基于3个英文版新生儿疼痛量表评估新生儿术后疼痛的信度和效度研究

背景 国外新生儿疼痛管理指南推荐了8个涉及术后和(或)机械通气疼痛评估量表,但尚未见中国新生儿人群的术后未行机械通气的疼痛量表评估信度和效度研究.目的 比较英文版啼哭、维持SpO2>95％所需氧浓度、心率或血压较基础值上升、面部表情、常醒(CRIES)量表,早产儿疼痛(PIPP)量表,新生儿疼痛、躁动及镇静评估(N?P...     

修订版早产儿疼痛量表对早产儿重复致痛性操作信效度及临床适用性的探讨

目的 探讨修订版早产儿疼痛评估量表(premature infant pain profile-revised,PIPP-R)的信效度和临床适用性.方法 选取2013年12月至2014年6月内蒙古医科大学附属医院NICU住院接受治疗,外周静脉留置针1次穿刺未成功的早产儿45例,用早产儿疼痛评估量表(premature infant pain profile,PIPP)和PIPP-R两个量表分别对同一患儿测血糖、第1次静脉留置针穿刺、第2次静脉留置针穿刺所致疼痛的评分进行评估.比较PIPP-R识别疼痛、识别重复致痛性操作所致疼痛的能力,评估所需时间,复本信度,Cronbach′s系数,评定者间的信度.结果 PIPP-R第1次静脉留置针穿刺疼痛评估分数高于测血糖疼痛评估分数,差异有统计学意义(t= -23.79,P=0.00),第1次静脉留置针穿刺与第2次静脉留置针穿刺PIPP 与PIPP-R评分比较差异无统计学意义(t= -1.78,P=0.08),第1次静脉穿刺PIPP-R疼痛评分所需时间较PIPP疼痛评分所需时间短,差异有统计学意义(t=27.99,P=0.00), PIPP-R与PIPP有较好的复本信度(r=0.96),PIPP-R量表Cronbach′s为0.91,评定者间信度为0.80.结论 PIPP-R适用于早产儿致痛性操作所致疼痛的评估,有较高的信效度.在临床疼痛评估方面省时、较灵活,但PIPP-R对早产儿重复致痛性操作的适用性需要进一步探讨.     

中文版《新生儿疼痛和不适量表》在0至5岁儿童急性发热舒适度的信度和效度研究

目的 评估中文版《新生儿疼痛与不适量表》（EDIN）在0～5岁儿童急性发热时舒适度研究中的信度、效度和反应度。方法 对英文版EDIN量表行翻译、回译,语言学、儿科学和量表学专家对EDIN翻译版本进行讨论、修改,形成中文EDIN预试验版。邀约5名儿科临床专家和30名急性发热儿童的监护人,在不对量表条目进行解释情况下,当场填写中文EDIN预试验版,分别行表面效度检验,形成中文版EDIN。纳入四川大学华西第二医院收治的100例0～5岁急性发热患儿作为中文版EDIN评价人群,行信度、效度和反应度评价,并以Wong-Baker量表为标准,检验中文版EDIN与Wong-Bakerl表测定结果的相关性。结果 ①5名儿科临床专家和30名急性发热患儿的监护人对中文EDIN预试验版填写完整,完成时间均＜5 min,反映中文版EDIN条目表达清楚,易于理解。② 97例急性发热患儿家长完成了对中文版EDIN填写,其数据用于信效度分析。分半信度为0.887,重测信度为0.734,总克朗巴赫系数为0.892。③中文版EDIN各条目的相关系数（r）在0.513~0.782,各条目与量表总分间的r在0.788~0.896。④对5个条目进行主成分分析,显示面部活动对总体方差贡献率为78.4%。⑤中文版EDIN与Wong-Baker量表得分的r为0.885,标准关联效度非常好。⑥分别在入院2 h后和首次填写72 h后行中文版EDIN评价,量表得分分别为7.56和2.82,效应尺度为-1.45,差异有统计学意义（P均为0.000）。结论 中文版EDIN信度、标准关联效度和反应度均良好,结构效度有待进一步验证,基本可以用于中国0～5岁儿童急性发热舒适度评价。     

