Pain Response In Infants Research Articles

Efektifitas Pemberian Non Nutritive Sucking Terhadap Respon Nyeri Neonatus Pada Pemberian Imunisasi Hb0 Diruang Perinatologi Rs X Husada Malang

Neonatal pain response is an unpleasant experience due to subjective damage to body tissues which can be assessed by facial expressions, body movements, crying and resting using a pain scale. This study aims to determine the effect of Non-Nutritive Sucking on neonatal pain response to HB0 immunization at Wava Husada Malang Hospital. This study used a quasi-experimental post test only control group design. The sample of this study were neonates with a maximum age of less than 24 hours as many as 28 respondents. Using Accidental sampling technique. The independent variable is Non-Nutritive Sucking and the dependent variable is neonatal pain response. Data collection is by taking samples according to the inclusion criteria which are divided into the intervention group and the control group, the data ratio scale. Data analysis used the Mann-Whitney U test (alpha 0.05). The mean response to pain in the control group was higher than the average response to pain in the intervention group. The results of the Mann-Whitney U statistical test obtained a value of Z = -3.90 with a p value = 0.000 which indicated that there was a significant difference in neonatal pain responses in infants during HB0 immunization between the intervention group and the control group.

Effects of White Noise Sound on the Severity of Muscle Vaccination Pain in Children Under Two Years.

Pain and its control is a significant health problem worldwide. The present study aimed to determine the effects of white noise (bird sound) on the severity of muscle vaccination pain in children under two years old. This study was a case-control study conducted in 2021. The samples included seventy children under two years old referred to the health centers in Ramsar City, Iran. The samples were selected using the convenient sampling method and divided into experimental and control groups. The data were collected using the demographic characteristics questionnaire, facial expression, and pain assessment in pediatric patients (FLACC). They were then analyzed by SPSS16 using an independent t-test and analysis of covariance (P<0.05). A significant difference was observed between the severity of muscle vaccination pain in children in the two groups (p=0.042); the pain intensity mean in the experimental group (6.45±2.01) was lower than the control group (8.94±1.28). This method can be a harmless and inexpensive intervention to reduce pain intensity and behavioral pain responses in infants during painful procedures, especially vaccination.

The effect of oscillometric blood pressure measurement on pain response in preterm infants.

Preterm neonates are exposed to many painful procedures in neonatal intensive care units. This study aims to evaluate the effect of oscillometric blood pressure (BP) measurement on pain response in preterm infants. This prospective study was performed over 4 months in a level III neonatal intensive care unit. Premature neonates whose gestational age was <34 weeks and postmenstrual age <36 weeks were included if they had no systemic diseases. BP measurement was performed on the right arm. The Premature Infant Pain Profile-Revised (PIPP-R) scores were evaluated three times before, during, and 10 min after BP measurement. During the 5-month period, 100 preterm neonates (53 male infants) were included in the study. Median birth weight and gestational age of the infants were 1148 (IQR: 1015-1300) g and 28 (IQR: 27-30) weeks, respectively. PIPP-R scores were found to be ≥7 in 34% of neonates. PIPP-R scores increased during BP measurement and decreased after. Our results demonstrated that oscillometric BP measurement which is generally accepted as a non-invasive tool for monitoring can produce mild pain in premature neonates of postmenstrual age <36 weeks.

Pain responses in preterm infants and parental stress over repeated painful procedures: a randomized pilot trial

