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The development of a tool to assess neonatal pain
Insights
This study developed the Neonatal Infant Pain Scale (NIPS) to measure infant pain during procedures. The NIPS demonstrated high validity and reliability for assessing pain in neonates.
Area of Science:
- Neonatal care
- Pain assessment
- Pediatric research
Background:
- Accurate pain assessment in neonates is crucial for appropriate clinical management.
- Existing pain assessment tools for neonates may lack comprehensive validation.
- Behavioral indicators are primary measures for pain in non-verbal infants.
Purpose of the Study:
- To develop and validate a behavioral pain assessment tool for preterm and full-term neonates.
- To establish construct validity, concurrent validity, interrater reliability, and internal consistency of the Neonatal Infant Pain Scale (NIPS).
- To explore the relationship between NIPS pain scores and infant characteristics.
Main Methods:
- Development of the Neonatal Infant Pain Scale (NIPS) based on behavioral responses.
- Videotaping of 90 intrusive procedures across 38 infants for behavioral scoring.
- Assessment of NIPS scores before, during, and after procedures.
- Concurrent validity using Visual Analogue Scale (VAS) and interrater reliability analysis.
- Internal consistency assessed using Cronbach's alpha.
Main Results:
- The NIPS effectively measured the intensity of infant responses to procedures, showing significant differences over time.
- High concurrent validity (r = .53–.84) and interrater reliability (r = .92–.97) were established for the NIPS.
- The NIPS demonstrated high internal consistency (Cronbach's alpha = .95, .87, .88).
- Gestational age and Apgar scores correlated with overall NIPS scores but not with pain responsiveness.
Conclusions:
- The Neonatal Infant Pain Scale (NIPS) is a valid and reliable tool for measuring acute pain in neonates.
- The NIPS is suitable for use in clinical trials and neonatal intensive care units.
- Further research can explore the NIPS's utility in diverse neonatal populations and clinical settings.
Abstract:
The objectives of this study were to (1) develop a behavioral assessment tool for the measurement of pain in the preterm and full-term neonate; (2) establish the construct and concurrent validity, interrater reliability, and internal consistency of the tool; and (3) examine the relationship between the pain scores and infant characteristics. Thirty-eight infants contributed to the 90 procedures videotaped for the study. The Neonatal Infant Pain Scale (NIPS) was used to score behavioral responses before, during, and after each intrusive procedure. The significant difference in NIPS scores over time indicates that the scale provides a measurement of intensity of infant responses to intrusive procedures. Concurrent validity was established by correlations, ranging from .53 to .84, between NIPS scores at each minute of observation and scores on the Visual Analogue Scale. Interrater reliability was high: Pearson correlations ranged from .92 to .97 across successive minutes of observation. The six component scores of the NIPS had high internal consistency: Cronbach's alphas were .95, .87, and .88 for before, during, and after the procedures, respectively. Although gestational age and five-minute Apgars were positively associated with NIPS scores over time, there was no association between these factors and responsiveness to pain, as measured by change in NIPS scores from before to during the procedure. Results are discussed in terms of the use of the NIPS in clinical trials and its clinical application in a neonatal intensive care unit.