Differences among uni- and multidimensional scales for assessing pain in term newborn infants at bedside

Abstract

Objectives: To determine the degree of agreement between behavioral versus multídimensional pain assessment scales in term newbom infants who were submitted to an acute nociceptive stimulus. Method:' Cross-sectional study of 400 healthy term newboms who received an intramuscular injection of vitamin K during the first 6 hour of life. Two behavioral pain scales (NFCS - Neonatal Facial Coding System and BIIP - Behavioral Indicators of Infant Pain) and one multidimensional tool (PIPP - Premature Infant Pain Profile) were applied by a sing observer before the procedure, during cleasing, during injection and two minutes after injection. Cochran Q. McNemar and kappa tests compared the presence and degree of agreement among the three scales. The Hotelling T2 test compared the groups of newborns for which the scales showed agreement of disagreement. A generalizad linear regression compared NFCS and BIIP across the four study periods. Results: Neonatal characteristics were: gestational age - 39 + 1 weeks; birth weight - 3169 + 316g; postnatal age - 67 + 45 minutes. During the painful procedure, 80% of newborns exhibited pain behaviors according to NFCS and BIIP, and 70% had pain according to PIPP (p < 0.001). Detection of pain by BIIP and NFCS was similar. The characteristics of the neonates and agreement among the scales were not associated. Conclusion: the NFCS and BIIP behavioral scales are more sensitive are more sensitive for the identification of pain in healthy term newborn infants than the multidimensional PIPP scale. (AU)