循证护理实践准备度评估量表的研制及信效度评价

目的：研制适合我国国情的循证护理实践准备度评估量表,并检验其信度和效度。方法：对PARIHS模式核心元素的衍变进行文献范畴分析,结合质性访谈结果构建循证实践准备度评估量表项目池,经两轮德尔菲专家函询确定量表测试稿,并请专家对形成条目相关性进行评估,测试内容效度。选取2016年12月-2017年1月参与复旦大学护理学院“第一期证据应用培训项目”的三级医院中所有参与实践项目的临床护士为调查对象,通过项目分析对测试量表进行条目筛选、探索性因素分析进行量表维度划分,并进行信度分析,形成正式量表。结果：共纳入300名调查对象,剔除44份无效问卷,最终256份（85.33%）问卷纳入正式分析。各条目与对应维度总分的相关系数为0.569~0.829（P<0.01）,各条目与量表总分的相关系数为0.482~0.781（P<0.01）,量表内容效度为0.976,探索性因素分析共提取出3个因子,各条目的因子负荷量为0.455~0.853,累积解释总方差为62.524%,3个因子分别命名为证据、组织环境、促进因素,正式量表包括31个条目。总的Cronbach′sα系数为0.959,3个维度的Cronbach′sα系数分别为0.940、0.933、0.915,拆半信度为0.978,重测信度为0.917。结论：研制的循证护理实践准备度评估量表具有良好的信度和效度,能够指导我国循证护理实践的开展。     

全身运动质量评估对高危新生儿神经学发育结局信度和预测效度的研究

摘要 目的 以全身运动(GMs)质量评估技术对高危新生儿神经发育结局的信度和预测效度进行临床应用研究。方法 按照纳入和排除标准选择在复旦大学附属儿科医院新生儿重症监护病房住院，出院后分别在新生儿科和康复科进行随访的高危新生儿为研究对象，均记录GMs。在早产阶段和扭动运动阶段至少记录1次GMs，在不安运动阶段至少记录1次GMs。随访至1周岁以上明确神经学发育结局，采用Peabody运动发育量表(PDMS 2)确定是否有运动发育迟缓。计算敏感度、特异度、阳性预测值和阴性预测值。通过30名评估者对12例研究对象进行GMs评估，用来检测评分者间信度。由6名评估者在第1次测试间隔2个月后，对12例研究对象进行第2次测试，用来测定重测信度。结果 纳入58例高危新生儿为研究对象，男34例，女24例，早产儿42（72%）例，孕周为27~36周，平均（31.4±2.0）周，出生体重为830~2 900 g，平均（1 642±408）g；足月儿16（28%）例，孕周为37~41周，平均（38.6±1.1）周，出生体重为2 650~4 150 g，平均（3 401±365）g；随访年龄最小为12个月，最大为40个月。在早产阶段和扭动运动阶段GMs记录115次，人均记录（2.0±0.8）次；在不安运动阶段GMs记录89次，人均记录（1.5±0.6）次。随访结局：7例（12%）诊断为痉挛型脑性瘫痪（脑瘫），5例（9%）评定为运动发育迟缓，46例（79%）评定为运动发育正常。评估者间信度ICC值为 0.97~0.99，重测信度ICC值为0.69。早产阶段和扭动运动阶段GMs评估预测效度：敏感度83%、特异度78%、阳性预测值为50%和阴性预测值为95%；不安运动阶段GMs评估预测效度：敏感度75%、特异度98%、阳性预测值为90%和阴性预测值为94%。结论 在高危新生儿出生后4~5月龄内应用GMs质量评估可以就后期神经发育结局作出准确有效的预测，对脑瘫的预测更为准确。GMs质量评估在不同评估者间的稳定性高，在初学者中具有中等程度的重测信度。GMs质量评估作为一种非侵入性、非干扰性的新型神经运动评估手段，操作简便，经济投入少，适于在我国应用和推广。     

