Related Experiment Video
Updated: Jul 5, 2026
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Influence of gestational age on the EDIN score: an observational study
G Ancora1, M Mastrocola, C Bagnara
1Institute of Neonatology, Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Italy. gina.ancora@unibo.it
Insights
Neonatal maturity, indicated by gestational age, affects how prolonged pain is expressed. The EDIN scale
Area of Science:
- Neonatalogy
- Pain Assessment
- Pediatric Research
Background:
- Hospitalized neonates, especially preterm infants, are susceptible to prolonged pain.
- The EDIN (Echelle Douleur Inconfort Nouveau-Né) scale is the sole validated tool for assessing prolonged pain in preterm infants.
- The influence of neonatal maturity on prolonged pain expression remains under-investigated.
Purpose of the Study:
- To determine if neonatal maturity, assessed by gestational age and postnatal age, impacts the expression of prolonged pain.
- To investigate the relationship between gestational age and pain scores in neonates.
- To explore factors influencing pain expression in hospitalized neonates.
Main Methods:
- Utilized the EDIN scale to evaluate 84 neonates (gestational age 25-41 weeks) in a neonatal intensive care unit over one year.
- Collected 1571 EDIN scores, categorizing them as indicative (>6) or not indicative (≤6) of pain.
- Employed logistic regression analysis, incorporating gestational age, postnatal age, painful situations, and analgesic treatment to assess their impact on EDIN scores.
Main Results:
- Gestational age demonstrated a positive association with EDIN scores (odds ratio 1.166; 95% CI 1.123 to 1.211).
- Postnatal age, sepsis, and the need for respiratory support were also found to significantly influence EDIN scores.
- These findings highlight the role of neonatal maturity in pain perception and expression.
Conclusions:
- Gestational age is a significant factor influencing the expression of prolonged pain in neonates.
- The EDIN scale's content validity could be enhanced by incorporating gestational age-specific categories.
- Assigning higher baseline scores to less mature newborns may improve the accuracy of the EDIN scale.
Background And Aim:
Hospitalised neonates, particularly if preterm, may be exposed to prolonged pain. At present the only validated scale to assess prolonged pain in preterms is the EDIN (Echelle Douleur Inconfort Nouveau-Né) scale. Gestational age has been shown to influence the response of infants to acute pain but its potential effect in the setting of prolonged pain has not been investigated. The aim of the present study was to evaluate whether neonatal maturity as expressed by gestational age and/or postnatal age influences their expression of prolonged pain.
Methods:
In a 1 year period, 84 neonates (gestational age 25-41 weeks), referred to the authors' neonatal intensive care unit were evaluated using the EDIN scale two to three times a day (1571 scores). The EDIN scores were categorised as indicative (>6) or not indicative (< or =6) of pain. Gestational age and postnatal age were included in a logistic regression analysis along with some painful situations and analgesic treatment to identify the impact on the EDIN scores.
Results:
Logistic regression analysis showed that the EDIN scores were positively associated with gestational age (odds ratio 1.166; 95% CI 1.123 to 1.211). Postnatal age, sepsis and presence of respiratory support also influenced the EDIN score.
Conclusions:
Gestational age influences expression of prolonged pain. Content validity of the EDIN scale could be improved by adding categories for gestational age and attributing higher basal scores to less mature newborns.