Objectives In this pilot study, the aims were to determine the feasibility of whether pain behavior in extremely and very preterm infants and perceived parental stress change when parents are involved in pain reducing measures, either actively, performing facilitated tucking or passively, observing the intervention, in comparison to the involvement of nurses only. In addition, the infant’s pain reactivity and parental stress over three time points of measurement was of interest. Methods Extremely and very preterm infants in need of subcutaneous erythropoietin were randomly assigned to the two intervention groups. The intervention encompassed that one parent of each infant was involved during the painful procedure: Either parents executed facilitated tucking themselves or stood by, observing the procedure. Usual care involved that nurse executed facilitated tucking. All infants received 0.5 ml of 30% oral glucose solution via cotton swab before the painful procedure. Infant pain was observed with the Bernese Pain Scale for Neonates (BPSN) and measured with the MedStorm skin conductance algesimeter (SCA) before, during, and after the procedure. Parents’ stress levels were measured before and after the painful procedure on the infant, using the Current Strain Short Questionnaire (CSSQ). Feasibility of a subsequent trial was determined by assessing recruitment, measurement and active parental involvement. Quantitative data collection methods (i.e. questionnaires, algesimeter) were employed to determine the number of participants for a larger trial and measurement adequacy. Qualitative data (interviews) was employed to determine parents’ perspectives of their involvement. Results A total of 13 infants (98% participation rate) were included along with their mothers. Median gestational age was 27 weeks (IQR 26-28 weeks), 62% were female. Two infants (12.5%) dropped out of the study as they were transferred to another hospital. Facilitated tucking turned out to be a good method to actively involve parents in pain reducing measures. No significant differences between the two intervention and control groups were found concerning parental stress and infant pain (p = .927). Power analysis indicated that at least N = 741 infants (power of 81%, α = .05) would be needed to obtain statistically significant results in a larger trial, as effect sizes were smaller than expected. Two of the three measurement tools – i.e. the BPSN and CSSQ) – proved easy to implement and were well accepted. owever, the SCA was challenging in this context. Measurements were also found to be time-consuming and resource-intense (i.e. health professionals as assistants). Conclusions Although the intervention was feasible and was readily accepted by parents, the study design was found to be challenging along with the SCA. In preparation of the larger trial, the study design needs to be revisited and adjusted. Thus, issues of time and resources may be resolved. In addition, national and international collaboration with similar neonatal intensive care units (NICU) needs to be considered. Thus, it will be possible to conduct an appropriately powered larger trial, which will yield important results to improve pain management in extremely and preterm infants in NICU.

The Impact of Breast Milk Taste and Smell in Reducing Pain in Infants Undergoing Blood Drawing Procedure: A Randomized Controlled Study.

Background: Infants hospitalized in neonatal intensive care units (NICUs) are exposed to numerous procedures that cause pain. In the literature, pain management methods in infants are evaluated by using breast milk in various ways. However, no study was found on whether the smell of breast milk, its taste, or both are more effective in pain management. Aim: The purpose of this study is to comparatively investigate the efficacy of breast milk taste and/or smell in reducing pain responses in infants undergoing a blood drawing procedure. Methods: The population of this study, which has a randomized controlled prospective design, consisted of infants who were treated in a NICU and met the inclusion criteria. The heart rate (HR), oxygen saturation (SpO2), and pain of the infants were evaluated before, during, and after the blood drawing procedure in all groups. Results: During and after the procedure, there were significant differences in terms of pain levels, SpO2 levels, and HR between the groups (p = 0.000). The lowest pain score during the procedure was found in the infants to whom breast milk taste and smell were administered together. The group with the second-lowest pain score was exposed to the taste of breast milk. The group with the highest pain score was the control group. Conclusion: Breast milk smell and taste are recommended for use as a nursing intervention to reduce pain, decrease the HR, and increase SpO2 in the NICU during painful procedures. Future research needs to explore different interventional practices.

Effect of kangaroo Care on Pain Response in Premature Infants during Blood Sampling

Effect of kangaroo Care on Pain Response in Premature Infants during Blood Sampling

Effect of Olfactory Stimulation with Breast Milk on Pain Responses to Heel Stick in Premature Infants: A Randomized Controlled Trial.

Purpose: This study aimed to evaluate the effect of breast milk olfactory stimulation on pain response in premature infants during heel stick tests. Methods: A quasi-experimental randomized controlled trial was conducted in the neonatal intensive care unit of a tertiary-level hospital in Seoul, Korea. A breast milk group was provided olfactory stimulation with breast milk 30 seconds before the start of heel stick sampling, and a control group underwent heel stick sampling without olfactory stimulation. To evaluate infants' pain response, the heel stick procedure was video recorded, and pain response was assessed separately by two blinded research assistants using the Premature Infant Pain Scale (PIPS) through behavioral response, heart rate on physiological monitoring, and blood oxygen saturation on pulse oximetry through the video recording. Results: Forty-eight premature infants (gestational age, within 28-37 weeks, n = 24; control) were included in this study. The pain scores of the breast milk group were significantly lower than those of the control group (z = -2.04, p = 0.021). Conclusion: Breast milk odor may reduce pain in premature infants during heel stick tests.

