<p>Pain Scales in Neonates Receiving Mechanical Ventilation in Neonatal Intensive Care Units – Systematic Review</p>

Abstract

Introduction: Recently, interest in the problem of proper prevention and monitoring of pain, especially acute, has been increasing in relation to various age groups. Greater awareness of the problem prompts discussion about the purpose of analgesia in newborns treated with mechanical ventilation. Aim: The purpose of the systematic review was to analyze current research on the use of pain scales in newborns treated with mechanical ventilation in the Neonatal Intensive Care Unit. Methods: Medline databases: PubMed, OVID, EBSCO, Web of Science and Cochrane Library were traced using the appropriate keywords. The search was limited to studies in English. The review took into account the years 2006-2019. Considering the criteria, 12 articles were included in further analysis, to which full access was obtained. Results: The analyzed scientific research showed differences in beliefs about the validity and credibility of the scales used. Researchers indicated that staff with practical experience in using scales in their daily practice was very skeptical of the results obtained on their basis. Conclusion: Based on this review, no explicit evidence can be obtained to support the use of one proper scale in pain assessment. It can be inferred that the COMFORT and N-PASS scales are effective for pain assessment and for determining the need for analgesics in mechanically ventilated neonates. These scales may be equally effective in assessing chronic pain, especially in mechanically ventilated children. On the other hand, the PIPP and CRIES scales are most commonly recommended for assessing acute and postoperative pain.

Knowledge and Practices in Neonatal Pain Management of Nurses Employed in Hospitals with Different Levels of Referral—Multicenter Study

“…The selection of an appropriate assessment tool depends on the clinical condition of the patient requiring intensive care. No single universal scale analyzing acute/procedure-related or chronic pain has been developed for this category of patients [16,31]. The study carried out by Avila-Alvarez et al [32] seems to confirm this statement, as these researchers showed that six completely different scales were used for pain monitoring in 10 neonatal intensive care units.…”

“…The author and his research team stated that more than 80% of nurses used pain assessment tools. All respondents who used pain assessment scales in their routine practice were confident in their use and interpretation with neonatal patients [16].…”

“…The highest rate was observed in subjects who felt confident in the identification of pain indicators using the tools which are available in their unit (M 3.49; SD ± 0.93), while the lowest rate was presented by the respondents (M 2.24; SD ± 2.49) who attended an introductory course in pain identification/evaluation when newly employed in the intensive care unit. The arithmetic mean regarding regular education in neonatal pain management was M 2.91 (SD ± 1.14), and an average of 2.67 (SD ± 1.06) respondents regularly use neonatal pain assessment tools [15,16].…”

“…It is recommended that pain intensity assessment requires the use of validated scales based on behavioral and/or physiological parameters. Such a tool should be selected with regard to the age of the child [4,15,16]. The results of recent studies seem to confirm that the medical personnel of the NICU have gained adequate knowledge about neonatal pain and the need for its systematic monitoring [8,[17][18][19].…”

Instrumentos De Evaluación Fisioterapéutica en Población Neonatal:

“…En nuestro medio es bastante usada la PIPP validada en diferentes regiones del mundo y con utilidad clínica para dolor agudo y postoperatorio al igual que la escala CRIES, estas son de uso en recién nacidos ya sea prematuro o a término. Las escalas COMFORT y N-PASS son efectivas para la evaluación del dolor y para determinar la necesidad de analgésicos en neonatos con ventilación mecánica (Popowicz, 2020).…”