Reliability of two behavioral tools to assess pain in preterm neonates

Guinsburg, Ruth; Almeida, Maria Fernandes Branco de; Peres, C.; Shinzato, Alexandre Ryuzo; Kopelman, Benjamin Israel

doi:10.1590/s1516-31802003000200008

Cited by 30 publications

(18 citation statements)

References 21 publications

(32 reference statements)

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“…The NFCS was adopted from the Facial Action Coding System of Grunau and Craig 13. It can differentiate between painful and non-painful stimuli and has well-founded validity 14. Studies have shown that 96–99% of term infants will demonstrate brow bulge, eye squeeze, deepening of the nasolabial furrow and open lips in response to heel lancing 12 13.…”

Section: Discussionmentioning

confidence: 99%

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Lingual sucrose reduces the pain response to nasogastric tube insertion: a randomised clinical trial

McCullough

Halton

Mowbray

et al. 2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Section: Discussionmentioning

confidence: 99%

“…The NFCS uses four facial responses: brow bulge, eye squeeze, deepened nasolabial furrow and open lips (possible score 0–4). The NFCS has been extensively validated and used in neonatal pain research 11 14 – 16…”

Section: Methodsmentioning

confidence: 99%

Lingual sucrose reduces the pain response to nasogastric tube insertion: a randomised clinical trial

McCullough

Halton

Mowbray

et al. 2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…27 The most commonly used assessment tools are listed in Table 1. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] For each tool, the physiologic and behavioral indicators of pain are described, the population for which they have been validated are delineated, and unique aspects are listed. Whatever assessment tools are used, continual multidisciplinary training of staff in the recognition of neonatal pain and in the use of the chosen pain-assessment tools should be provided.…”

Section: Assessment Of Pain and Stress In The Neonatementioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

406

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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“…Moreover, this scale is easy to use at the bedside and has adequate reliability (26). The BIIP is a behavioral tool that combines an assessment of the wake/sleep state with two specific hand movements (finger splay, fisting) and facial actions.…”

Section: Discussionmentioning

confidence: 99%

Differences between uni- and multidimensional scales for assessing pain in term newborn infants at the bedside

Arias

Guinsburg

2012

Clinics

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OBJECTIVES:This study sought to determine the level of agreement between behavioral and multidimensional pain assessment scales in term newborn infants submitted to an acute nociceptive stimulus.METHODS:This cross-sectional study was performed on 400 healthy term newborns who received an intramuscular injection of vitamin K during the first 6 hours of life. Two behavioral pain scales (the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain) and one multidimensional tool (the Premature Infant Pain Profile) were applied by a single observer before the procedure, during cleansing, during injection and two minutes after injection. The Cochran Q, McNemar and kappa tests were used to compare the presence and degree of agreement between the three scales. The Hotelling T2 test was used to compare the groups of newborns for which the scales showed agreement or disagreement. A generalized linear regression was used to compare the results of the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain across the four study time points.RESULTS:The neonates studied had a gestational age of 39±1 weeks, a birth weight of 3169±316 g and and postnatal age of 67±45 minutes. During the stimulus procedure, 80% of the newborns exhibited pain behaviors according to the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain, and 70% experienced pain according to the Premature Infant Pain Profile (p<0.001). The frequencies of the detection of pain using the Behavioral Indicators of Infant Pain and the Neonatal Facial Coding System were similar. The characteristics of the neonates were not associated with the level of agreement between the scales.CONCLUSION:The Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain behavioral scales are more sensitive for the identification of pain in healthy term newborn infants than the multidimensional Premature Infant Pain Profile scale.

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Reliability of two behavioral tools to assess pain in preterm neonates

Abstract: The results strengthen the reliability of the Neonatal Facial Coding System for bedside pain assessment in preterm neonates.

Cited by 30 publications

References 21 publications

Lingual sucrose reduces the pain response to nasogastric tube insertion: a randomised clinical trial

Lingual sucrose reduces the pain response to nasogastric tube insertion: a randomised clinical trial

Prevention and Management of Pain in the Neonate: An Update

Differences between uni- and multidimensional scales for assessing pain in term newborn infants at the bedside

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