中文版《婴幼儿社会认知发展筛查量表》的信度和效度评价

目的对中文版《婴幼儿社会认知发展筛查量表》进行信度和效度评价。 方法在广州市和佛山市选取无精神发育疾病、无重大生理疾病的正常婴幼儿843名,选取中山大学附属第三医院儿童发育行为中心确诊为孤独症的幼儿170例,对中文版《婴幼儿社会认知发展筛查量表》进行修订,并且评价量表的信度和效度。结果①信度分析：全量表及4个子量表的Cronbach′s α系数均>0.7;全量表及4个子量表的分半信度系数为0.69～0.94;全量表及4个子量表的重测信度系数为0.79～0.95。②效度分析：各条目与全量表的相关系数为0.31～0.86;除认人子量表与所属条目n10的相关系数为0.40,各子量表与其他所属条目相关系数均＞0.5,但与其他子量表所属条目相关性不强;各子量表间、子量表与全量表间的相关系数均>0.5。因子分析共提取6个公因子,解释总变异的60.63％,因子分析结果与原量表结构基本一致。2～3.5岁正常幼儿全量表和4个子量表得分都显著高于同年龄段孤独症幼儿。结论中文版《婴幼儿社会认知发展筛查量表》具有较好的信度和效度,且操作简便,可用于临床上评价0.5～3.5岁婴幼儿社会认知能力的发展情况。     

新生儿重症监护病房医护人员对新生儿疼痛评估和镇痛管理的认知现状调查

目的 了解新生儿重症监护病房（neonatal intensive care unit，NICU）医护人员对新生儿疼痛评估和镇痛管理的认知现状。 方法 根据《新生儿疼痛评估与镇痛管理专家共识（2020版）》自制量表，采用此量表对江苏省新生儿科医疗质量控制中心成员单位的NICU医护人员发放问卷调查表，分析其对新生儿疼痛的基本知识、评估和管理的掌握水平。 结果 共收回有效问卷957份，其中医生383份，护士574份。医生与护士对新生儿疼痛基本知识的答题正确率的均值分别为38%和39%；对新生儿疼痛评估的答题正确率的中位值分别为0%和50%；对镇痛管理的答题正确率的均值分别为73%和68%。接受过疼痛相关培训的医护人员对新生儿疼痛基本知识和疼痛评估的答题正确率较未接受相关培训的医护人员显著增高（P<0.05）。三级医院医护人员对新生儿疼痛基本知识和疼痛评估的答题正确率较二级医院医护人员显著增高（P<0.05）。 结论 NICU医护人员对新生儿疼痛的认识不足，需开展有关新生儿疼痛知识的专项培训，建议侧重对《新生儿疼痛评估与镇痛管理专家共识（2020版）》的推广和临床应用，以提高医护人员对新生儿疼痛评估和镇痛管理的水平。     

家属版复苏陪伴利弊评估量表的汉化及信效度研究

目的：对家属版复苏陪伴利弊评估量表(FPDR-BRS)进行汉化,并检测其信效度。方法：翻译并修订FPDR-BRS,采用中文版FPDR-BRS对2016年5月24日至2016年11月2日253名儿童急诊Ⅰ、Ⅱ级及急诊重症留观病危患儿的家属进行调查,分析评价其信度和效度。结果：对中文版FPDR-BRS在临界组比较、条目与总分相关、同质性检验3个方面进行量表的项目分析,结果显示量表条目具有良好的适切及可靠程度。量表的内容效度指数为1.0。分别对利益和风险子量表进行探索性因子分析,利益项量表因子分析结果显示,Bartlett球形检验KMO值为0.876（P＜0.01）,主成分分析提取2个主因子,可解释总体方差的53.0%,各条目的因子载荷为0.588~0.795,可很好地解释原量表的13个条目,分别命名为充分理解与积极应对,Cronbach's α系数为0.873;风险项量表因子分析结果显示,Bartlett球形检验KMO值为0.883（P＜0.01）,主成分分析提取2个主因子,可解释总体方差的64.5%,各条目的因子载荷为0.726~0.892,可很好地解释原量表的10个条目,分别命名为个人风险与人员风险,Cronbach's α系数为0.890。结论：中文版FPDR-BRS具有良好的信度和效度,可以应用于评估家属对复苏陪伴的态度及意向。     

