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

Abstract

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.