Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors

Abstract

Background Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates’ pain responses and may lead to inaccurate pain assessment when not appropriately considered. Objectives We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN. Methods We videotaped 154 full‐term and preterm neonates of different GAs during 1–5 capillary heel sticks in their first 14 days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models. Results Premature birth (b = −0.721), caffeine (b = −0.302), and the behavioural states quiet and awake (b = −0.283), active and asleep (b = −0.158), and quiet and asleep (b = −0.498) were associated with changes in behavioural pain scores. Premature birth (b = −0.232), mechanical ventilation (b = −0.196), and duration of the heel stick procedure (b = 0.0004) were associated with changes in physiological pain scores. Premature birth (b = −0.907), Caffeine (b = −0.402), the behavioural states quiet and awake (b = −0.274), and quiet and asleep (b = −0.459), and duration of the heel stick procedure (b = 0.001) were associated with changes in the modified BPSN total scores. Conclusions Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates’ pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs. Significance We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.

Warming Prior to Heel Stick

“…Therefore, it can only be concluded that warming as a possible additional procedure did not influence the infants' COMFORTneo score. Other elements could also influence pain evaluation, as described by Schenk et al 32 They concluded that individual contextual factors such as behavioral state, ventilation status, and postmenstrual age have an impact on the infants' pain response and recommended that clinicians incorporate this in their evaluation to achieve a more accurate clinical pain assessment of the infants. Our study did not consider this because the protocol was approved prior to the publication of this study.…”