A Factor Analysis of the COMFORTneo Scale: What Are We Measuring?

Area of Science:

• Neonatal care
• Pediatric pain and stress assessment
• Infant development

Background:

• Extremely preterm infants (<26 weeks) and preterm infants (26-36 weeks) experience significant procedural pain and stress.
• Distinguishing between pain and stress is challenging in clinical neonatal settings.
• The COMFORTneo scale is used to assess infant states, but its construct validity in different gestational age groups is unclear.

Purpose of the Study:

• To evaluate if the COMFORTneo scale can differentiate between pain and stress constructs in extremely preterm (EPT) and preterm (PT) infants.
• To assess the underlying structure of the COMFORTneo scale across different subgroups of preterm infants.
• To explore NICU professionals' understanding of the constructs measured by the COMFORTneo scale.

Main Methods:

• Analysis of COMFORTneo scores from 1021 preterm infants (2018-2022).
• Categorization into four subgroups: EPT ventilated, EPT non-ventilated, PT ventilated, PT non-ventilated.
• Application of exploratory and confirmatory factor analyses, supplemented by a professional questionnaire.

Main Results:

• Exploratory factor analysis revealed a unidimensional structure for EPT infants and a two-factor structure for PT infants.
• Confirmatory factor analysis supported these findings, with good model fit indices.
• NICU professionals showed varied interpretations of the constructs represented by COMFORTneo items, indicating inconsistent differentiation.

Conclusions:

• The COMFORTneo scale captures a single construct in EPT infants and two related constructs in PT infants.
• NICU professionals do not consistently differentiate between these constructs in clinical practice.
• Developmentally sensitive interpretation of COMFORTneo scores is crucial, and reliance solely on total scores should be avoided.