Validity and Reliability of Pain and Behavioral Scales for Preterm Infants: A Systematic Review

Area of Science:

• Neonatal Intensive Care Unit (NICU) research
• Pediatric pain assessment
• Infant behavioral science

Background:

• Preterm newborns in the NICU experience significant stress and pain.
• Accurate assessment tools are crucial for effective pain management and care.
• Existing instruments for evaluating infant behavior, stress, and pain require systematic review.

Approach:

• A systematic literature search was conducted across multiple databases, yielding 12,295 records.
• 37 studies met the inclusion criteria for assessing instruments in preterm infants.
• The COnsensus-based Standards for selecting health Measurement INstruments (COSMIN) checklist evaluated instrument quality and measurement properties.

Key Points:

• 25 scales were identified for assessing behavior, pain, and/or stress in preterm infants.
• The Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Indicators of Infant Pain (BIPP) demonstrated high quality and validity.
• Several scales, including PIPP-R, Bernese Pain Scale for Neonates (BPSN), and others, showed excellent inter-rater reliability and internal consistency.

Conclusions:

• The BIPP and PIPP-R scales are considered appropriate for assessing preterm infants based on reliability, consistency, and quality assessments.
• These validated instruments are essential for improving pain and stress management in the NICU.
• Further research may focus on refining and validating additional assessment tools for this vulnerable population.