Effect of Positioning on the Pain Response of Infants Vaccinated with Inactivated Polio and Pentavalent (dtwp-hepatitis B-hemophilus Influenza B) Vaccines

Objective – To compare the acute pain response to sequential vaccination in two different positions: holding the baby on the parent’s lap during vaccination injections (cuddle position) and making infants lie supine on the bed during vaccination procedure (bed position) after administration of IPV and pentavalent vaccines. Material and Methods − A total of 68 infants 34 each in cuddle and bed positions were included in the study. The procedure of injection was video recorded and later analysed by two resident interns for the pain response before and after the procedure using the neonatal infant pain scale (NIPS). Results − The baseline NIPS scores, median (IQR) was 0 (0-1) in the cuddle position and 0 (0-2) in the bed position. The pain response in both cuddle and bed positions was similar with a final NIPS score, median (IQR), of 7 (7-7). Conclusion − The parent held ‘cuddle position’ did not benefit the infants in terms of reducing acute pain response to vaccine injections compared to the supine (bed) position on the table.

Efektivitas Metode 5 S terhadap Respon Nyeri pada Bayi Usia 2-6 Bulan saat Imunisasi Pentavalen

Pentavalent immunization is an immunization developed from a combination of vaccines so that there are eight antigens that can be given to children, namely Hepatitis B, BCG, Oral Polio, Diphtheria, Pertussis, Tetanus, Hib and Measles. The act of immunization can cause pain in babies, so that the baby becomes fussy. The aim of this study is to determine the effectiveness of the 5 S Method (Swaddling, Side / Stomach Position, Shushing, Swinging, Sucking) on Pain Response in Infants aged 2-6 Months during Immunization. Pentavalent. The design of this research is experimental research with the design of Post Test Only Control Group Design. The total sample in this study was 36 babies. This research was conducted at Puskesmas Bestari, Medan. Sampling using consecutive sampling. Collecting data using a FLACC scale questionnaire. Data analysis using paired t-test. The results showed that the effect of the 5S method on the pain response of infants aged 2-6 months during pentavalent immunization was shown by the statistical t-test with p = 0.007 and significantly reduced the pain response of infants at 15 seconds, second. 30, 45 seconds, and can reduce the length of crying babies after injection of pentavalent immunization. The results of this study are expected that nurses can use the 5 S method in relieving the pain response and the duration of crying in infants during immunization or when inserting sharp objects into the baby's body.

Pengaruh Metode 5’S (Swadding, Stomach Position, Sushing, Swingging, Sucking) terhadap Respon Nyeri Bayi Setelah Imunisasi HB-0

Immunization is a source of acute pain in infants that can cause trauma, nonpharmacological techniques that can be done is by giving of 5'S method(swaddling, stomach position, sushing, swinging, and sucking) which are effective and easy to do and the purpose of this study was to find out whether there is an effect of 5'Smethod (swaddling, stomach position, sushing, swinging and sucking) on pain response in infants after Hb-0 immunization at Grandmed Hospital LubukPakam, the method and design of this study was Quasy Experiment with one group pre test and post test design. the population in this study were infants aged0-7 days who received Hb-0 immunization, amounting to 40 people with purposive sampling technique according to inclusion criteria and pain measurement uses the NIPS (Neonatal Infant Pain Scale) pain scale, the data analysis was performed by Paired Sample t-test with a confidence level of 0.05%, the results of the study were lower pain in the treatment group with p = 0.0000 &lt;0.05 (&lt;ɑ), the conclusion of this study is that there was an effect of the 5'S method (swaddling, stomach position, sushing, swinging, and sucking) on pain response in infants after Hb-0 immunization.Immunization is a source of acute pain in infants that can cause trauma, nonpharmacological techniques that can be done is by giving of 5'S method(swaddling, stomach position, sushing, swinging, and sucking) which are effective and easy to do and the purpose of this study was to find out whether there is an effect of 5'Smethod (swaddling, stomach position, sushing, swinging and sucking) on pain response in infants

