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Updated: Apr 26, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The Neonatal Pain, Agitation and Sedation Scale reliably detected oversedation but failed to differentiate between
V Giordano1, P Deindl, S Kuttner
1Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Aim:
The aim of this study was to analyse the sedation subscale of the Neonatal Pain, Agitation and Sedation Scale (N-PASS), because the N-PASS has only been validated for the assessment of acute and prolonged pain.
Methods:
The nurses' expert opinion regarding the level of sedation of the study patients was used as reference scale. Paired assessments of both the N-PASS sedation subscale and the nurses' expert opinion were performed in 50 sedated neonates from 23 to 44 weeks of postmenstrual age.
Results:
A total set of 503 paired observations was included into analysis. The median N-PASS sedation subscale scores were significantly different for the three nurses' expert opinion categories, with minus eight for oversedation, minus two for adequate sedation and zero for undersedation (p < 0.0001). Interobserver agreement for the N-PASS sedation subscale was excellent - linearly weighted Cohen's Kappa was 0.93 - as was the internal consistency of 0.88, estimated by a Cronbach's alpha. The internal consistency increased to 0.90 if the vital sign item of the subscale was deleted.
Conclusion:
The N-PASS sedation subscale reliably detected oversedation, but failed to differentiate between adequate and undersedation. We therefore recommend using additional methods to ensure adequate assessment of sedation in neonates.
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