Neonatal Facial Coding System for Assessing Postoperative Pain in Infants: Item Reduction is Valid and Feasible

Peters, Jeroen; Koot, Hans M.; Grunau, Ruth E.; Boer, Josien de; Druenen, Marieke J van; Tibboel, Dick; Duivenvoorden, Hugo J.

doi:10.1097/00002508-200311000-00003

Cited by 124 publications

(90 citation statements)

References 56 publications

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“…The NFCS can be used for assessing acute procedural and post-operative pain in infants between 23 weeks gestational age up to 18 months of age. Indeed, we retained 5 facial actions for use on the BIIP, including the 2 lower facial actions found to be valid for assessing post-operative pain in infants beyond the newborn period (Peters et al, 2003) for these reasons. However, as we described, the NFCS includes facial actions only, actions which may be dampened in infants who are sicker or who have had ongoing exposure to skin-breaking procedures.…”

Section: Discussionmentioning

confidence: 99%

“…All of these indicators have been validated individually for assessing acute pain in preterm infants (Grunau et al, 2000;Stevens et al, 2000;Morison et al, 2003;Holsti et al, 2004). Moreover, the 5 facial actions we selected have been validated for assessing postoperative pain in infants born preterm and up to 18 months of age (Peters et al, 2003). Sleep/ wake states were coded according to the definitions provided in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) (Als, 1984).…”

Section: Behavioral Indicators Of Infant Pain (Biip)-mentioning

confidence: 99%

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Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Holsti

Grunau²

2007

Pain

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155

117

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Accurate pain assessment in preterm infants in the neonatal intensive care unit (NICU) is complex. Infants who are born at early gestational ages (GA), and who have had greater early pain exposure, have dampened facial responses which may lead to under-treatment. Since behavioral and physiological responses to pain in infants are often dissociated, using multidimensional scales which combine these indicators into a single score may limit our ability to determine the effects of interventions on each system. Our aim was to design a unidimensional scale which would combine the relatively most specific, individual, behavioral indicators for assessing acute pain in this population.The Behavioral Indicators of Infant Pain (BIIP) combines sleep/wake states, 5 facial actions and 2 hand actions. Ninety two infants born between 23-32 weeks GA were assessed during 3, one minute Phases of blood collection. Outcome measures included changes in BIIP and in Neonatal Infant Pain Scale (NIPS) scores coded in real time from continuous bedside video recordings; changes in heart rate (HR) were obtained using custom physiological processing software.Scores on the BIIP changed significantly across Phases of blood collection (p < 0.01). Internal consistency (0.82) and inter-rater reliability (0.80-0.92) were high. Correlations between the BIIP and NIPS were modest (r = 0.64, p < 0.01) as were correlations between the BIIP and mean heart rate (r = 0.45, p < 0.01). In this initial study, the BIIP has been shown to be a reliable, valid scale for assessing acute pain in preterm infants in the NICU. Keywordspremature; infant; pain; assessment IntroductionPreterm infants undergo repeatedly painful diagnostic and therapeutic procedures to ensure their survival. In order to provide appropriate pain management in this population, accurate assessment of pain is necessary (Anand et al., 2005), yet complex because we are limited to indirect measures of pain responses. And although infant pain responses have both behavioralCorresponding author: Dr. Liisa Holsti, Centre for Community Child Health Research, F611, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4. Canada, Phone: 604-875-2000, local 5200, Fax: 604-875-2384, E-mail address: lholsti@cw.bc.ca. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. and physiological components, dissociations between behavioral and physiological pain responses are common (Barr, 1998;Morison et al., 2001). Furthermore, facial actions are the relatively most specific behavioral pain indicators in preterm infants, yet these responses may be dampened. Grunau et al...

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Section: Discussionmentioning

confidence: 99%

Section: Behavioral Indicators Of Infant Pain (Biip)-mentioning

confidence: 99%

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Holsti

Grunau²

2007

Pain

Self Cite

155

117

View full text Add to dashboard Cite

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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

414

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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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“…The facial expression of pain is unique and different from the six basic emotions [14] which are widely accepted by psychologists. The importance of face has been acknowledged in all multidimensional pain instruments [18].…”

Section: Related Workmentioning

confidence: 99%

“…There are ten discrete facial actions, including brow bulge, nasolabial furrow, eye squeeze, chin quiver, open lips, lip purse, horizontal mouth stretch, vertical mouth stretch, taut tongue, and tongue protrusion [27]. Based on the facial actions defined in NFCS, several frame-level geometric distance parameters were designed to capture the facial activities of pain.…”

Section: Frame-level Facial Configuration Measurementmentioning

confidence: 99%

Infants' Pain Recognition Based on Facial Expression: Dynamic Hybrid Descriptions

Zhi

Goldgof

Ashmeade

et al. 2018

IEICE Trans. Inf. & Syst.

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SUMMARYThe accurate assessment of infants' pain is important for understanding their medical conditions and developing suitable treatment. Pediatric studies reported that the inadequate treatment of infants' pain might cause various neuroanatomical and psychological problems. The fact that infants can not communicate verbally motivates increasing interests to develop automatic pain assessment system that provides continuous and accurate pain assessment. In this paper, we propose a new set of pain facial activity features to describe the infants' facial expression of pain. Both dynamic facial texture feature and dynamic geometric feature are extracted from video sequences and utilized to classify facial expression of infants as pain or no pain. For the dynamic analysis of facial expression, we construct spatiotemporal domain representation for texture features and time series representation (i.e. time series of frame-level features) for geometric features. Multiple facial features are combined through both feature fusion and decision fusion schemes to evaluate their effectiveness in infants' pain assessment. Experiments are conducted on the video acquired from NICU infants, and the best accuracy of the proposed pain assessment approaches is 95.6%. Moreover, we find that although decision fusion does not perform better than that of feature fusion, the False Negative Rate of decision fusion (6.2%) is much lower than that of feature fusion (25%). key words: infants pain assessment, temporal geometric descriptor, LBP-TOP, decision fusion, video analysis

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Neonatal Facial Coding System for Assessing Postoperative Pain in Infants: Item Reduction is Valid and Feasible

Abstract: This study demonstrates that the NFCS is a reliable, feasible, and valid tool for assessing postoperative pain. The reduction of the NFCS to 5 items increases the specificity for pain assessment without reducing the sensitivity and validity for detecting changes in pain.

Cited by 124 publications

References 56 publications

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Prevention and Management of Pain in the Neonate: An Update

Infants' Pain Recognition Based on Facial Expression: Dynamic Hybrid Descriptions

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