Effects of Music Based Intervention (MBI) on Pain Response and Neurodevelopment in Preterm Infants

Effects of Music Based Intervention (MBI) on Pain Response and Neurodevelopment in Preterm Infants

The impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review protocol.

The objective of this review is to determine if electronic health (eHealth) educational interventions for infant procedural pain and pain management impact parental outcomes (mental health outcomes, knowledge utilization outcomes, and parental involvement in care outcomes) and infant outcomes (morbidity outcomes, pain outcomes, health system outcomes). Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, yet infants often receive little to no pain management. While research has shown that parents can reduce their infant's pain during procedures by breastfeeding or skin-to-skin contact, parents may not be aware of their role in pain management. Despite the recent rapid increase in eHealth resources to educate parents about infant pain management, their impact has yet to be evaluated. This review will consider studies that include eHealth educational interventions targeted at parents during pregnancy and up to one year postpartum. All experimental study designs will be included. Primary outcomes will include: parental stress and anxiety, self-efficacy, knowledge, attitudes, eHealth intervention usage, acceptance of eHealth intervention, involvement in pain management, and infant pain response. PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO will be searched for studies published in English. Critical appraisal and data extraction will be conducted by two independent reviewers using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.

NON-NUTRITIVE SUCKING (NNS) AND PAIN RESPONSE NEONATAL

Pain is a sensation that is difficult to remember. Pain exposure is a stimulus that can damage the development of the baby's brain and contribute to learning disorders and behavior in childhood. Therefore nursing intervention is needed that can reduce the pain response in infants, especially during hospital treatment. The aim of the study was to determine the effect of non-nutritive sucking (NNS) and ASI (Air Susu Ibu or Breast Milk) on oral responses to acute pain in the neonate when invasive actions were performed. The benefits of research as evidence-based practiced about administering NNS and ASI orally to pain responses in neonates when experiencing pain. The research design uses experimental nonequivalent control group before and after design. The population of all neonates admitted to Dr. Soekardjo Tasikmalaya, with a total sample of 30 respondents consisting of 15 ASI respondents and 15 respondents for the NNS group. Pain assessments instruments CRIES (Crying, Requiring an increase in oxygen, Increased vital sign, Expression, Sleeplessness) was applied. Data analysis used non parametric tests Mann Whitney and Wilcoxon. The results of the study showed no significant differences in pain response before and after the intervention (p-value 0.236). It was suggested that nurses can improve health education for parents to be able to provide breastfeeding during treatment, especially when the baby receives invasive action.

Effect of Eye Shield versus Massage on Preterm Infants’ Pain Response during Venipuncture

Background: Evidence demonstrates that controlling pain in the preterm infants during the neonatal periods is improving physiological, behavioral and hormonal outcomes. Eye shield and massage may play an important role as a non-pharmacological pain management during venipuncture. Aim: Is to investigate effect of eye shield and massage on preterm infants’ pain response during venipuncture. Patients and Methods: Time seriesquasi experimental research design was carried out on a randomized sample of 100 newborn infants attending the Neonatal Intensive Care Unit (NICU) of El Manial University Hospital (Kasr Al Ainy), (30control group,30 eye shield group and 30 massage group). Neonatal assessment tool and Preterm Infant Pain Profile (PIPP) were utilized for data collection. Results: There was a significant mean difference between control, eye shield and massage groups regarding PIPP pain assessment scores in three time frames (before venipuncture T0, during T1 and after T2) at P? 0.00 but there wasn’t a significant mean differences after 5 min (T3). Massage group had the fewest mean PIPP score during four time frames (3.50±0.97 before venipuncture, 8.16±1.91 during venipuncture, 4.30±4.30 after venipuncture and 3.22±0.81 after 5 minutes of venipuncture). Conclusion: ANOVA indicated that massage and eye shield groups showed a significant reduction in preterm infant’s pain response than control group during venipuncture but massage was more effective than eye shield. Recommendations: Further studies needed to evaluate the effect of massage in combination with eye shield on preterm infant pain response.