婴幼儿血管瘤生活质量专用量表的信度与效度检验及其临床应用

目的国内尚没有评价婴幼儿血管瘤患儿生活质量的专用量表(quality-of-life instrument for IH,IH-QOL)。本研究拟对婴幼儿血管瘤生活质量专用量表中文版的信度与效度进行验证,目的在于评价其在中国人群中的适用性。方法研究者译制出婴幼儿血管瘤生活质量专用量表中文版,并使用该版本对婴幼儿血管瘤患儿的生活质量进行调查。计算该中文版Cronbach'sα系数,分析其信度与效度,并对影响婴幼儿血管瘤生活质量专用量表评分的因素进行分析。结果本研究共纳入201例婴幼儿血管瘤。婴幼儿血管瘤生活质量专用量表中文版Cronbach'sα系数为0. 766,说明其具有良好的信度和结构效度。多元线性回归分析显示,IH位置和大小是影响IH-QOL总分的影响因素(P 0. 05)。IH位置和大小可以解释的变异占总变异的24. 7%。回归分析最终模型有统计学意义(F=4. 279,P=0. 006)。结论婴幼儿血管瘤生活质量专用量表中文版具有良好的信度与效度,可用于评估我国婴幼儿血管瘤患儿及其父母生活质量。婴幼儿血管瘤瘤体位置及大小是影响其生活质量的因素。     

中文版北极星移动评价量表在Duchenne型肌营养不良症患儿的信度和效度研究

目的：确定中文版北极星移动评价量表（NSAA）应用在Duchenne型肌营养不良症（DMD）患儿的信度和效度。方法：纳入对象为2014年1月至2016年1月在复旦大学附属儿科医院康复科接受功能评估的DMD患儿,均经基因检测或肌肉活检明确诊断,能独立行走≥10 m,无严重认知障碍。2名物理治疗师同时对DMD患儿进行测试,检验不同测试者间的信度;同一评价者在第1次评价后3~7 d进行第2次评价,检测重测信度;采用《国际功能、残疾和健康分类》儿童和青少年版（ICF-CY）的类目编码与NSAA的项目概念进行关联,确定NSAA的内容效度;通过分析NSAA的分值与6 min步行距离的相关性进行关联效度分析。结果：2个治疗师对20名DMD男孩的不同测试结果间的信度分析显示,NSAA原始分和线性分信度ICC分别为0.96和0.97;1名治疗师前后3～7 d重测16名DMD男孩,NSAA的原始分和线性分具有很好的重测信度（ICC=0.96）;NSAA17个项目共与8个ICF-CY编码发生了20次关联,8个编码都属于d4（移动）下属,表明NSAA的评价内容主要聚焦于DMD患儿活动能力中的移动能力;143例DMD男孩的NSAA原始分和线性分与6min步行距离具有中等程度的相关性（r分别为0.40和0.38）。结论：中文版NSAA量表无论是原始分还是线性分都具有良好的心理测量学特性,结合其他的评价指标,NSAA可以有效地评价中国DMD男孩的活动能力。     

Postoperative pain assessment in the neonatal intensive care unit

OBJECTIVES: To compare the convergent validity of two measures of pain (premature infant pain profile (PIPP) and crying, requires oxygen, increased vital signs, expression, and sleepless (CRIES)) in real life postoperative pain assessment in infants. METHODS: This study was a prospective, repeated measures, correlational design. Two staff nurses were randomly assigned either the PIPP or CRIES measure. An expert rater assessed each infant after surgery, and once a day using the visual analogue scale (VAS). SETTING: A level III neonatal intensive care unit in a metropolitan university affiliated paediatric hospital. RESULTS: Pain was assessed in 51 neonates (28-42 weeks of gestational age) after surgery. There was no significant difference in the rates of change between the pain assessment measures across time using repeated measures analysis of variance (F(50,2) = 0.62, p = 0.540), indicating correlation between the measures. Convergent validity analysis using intraclass correlation showed correlation, most evident in the first 24 hours (immediately, 4, 8, 20, and 24 hours after the operation). Correlations were more divergent at 40 and 72 hours after surgery. No significant interactions were found between gestational age and measure (F(304,4) = 0.75, p = 0.563) and surgical group and measure (F(304,2) = 0.39, p = 0.680). CONCLUSIONS: PIPP and CRIES are valid measures that correlate with pain for the first 72 hours after surgery in term and preterm infants. Both measures would provide healthcare professionals with an objective measure of a neonatal patient's pain.     

