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[Pain symptomatology in premature infants]
T Debillon1, B Sgaggero, V Zupan
1Service de réanimation néonatale, hôpital Antoine-Béclère, Clamart, France.
Insights
This study developed a validated pain scale for premature infants, enabling objective assessment of pain and well-being. The scale aids in crucial care and therapeutic decisions for neonates.
Area of Science:
- Neonatal care
- Pain assessment in infants
- Pediatric pain management
Context:
- Assessing pain in premature infants is challenging due to limited communication abilities.
- Neonatal intensive care units (NICUs) require reliable methods for pain evaluation.
- Understanding pain manifestations is crucial for infant well-being.
Purpose:
- To identify indicators of acute and chronic pain versus well-being in premature babies.
- To develop and validate a "pain scale" for objective pain assessment in neonates.
- To improve pain management strategies for premature infants.
Summary:
- A five-item pain scale was developed, assessing facial activity, body movement, sleep, interaction, and comfort.
- The scale differentiates between well-being, acute pain, and chronic pain/discomfort in premature infants.
- High inter-examiner concordance (80%) and scale sensitivity (77% score variation) were observed in 50 infants.
Impact:
- Provides an objective tool for pain and discomfort assessment in premature babies.
- Facilitates informed care and therapeutic decisions in neonatal settings.
- Enhances the quality of care for vulnerable premature infants.
Background:
Assessing pain in premature babies is difficult because of their limited capacities to communicate. The aim of this study was to recognize manifestations of acute and chronic pain or, on the contrary, of well-being state, and to validate a "pain scale" for premature babies.
Population And Methods:
Premature babies less than 28 days of age (most of them less than 32 weeks of gestational age) were carefully observed during their stay in a neonatal intensive care unit by nurses, physicians, physiotherapists and a psychiatrist. All signs and symptoms were collected during situations a priori painful and compared to the behavior of the well-being states. Photographs and videofilms were also analysed.
Results:
Five items, scored from 0 to 4, were established, based on facial activity, movements and posture of the body, quality of sleep, relationship with the examiner, and efficacy of measures of comforting. These items permitted to describe four patterns corresponding to 1: well-being status, 2: acute pain, 3 and 4: durable pain or discomfort either through clinical picture of irritability or motionlessness. A strict concordance of scores for the five items between the different examiners was found in 80% of the 50 babies studied. The sensibility of the scale (studied in 12 babies) appeared accurate (77% of variation of the scores during hospitalization).
Conclusions:
An objective assessment of pain and discomfort in premature babies can be made using a "pain scale" useful for care and therapeutic decisions.