of procedure - T₂).
  
  
  RESULTS
  In T₀ versus T₁ time frame, a sharp increase of percentage was observed in all pain scales independently of procedure with high statistical significance (P ∼ 0.00). NIPS showed the highest (venepuncture 742%; heel lancing 1472%) and PIPP the lowest increase (venepuncture 303%; heel lancing 510%). In T₁ versus T₂ time frame, for venepuncture NIPS showed the highest (49%) and PIPP the lowest (38%) percentage of decrease, whereas for heel lancing PIPP had the highest (28%) and NIPS the lowest (20%) one. All pain scales showed significant individual and overall variability (CV > 30%). PIPP had the lowest (42.7 + 14.3) and NIPS the highest (103.8 + 91.3) overall coefficient of variation. DAN's confidence parameters were the most uniform ones (se 1.0, sp 0.93, ppv 0.93, npv 1.0), whereas PIPP's confidence parameters were the highest while measuring high intensity pain (se 0.94, sp 1.0, ppv 1.0, npv 0.94).
  
  
  CONCLUSIONS
  DAN is a pain scale convenient for the use in clinical settings, especially if a fine distinction of magnitude of the present pain is not needed, whereas PIPP can be used if adequate equipment is available.
authors.affiliation: Department of Intensive Care, Institute of Child and Youth Healthcare of Vojvodina, Novi Sad, Serbia. sspas@ptt.rs
authors.forename: Slobodan
authors.initials: S
authors.lastname: Spasojevic
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Bregun-Doronjski
mesh_terms: D003955:Diagnostic Tests, Routine / Q000009:adverse effects; D006365:Heel; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening; D009725:Nurseries, Hospital; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010147:Pain Measurement / Q000379:methods* / Q000592:standards; D018962:Phlebotomy; D012107:Research Design / Q000592:standards; D014894:Weights and Measures