Measurement of pain-like response to various NICU stimulants for high-risk infants

BACKGROUND: Infants during neonatal intensive care are invariably exposed to various procedural and environmental stimuli in which the pain-like responses may vary depending on the nature of the stimuli and the infants' condition. AIM: To examine firstly the pain-like responses to frequent stimulants in the neonatal intensive care unit (NICU) using CRIES, FLACC and PIPP, and secondly the clinical feasibility and validity of using these pain measurements for high-risk infants. STUDY DESIGN AND SUBJECTS: In a correlational study of 110 premature infants receiving neonatal intensive care, the pain-like responses to 274 observations of 8 types of frequently applied stimulant, classified into three categories according to the degree of invasiveness, were observed using CRIES, FLACC and PIPP. RESULTS: There was a significant difference in response scores among the three categories for CRIES and PIPP. In post-hoc Scheffé test, category A had the highest response scores. The response scores from CRIES and FLACC were lower for the premature infants than for the full-term infants in both categories A and B, whereas the PIPP scores were higher for the premature infants than for the term infants in category C. CONCLUSIONS: Full-term infants tended to express more distinct pain-like responses to invasive procedures or direct contacts than premature infants did. However, PIPP may be more sensitive to evaluate the negative effects of environmental auditory stimulants, particularly for premature infants receiving neonatal intensive care. Further study to refine these instruments may increase the clinical feasibility of pain measurements in high-risk infants.     

Pain and stress assessment after retinopathy of prematurity screening examination: Indirect ophthalmoscopy versus digital retinal imaging

ABSTRACT: BACKGROUND: Increasingly, neonatal clinics seek to minimize painful experiences and stress for premature infants. Fundoscopy performed with a binocular indirect ophthalmoscope is the reference examination technique for screening of retinopathy of prematurity (ROP), and it is associated with pain and stress. Wide-field digital retinal imaging is a recent technique that should be evaluated for minimizing infant pain and stress. METHODS: The purpose of the study was to assess and compare the impact of using a binocular indirect ophthalmoscope (BIO), or wide-field digital retinal imaging (WFDRI) on pain and stress in infants undergoing ROP screening examination. This was a comparative evaluation study of two screening procedures. Ophthalmologic examinations (N = 70) were performed on 24 infants with both BIO and WFDRI. Pain assessments were performed with two specific neonatal scales (Crying, requires oxygen, increased vital signs, expression and sleeplessness, CRIES and, Premature infant pain profile, PIPP) just prior to the examination, and 30 seconds, 1 hour, and 24 hours later after ending the examination. RESULTS: Changes over time were significantly different between BIO and WFDRI with both scales (PIPP score, p = .007, and CRIES score, p = .001). Median PIPP score (interquartile interval) at baseline was 4 (3-5). At 30 seconds the score was 8 (6-9) for BIO and 6 (5-7) for WFDRI, respectively. The increase in PIPP score between baseline and 30 seconds was significantly lower with WFDRI (p = .006). The median increase in CRIES score from baseline to 30 seconds was 1 point lower for WFDRI than for BIO (p < .001). No significant difference in response remained at 1 hour or 24 hour assessments. CONCLUSIONS: A transient short-term pain and stress response occurs with both BIO and WFDRI. Infants examined for screening of ROP with digital retinal imaging present less pain and stress at 30 seconds following completion of the exam when compared with binocular indirect ophthalmoscopy.     

Assessing and treating pain in the newborn

OBJECTIVES: To update information about available neonatal pain assessment and pain relief methods.METHOD: Medical literature review of the past 10 years, including textbooks, general reviews, systematic reviews, prospective, randomized controlled studies, retrospective works and case studies. Literature was reviewed based on the author clinical and scientific experience regarding pain evaluation and treatment.RESULTS: Lack of verbal expression of pain is one of the major impediments to adequate pain relief in the neonatal period. Nowadays, several valid pain assessment tools are available, including the analysis of the neonate facial features and multidimensional tools, as NIPS, CRIES, and PIPP. Non-pharmacological pain relief can be achieved by non-nutritive suction and suction of dextrose water. Neonatal analgesia, in general, includes de the use of paracetamol, opioids and local anesthetics. Opioids remain the main resource for acute pain treatment in the neonatal intensive care unit. Sedatives are important agents to decrease patient activity and restlessness, but they do not relieve pain.CONCLUSION: Based on medical, ethical, and humanitarian grounds, neonatal pain should be considered and treated.     

Is the ABC pain scale reliable for premature babies?

