Validation of the Persian Version of Premature Infant Pain Profile-Revised in Hospitalized Infants at the Neonatal Intensive Care Units

Abstract

Background: Premature infants undergo several painful procedures in the neonatal intensive care units leading to many short-term and long-term detrimental effects on their health. Identifying pain in infants is complex because they are not able to express pain verbally. Hence, using a validated tool to assess pain in infants is essential to ensure effective control of pain. Objectives: The present study aimed to validate the Persian Premature Infant Pain Profile-revised (PIPP_R) in preterm and term infants hospitalized at neonatal intensive care units. Methods: This methodological cross-sectional study recruited 145 infants in four gestational age groups < 28, 28 - 31, 32 - 36, ≥ 37 weeks) at two NICUs in north of Iran. After obtaining permission from the tool designer, the tool was translated and back-translated, and the pain scores were compared during painful procedures in the four groups of infants as well as during two painful and non-painful procedures in three groups of premature infants in order to determine the construct validity of the tool. Infant pain responses were filmed 30 seconds before, during and after the procedure. Inter-rater reliability was determined through interclass correlation coefficient (ICC). The internal consistency of the tool was determined by Cronbach’s alpha in 145 infants during a painful procedure based on 6 PIPP-R indicators. Two physiological measures: increase in heart rate and decrease in oxygen saturation, three facial measures: brow bulge, eye squeeze and nasolabial furrow, and contextual indicators behavioral state. Gestational age was not included. Results: Irrespective of gestational age, PIPP-R scores were significantly higher during painful procedures (9.59 ± 2.55) compared to non-painful procedures (3.34 ± 1.48). A comparison of pain scores among four infant groups showed a significant difference in pricking scores among the groups (P value < 0.001). The reliability of the tool was determined by calculating ICC (0.99). The internal consistency of the instrument was determined for 6 indicators (α = 0.71). Conclusions: The results showed that the Persian version of PIPP-R has a high construct validity and reliability and can be used as a valid tool to assess pain in preterm and term infants by physicians and nurses in clinical practices. The applicability of the tool by nurses must be assessed.