Neonatal Pain, Agitation, and Sedation Scale’s use, reliability, and validity: a systematic review

Abstract

The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) is recommended by the American Academy of Pediatrics to measure neonatal pain and sedation. However, little is known regarding its reliability and validity for diverse neonatal subpopulations. Twenty-nine studies were included in our review, demonstrating broad application of N-PASS and good or excellent reliability and validity for various neonatal subpopulations. Our systematic review found N-PASS to be valid and reliable for many but not all neonatal subpopulations. There is a lack of support for N-PASS reliability and validity for measuring prolonged pain and sedation in nonmechanically ventilated infants and for acute pain in postoperative infants in any gestational age category. Overall, N-PASS is a psychometrically sound and pragmatic instrument evaluating pain and sedation for most neonatal populations. Future research using N-PASS is encouraged to evaluate and report its validity and reliability, especially for neonatal subpopulations not included in this review.

RETRACTED ARTICLE: The Neonatal Withdrawal Assessment Tool (NWAT): pilot inter-rater reliability and content validity

“…For preterm infants, there are validated measures for the evaluation of pain, including the Neonatal Pain, Agitation and Sedation Scale (N-PASS), however this is targeted to assess acute pain and was not designed to assess withdrawal measures in the setting of prolonged pharmacological sedation [10][11][12][13] . The Withdrawal Assessment Tool -Version 1 (WAT-1) metric is the best tool currently validated for diagnosis and assessment of iatrogenic withdrawal in older pediatric patients with meta-analysis data demonstrating high reliability and validity [14][15][16] .…”

Dexmedetomidine: An Alternative to Pain Treatment in Neonatology

“…There are up to 65 scales to evaluate pain or sedation in children in a preverbal stage of development [ 15 , 16 ]. The American Academy of Pediatrics (AAP) recommends using the following 5 scales to assess neonatal pain ( Table 1 ): Neonatal Facial Coding System (NFCS), Premature Infant Pain Profile-Revised (PIPP-R), Neonatal Pain, Agitation and Sedation Scale (N-PASS), Behavioral Indicators of Infant Pain (BIIP) and Acute Pain in Newborns/Douleur Aiguë du Nouveau-né (APN/DAN) [ 15 , 17 ].…”

Nurses' perceptions of infants’ procedural pain assessment and alleviation with non-pharmacological methods in Estonia

“…Based on the previous literature, Beltramini et al (2017), Pölkki et al (2014) and Morgan et al (2020) argue that there are several suitable validated scales for measuring procedural pain in infants. In our study, nurses reported that most of the pain scales named in the questionnaire were unfamiliar to them and they had not used them in their daily work.…”

“…A systematic review by Maaskant et al (2016) indicates that the COMFORT scale is sufficiently reliable in relaying pain information. Pölkki et al (2014) developed in close collaboration with nurses the Neonatal Infant Acute Pain Assessment Scale (NIAPAS) and Morgan et al (2020) adds that the Neonatal Pain Agitation Sedation Scale (N-PASS) is a suitable instrument in evaluating pain and sedation for most infants' populations. In addition, Face, Legs, Activity, Cry, Consolability scale (FLACC) has found a suitable tool for pain assessment in infants (Beltramini et al, 2017;Crellin et al, 2018;Witt et al, 2016).…”