Comparison of Neonatal Pain, Agitation, and Sedation Scale with Premature Infant Pain Profile for the assessment of acute prolonged pain in neonates on assisted ventilation: A prospective observational study

Abstract

Aim:This study aimed to compare Neonatal Pain, Agitation, and Sedation Scale (N-PASS) with Premature Infant Pain Profile (PIPP) for the assessment of acute prolonged pain in ventilated neonates.Methods:This study was conducted in two phases. In phase 1 of the study, we assessed whether neonates on assisted ventilation experienced acute prolonged pain. In phase 2, the aim was to compare N-PASS with PIPP for the assessment of acute prolonged pain in neonates on assisted ventilation..Design:This is a prospective observational study.Study Setting and Duration:This study was conducted at a tertiary care neonatal intensive care unit for 6 months.Inclusion Criteria:Neonates on assisted ventilation for >48 h were selected for this study.Exclusion Criteria:Neonates with lethal congenital anomalies and severe encephalopathy were excluded from the study. N-PASS and PIPP tools were used to assess acute prolonged pain in ventilated neonates. Taking PIPP as gold standard and N-PASS as a new test, the correlation coefficient was calculated. The sensitivity, specificity, positive predictive value, and negative predictive value were also computed. The time taken to administer the tools was also computed.Results:The average PIPP score for ventilated neonates was 8.33. The correlation coefficient of N-PASS when compared to PIPP was 0.62. The average time taken to apply the N-PASS scale was 4.42 min as compared to 8.20 min for PIPP scale. In term neonates, the sensitivity, specificity, positive predictive value, and negative predictive value of N-PASS were 75%, 100%, 100%, and 60%, respectively. The corresponding values in preterm neonates were lesser.Conclusions:The study proves that neonates on assisted ventilation experience acute prolonged pain. N-PASS is clinically reliable and valid to assess acute prolonged pain in ventilated term neonates. The N-PASS is quicker than PIPP in assessing acute prolonged pain in ventilated neonates.Future Directions:The modified N-PASS tool (including the gestational age) should be developed.

Systematic review and meta‐analysis suggest that varying prevalence of non‐acute pain in critically ill infants may be due to different definitions

“…The authors of six studies were contacted to clarify whether infants with neonatal abstinence syndrome from maternal drug use were included and two did not provide clarification. A decision was made to include these studies on the following basis.…”

“…The authors of four studies were contacted to provide prevalence data, but one author did not respond to the request and was excluded from the final list of eligible studies. The authors of three studies were contacted because they used non‐validated cut‐off scores for the pain assessment tools.…”

“…Only two studies had a low risk of bias, seven had an uncertain risk of bias, and two had a high risk of bias (Table ) . Due to the nature of the population, we were reviewing we did not expect the samples to be representative of national cohorts and this was the case.…”

“…This was evaluated by comparing the study's method of assessment against the validated use of the pain assessment tool (Table ). We needed to contact the authors to get additional information on seven studies that did not provide specific details to derive accurate prevalence estimates . Asymmetry (Figure ) was found in the funnel plots for all the pooled studies and in the plots for the subgroup analyses which suggested risk of bias between the studies.…”

“…Only three studies (Table ) defined non‐acute pain. Prolonged pain was pain ‘lasting several hours or days’, acute prolonged pain had ‘a clear beginning and expected end point’, and chronic pain was ‘a pathological pain state persisting beyond the normal tissue healing time of usually 3 months’ . Another study used a definition based on a treatment algorithm and the need to change the analgesia regimen.…”