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Updated: Jul 16, 2026
Electrophysiological Measurements and Analysis of Nociception in Human Infants
Published on: December 20, 2011
Initial validation of the Behavioral Indicators of Infant Pain (BIIP)
1Centre for Community Child Health Research, Child and Family Research Institute, Vancouver, Canada School of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada Department of Pediatrics, University of British Columbia, Vancouver, Canada Children's and Women's Health Centre of British Columbia, Vancouver, Canada.
Insights
A new scale, the Behavioral Indicators of Infant Pain (BIIP), accurately assesses acute pain in preterm infants in the neonatal intensive care unit (NICU). This tool helps ensure proper pain management for vulnerable newborns.
Area of Science:
- Neonatal care
- Pain assessment
- Pediatric research
Background:
- Accurate pain assessment in preterm infants is challenging due to dampened responses in premature infants.
- Existing multidimensional pain scales may obscure individual system responses to interventions.
- Early pain exposure in preterm infants can lead to altered pain signaling.
Purpose of the Study:
- To develop a unidimensional scale for assessing acute pain in preterm infants.
- To identify specific behavioral indicators of pain in this population.
- To create a reliable and valid tool for neonatal intensive care unit (NICU) pain assessment.
Main Methods:
- Development of the Behavioral Indicators of Infant Pain (BIIP) scale, incorporating sleep/wake states, facial actions, and hand actions.
- Assessment of 92 preterm infants (23-32 weeks gestational age) during blood collection procedures.
- Real-time video coding of BIIP and Neonatal Infant Pain Scale (NIPS) scores, with heart rate (HR) data analyzed using physiological software.
Main Results:
- The BIIP scale demonstrated significant changes across blood collection phases (p<0.01).
- High internal consistency (0.82) and inter-rater reliability (0.80-0.92) were observed for the BIIP.
- Modest correlations were found between BIIP and NIPS (r=0.64) and BIIP and mean HR (r=0.45).
Conclusions:
- The Behavioral Indicators of Infant Pain (BIIP) is a reliable and valid tool for assessing acute pain in preterm infants.
- The BIIP scale offers a focused approach to pain assessment in the NICU.
- This new scale can aid in more precise pain management strategies for preterm neonates.
Abstract:
Accurate pain assessment in preterm infants in the neonatal intensive care unit (NICU) is complex. Infants who are born at early gestational ages (GA), and who have had greater early pain exposure, have dampened facial responses which may lead to under-treatment. Since behavioral and physiological responses to pain in infants are often dissociated, using multidimensional scales which combine these indicators into a single score may limit our ability to determine the effects of interventions on each system. Our aim was to design a unidimensional scale which would combine the relatively most specific, individual, behavioral indicators for assessing acute pain in this population. The Behavioral Indicators of Infant Pain (BIIP) combines sleep/wake states, 5 facial actions and 2 hand actions. Ninety-two infants born between 23 and 32 weeks GA were assessed during 3, 1 min Phases of blood collection. Outcome measures included changes in BIIP and in Neonatal Infant Pain Scale (NIPS) scores coded in real time from continuous bedside video recordings; changes in heart rate (HR) were obtained using custom physiological processing software. Scores on the BIIP changed significantly across Phases of blood collection (p<0.01). Internal consistency (0.82) and inter-rater reliability (0.80-0.92) were high. Correlations between the BIIP and NIPS were modest (r=0.64, p<0.01) as were correlations between the BIIP and mean heart rate (r=0.45, p<0.01). In this initial study, the BIIP has been shown to be a reliable, valid scale for assessing acute pain in preterm infants in the NICU.
