Abstract
BackgroundA number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; however, no reliable or valid measure exists for infants who are at risk for neurological impairments (NI). The objective of this study was to establish consensus about which behavioural, physiologic and contextual indicators best characterize pain in infants at high, moderate and low levels of risk for NI.MethodsA 39- item, self-administered electronic survey that included infant physiologic, behavioral and contextual pain indicators was used in a two round Delphi consensus exercise. Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI.ResultsThe strength of agreement between expert raters was moderate in Round 1 and fair in Round 2. In general, pain indicators with the highest concordance for all three groups were brow bulge, facial grimace, eye squeeze, and inconsolability. Increased heart rate from baseline in the moderate and severe groups demonstrated high concordance. In the severe risk group, fluctuations in heart rate and reduced oxygen saturation were also highly rated.ConclusionThese data constitute the first step in contributing to the development and validation of a pain measure for infants at risk for NI. In future research, we will integrate these findings with the opinions of (a) health care providers about the importance and usefulness of infant pain indicators and (b) the pain responses of infants at mild, moderate and high risk for NI.
Highlights
A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; no reliable or valid measure exists for infants who are at risk for neurological impairments (NI)
Delphi survey: expert opinions about managing pain in infants at risk for NI A 39- item self-administered survey was developed by the study investigators to include indicators representing infant physiologic, behavioral and contextual pain responses [2] as well as pain indicators identified by parents and health professionals
A total of 6/42 individuals returned an email message stating that they were declining from completing the survey as Increased heart rate from
Summary
A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; no reliable or valid measure exists for infants who are at risk for neurological impairments (NI). Stevens et al [2], found that during the first day of life, neonates at highest risk for NI experienced the greatest number of painful procedures (e.g., suctioning, heel lances, intravenous starts) compared to lower risk groups and were administered the least amount of opiods [2]. To appropriately manage these at-risk infants, a reliable and valid approach to assessing pain is required
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