AIM: We recently developed the ABC scale to assess pain in term newborns. The aim of the present study was to assess the reliability of the scale in preterm babies. MATERIAL AND METHODS: The scale consists of three cry parameters: (a) pitch of the first cry, (b) rhythmicity of the bout of crying and (c) cry constancy. Changes in these parameters were previously found to distinguish medium and high levels of pain as evaluated by spectral analysis of crying. We enrolled 72 babies to perform the steps usually requested to validate a scale, namely the study of the concurrent validity, specificity and sensibility. Moreover, we assessed the interjudge reliability and the clinical utility and ease of the scale. RESULTS: A good correlation (r = 0.68; r(2)= 0.45; p < 0.0001) was found between scores obtained with the ABC scale and the premature infant pain profile (PIPP) scale, demonstrating a good concurrent validity. The scale also showed good sensitivity and specificity (we found statistically significant differences between mean values of scores obtained in babies who underwent pain and babies who underwent non-painful stimulus.) Interobserver reliability was good: Cohen's kappa = 0.7. CONCLUSION: The good correlation between the two scales shows that the ABC scale is also reliable for premature babies.     

Pain assessment in the neonate using the Bernese Pain Scale for Neonates

BACKGROUND: Neonates who require treatment in the neonatal intensive care unit (NICU) are subjected to many invasive painful procedures. AIMS: Assessment of pain in preterm and term neonates with or without ventilation on continuous positive airway pressure using the Bernese Pain-Scale for Neonates (BPSN). The validity and the reliability of the BPSN was established. STUDY DESIGN AND SUBJECTS: Pain assessments (n=288) were performed by 6 health care workers in different situations of term and preterm neonates. Each neonate (n=12) was observed in four given situations (after feeding, while a foot was being warmed, while a routine capillary blood sample was taken and 15 min after the blood sample was taken). Pain assessments were made by two nurses at the bedside using the BPSN, the Visual-Analogue Scale (VAS) and the Premature Infant Pain Profile (PIPP). At the same time, a video sequence was made which was shown later to four different nurses to assess pain using the BPSN, the PIPP, and the VAS. RESULTS: The construct validity of the BPSN was very good (F=41.3, p<0.0001). Moreover, concurrent and convergent validity of the BPSN compared to VAS and PIPP was r=0.86, and r=0.91, p<0.0001, respectively. Finally, the study demonstrated high coefficients for interrater (r=0.86-0.97) and intrarater reliability (r=0.98-0.99). CONCLUSION: The BPSN was shown to be a valid and reliable tool for assessing pain in term and preterm neonates with and without ventilation.     

The relationship between behavioral states and pain responses to various NICU procedures in premature infants

An explanatory observational study was conducted to assess the behavioral state before and during various procedures in the neonatal intensive care unit (NICU) and to investigate the relationship between the behavioral state measured by Anderson Behavioral State Scoring System (ABSS) and the degree of pain responses as measured using CRIES (Crying, Requires O(2) for oxygen saturation above 95, Increased vital signs, Expression, and Sleeplessness.) and PIPP (Premature Infants' Pain Profile). Ninety-one observations in 6 NICU procedures were made from 54 infants with a mean gestational age (GA) of 30(+4) weeks and a mean body weight (BW) of 1484.87 g. A positive relationship was identified between ABSS and CRIES, both before (r=0.244, p=0.020) and during (r=0.745, p=0.000) the procedures, and between CRIES and PIPP (r=0.447, p=0.000) during the procedures. However, no correlation was identified between PIPP and ABSS before (r=-0.055, p=0.651) and during (r=0.214, p=0.074) the procedures. This study concluded that relatively healthy, premature infants are in a state of quiet or active sleep and can adequately express pain-related responses to the NICU procedures that are appropriate with the nature of stimulation. However, it was observed that clinicians tend to pay little attention to the state of premature infants before performing the procedures, regardless of their invasive and stimulatory nature. Further research needs to be conducted on the pain responses in physiologic and behavioral expression of critically ill infants who possibly have alteration and developmental limitations in response.     

