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A Critical Evaluation of the COMFORTneo Scale's Validity and Applicability for Preterm Infants

Erik Koning1, Arend F Bos1, Elisabeth M W Kooi1

  • 1Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital University Medical Center Groningen, University of Groningen Groningen the Netherlands.

Paediatric & Neonatal Pain
|July 7, 2025
PubMed

Insights

The COMFORTneo pain scale shows unidimensionality in preterm infants but struggles to accurately distinguish pain in extremely preterm infants, especially those on ventilators. Further validation is needed for this vulnerable population.

Area of Science:

  • Neonatal intensive care
  • Pediatric pain assessment
  • Infant development

Background:

  • The COMFORTneo scale is a common tool for assessing pain in infants.
  • Its reliability for extremely preterm (EPT) infants (gestation < 26 weeks) is not well established.
  • Accurate pain assessment is critical for optimal care of premature infants.

Purpose of the Study:

  • To evaluate the validity and discriminatory ability of the COMFORTneo scale in extremely preterm (EPT) infants compared to other preterm (PT) infants.
  • To assess the unidimensionality of the COMFORTneo scale in EPT infants.
  • To identify specific items within the COMFORTneo scale that may not effectively differentiate pain in EPT infants.

Main Methods:

  • Retrospective cohort study of infants born before 37 weeks' gestation between 2018-2022.
  • Analysis of COMFORTneo scale data from a tertiary neonatal intensive care unit.
  • Statistical evaluation using the partial credit model for unidimensionality and differential item functioning for discriminatory ability.

Main Results:

  • The COMFORTneo scale demonstrated unidimensionality across all preterm infants studied.
  • In EPT infants, specific items (alertness, facial tension) failed to discriminate pain in ventilated infants.
  • Agitation and muscle tone items were ineffective in distinguishing pain in non-ventilated EPT infants.

Conclusions:

  • While the COMFORTneo scale is unidimensional for preterm infants, its ability to discriminate pain is limited in extremely preterm infants.
  • Certain COMFORTneo items require re-evaluation for their effectiveness in EPT infants, particularly those requiring mechanical ventilation.
  • Further research is needed to refine pain assessment tools for the unique needs of extremely preterm infants.

Keywords:
AssessmentNICUPainPreterm

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