Pilot study of a pain assessment tool in the Neonatal Intensive Care Unit

To develop and validate a pain assessment tool to assess procedural pain experienced by mechanically ventilated neonates.

Assessment of ventilated infants, before, during and after a known routine traumatic procedure using the Nepean Neonatal Intensive Care Unit Pain Assessment Tool (NNICUPAT). This tool scores physiological and behavioural responses to pain. Variables used in the NNICUPAT included facial expression, body movement, skin colour, saturation, respiratory rate, heart rate and nurses' perception of pain. To test the validity of the NNICUPAT, it was compared to a visual analogue scale (VAS), which is a unidimesional observation measure, where zero equals no pain and 10 equals severe pain.

Thirty ventilated neonates (mean gestation 28 +/- 3.3 standard deviation (SD)) weeks) were enrolled in the pilot study over a 9-month period. The total score before the procedure was: 0.26 +/- 0.14 (mean +/- standard error of the mean (SEM)) range 0-3; total score during the procedure 5.1 +/- 2.2 (mean +/- SD) range 1-10; and the total score after the procedure was 0.26 +/- 0.15 (mean +/- SEM) range 0-3. There was a significant correlation between the NNICUPAT and the VAS during the procedure (r = 0.825, P = < 0.01) and after the procedure (r = 0.375, P = < 0.05). Inter-rater reliability was calculated between the principle coder and other coders (using the NNICUPAT) and showed a significant correlation before (r = 0.88, P < 0.01) and during (r = 0.88, P < 0.01) the procedure.

The NNICUPAT does show validity in the assessment of procedural pain in the ventilated neonate. Further evaluation of both inter- and intra-rater reliability will be necessary to establish the ongoing validity of the NNICUPAT.