Inter-observer reliability of two pain scales for newborns

AIM: To assess inter-observer reliability of two of the most widely used pain scales for newborns. BACKGROUND: More than 30 scales exist to assess neonatal pain, but they are rarely used because they are too complicated or unreliable. METHOD: We scored pain level in two groups of babies during a heelprick. The first group of 20 premature babies (mean gestational age: 34.2+/-1.2 weeks) was studied using the PIPP scale, and the second group of 20 term babies (mean gestational age: 39.5+/-0.9 weeks) with the NIPS scale. We compared the pain scores assigned by the nurse who took the blood sample (nurse A) and those assigned by another who was present during heelprick (nurse B) with those assigned by a nurse who later watched the video clip of the procedure (nurse C). We chose the latter as "objective" score, because in this case the scorer could watch the recorded event several times, timing and scoring it thoroughly. FINDING: NIPS: 8/20 scores were different between nurse A and nurse C, but only in one case was this difference greater than 2 (Cohen's K=0.60). In the case of nurse B, there were 12/20 differences with respect to the score assigned by nurse C but only one baby was assigned a score that differed by more than 2 (Cohen's K=0.30). PIPP: 16/20 scores were different between nurse A and nurse C; in 9 cases this difference was more than 2 (Cohen's K=0.10). In the case of nurse B, differences with respect to the score assigned by nurse C occurred in 17/20 cases and for six babies the difference in score was more than 2 (Cohen's K=0.16). CONCLUSION: Our results indicate a higher inter-observer reliability of NIPS than PIPP, though NIPS did not have a very high inter-observer agreement score. Caregivers who use them to assess pain in real time at the cribside should be aware of the limits we have highlighted in this study.     

Feeding and oral glucose--additive effects on pain reduction in newborns

AIMS: The aims of this study were to compare the pain reducing effect of oral glucose with that of being breast-fed shortly before venipuncture in newborns, and also the pain score and crying time with parents' assessment. DESIGN: Randomised, controlled trial. SUBJECTS: 120 full term newborns undergoing venipuncture randomly assigned to on of four groups: I, Breast-fed and 1-ml placebo; II, Breast-fed and 1-ml 30% glucose; III, Fasting and 1-ml placebo; and IV, Fasting and 1-ml 30% glucose. OUTCOME MEASURES: Pain during venipuncture was measured with the Premature Infant Pain Profile (PIPP). Crying time was recorded. The parents assessed their babies' pain on a Visual Analogue Scale (VAS). RESULTS: The PIPP score was significantly lower in the infants receiving glucose, than in those not given glucose (p=0.004). There was no significant difference in PIPP score between the infants who were fed and the fasting infants. The PIPP score was lower in group II (median 7) than in group I (md 10). There was a similar difference between group IV (md 9) and group III (md 11). The median crying times during the first 3 min in groups I, II, III, and IV were 63, 18, 142 and 93 s, respectively. There was low agreement between the parents' assessment of pain and the PIPP score and crying time. CONCLUSION: Breast-feeding shortly before venipuncture has no major impact on the pain score but on crying time. The combination of oral glucose and breast-feeding shows the lowest pain score and significantly shorter duration of crying.     

Sucrose and non-nutritive sucking for the relief of pain in screening for retinopathy of prematurity: a randomised controlled trial

BACKGROUND: Screening is necessary for infants at risk of retinopathy of prematurity. Despite local anaesthetic drops, infants find eye examinations distressing, displaying behavioural and physiological changes indicating acute pain. Oral sucrose and non-nutritive sucking reduce pain responses associated with invasive procedures. OBJECTIVE: To evaluate the use of oral sucrose and/or pacifier for reducing pain responses during eye examinations. METHODS: Forty infants <32 weeks gestation or <1500 g birth weight, in two neonatal units, were randomised to one of four interventions administered two minutes before their first screening examination: 1 ml sterile water as placebo (group 1, n = 10), 1 ml 33% sucrose solution (group 2, n = 10), 1 ml sterile water with pacifier (group 3, n = 9), or 1 ml 33% sucrose solution with pacifier (group 4, n = 11). Examinations were videotaped. Two observers, blind to the intervention, assessed recordings. Pain responses were scored using the premature infant pain profile (PIPP). RESULTS: The groups were similar in gestation, birth weight, and age at examination. Mean PIPP scores were 15.3, 14.3, 12.3, and 12.1 for groups 1, 2, 3, and 4 respectively. Analysis of variance showed a significant difference in PIPP score between groups (p = 0.023). Infants randomised to pacifiers scored lower than those without pacifiers (p = 0.003). There was no difference between groups receiving sucrose and those receiving water (p = 0.321). CONCLUSIONS: Non-nutritive sucking reduced distress responses in infants undergoing screening for retinopathy of prematurity. The difference in response was large enough to be detected by a validated assessment tool. No synergistic effect of sucrose and pacifier was apparent in this group.