Psychophysical parameters of a multidimensional pain scale in newborns

Abstract

The Premature Infant Pain Profile (PIPP) is a promising multidimensional tool for comparison and testing of new technologies in newborn pain assessment studies since it may adhere to basic psychophysical parameters of intensity, direction, reactivity, regulation and slope described in analyses of physiological pain indicators. The aim of this study was to evaluate whether these psychophysical parameters can be achieved using the PIPP in acute pain assessment. Thirty-six healthy term newborn infants were conveniently sampled whilst being videotaped before, during and after heel prick blood sampling. The images were blind-scored by three trained independent raters and scored against the PIPP. The PIPP and its facial action indicators met the parameters of intensity, reactivity and regulation (all p < 0.001). The heart rate variability did not meet any parameter (all p > 0.05). The oxygen saturation variability met only the intensity parameter (p < 0.05). The behavioural state indicator met all parameters and had the best correlation to the psychophysical parameters of all indicators of PIPP (all p < 0.001). We concluded that the overall PIPP meets the assumptions of these psychophysical parameters, being the behavioural state indicator which best fit the model.

Sleep deprivation, pain and prematurity: a review study

“…It is in AS that the maturation and differentiation of the CNS and memory consolidation occur and learning patterns of emotional behavior develop 7,12,13,16,17 . QS, compatible with Non Rapid Eye Movement sleep (NREM) in adults, is already identified in the electroencephalogram at 32 weeks of gestation, but is only well developed in the [36][37][38] th week of gestation. It is formed after stabilization networks of specific excitatory and inhibitory components of the thalamus and cortex.…”

“…The validity of these scales is questioned by scientists in terms of the specificity of patients that can be evaluated (preterm, at-term or postterm neonates), the level of risk to the integrity of the CNS, which is difficult to analyze in sick babies or in critical NICU situations 37 . To validate new devices for pain assessment, it is mandatory to choose comparable instruments, and the methodology employed in these instruments of pain assessment should be considered, since there are different theoretical models in use.…”

Bayesian estimation on diagnostic performance of Face, Legs, Activity, Cry, and Consolability and Neonatal Infant Pain Scale for infant pain assessment in the absence of a gold standard

“…The results were expressed as the mean AE standard deviation or median, unless otherwise stated. Agreement between observers was analyzed using intra-class correlation coefficients (ICC): ICC > 0.75 for excellent concordance, 0.40-0.75 for moderate concordance, and <0.40 for low concordance (15). As described by Branscum et al (16), we used a Bayesian latent class model to estimate the sensitivity and specificity of the FLACC and/or NIPS test(s) for infant pain assessment in the absence of a gold standard.…”

“…The results were expressed as the mean ± standard deviation or median, unless otherwise stated. Agreement between observers was analyzed using intra‐class correlation coefficients (ICC): ICC > 0.75 for excellent concordance, 0.40–0.75 for moderate concordance, and <0.40 for low concordance . As described by Branscum et al .…”

Pain in Premature Infants: What Is Conclusive Evidence and What Is Not

“…Since previous reviews have provided details of available pain assessments tools for preterm infants with documented validity and reliability (e.g., Hummel et al, 49 Lawrence et al, 53 de Oliveira et al, 66 and Duhn et al 67 ) this paper provides a brief summary of the most commonly used behavioral tools with the documented reliability and validity of each when available (see Table 2). …”