Comparison of pain response to vein puncture versus heel lance among preterm infants undergoing blood sampling

Background Pain in neonates is largely underestimated and neglected. Accurate pain assessment is the first step toward effective pain management. Skin-breaking procedures such as heel lances, vein punctures, and arterial punctures are the most frequently performed painful procedures in neonatal ICUs. Few studies have been done to compare preterm infants’ pain response to heel lance vs venipuncture. Aim The aim was to compare pain response to venipuncture vs heel lance among preterm infants undergoing blood sampling. Materials and methods A comparative descriptive research design was used on a convenient sample of 60 preterm infants less than 37 weeks of gestation who were undergoing blood sampling for complete blood count, blood chemistry, or glucose estimation. Neonatal assessment sheet, blood sampling assessment sheet, and premature infant pain profile scale were used to collect data from two neonatal ICUs of both Cairo University Children Hospital (El Monira) and El Manial University Hospital (Kaser El Aini). After a written consent from parents, the same preterm infant pain response was continuously monitored 30 s before procedure and up to 6 min during the procedure over 2 days (one for venipuncture and one for heel lance). Results The total mean premature infant pain profile score significantly increased during venipuncture than heel lance. Behavioral state was significantly more unstable during vein puncture than heel lance. Venipuncture procedure significantly increased heart rate and decreased oxygen saturation more than heel lance. Conclusion Preterm infants perceive pain as demonstrated by premature infant pain profile scale and vein puncture is the more painful procedure than heel lancing for blood sampling in preterm infants. Recommendations Premature infant pain profile scale should be included in the routine assessment for preterm infants.

Oral Sucrose for Pain Relief During Clubfoot Casting: A Double-Blinded Randomized Controlled Trial

Idiopathic clubfoot treatment is treated by manipulation and casting utilizing the Ponseti technique which can make the infant fussy and irritable. The goal of this study was to determine which intervention could decrease this pain response in infants undergoing Ponseti casting for idiopathic clubfeet. Our hypothesis was that the administration of oral sucrose solution or milk would be the most effective in accomplishing that goal. We conducted a double-blinded randomized controlled trial at a tertiary pediatric orthopaedic center on 33 children (average age=17.94 d; SD=20.51 d) undergoing clubfoot manipulation and casting and their guardians. Each cast was considered a new event and was randomized to an oral 20% sucrose solution (S), water (W), or milk (M) in a bottle (breast or nonbreast). We assessed the Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation before, during, and after the casting. A total of 131 casts were randomized and 118 analyzed (37 M, 42 S, 39 W). Each child underwent an average of 3.97 casts (SD=1.74). There were no significant differences seen between the groups before casting in their mean NIPS score (M=2.2; SD=2.38, S=1.84, SD=2.18, W=1.61, SD=2.12). However during casting, mean NIPS score for both milk, 0.91 (SD=1.26, P=0.0005) and sucrose, 0.64 (SD=1.27, P<0.0001) were significantly less than water, 2.27 (SD=2.03) but not different from each other (P=0.33). Postcasting, the sucrose NIPS score, 0.69 (SD=1.53) continued to be significantly less than milk, 2.11 (SD=2.37, P=0.0065. There was no correlation between heart rate or oxygen saturation and NIPS. Sucrose solution and milk during Ponseti casting and manipulation were effective in decreasing the pain response in children undergoing manipulation and casting for clubfeet. The sucrose solution administration continued the pain relief into the postcasting period. In addition to the benefits of improving the patient experience during casting, a less irritable child may result in better casting. Level 1 evidence.

THE IMPACT OF COMBINATION OF BREASTFEEDING AND EFFLEURAGE MASSAGE IN REDUCING PAIN RESPONSE IN INFANTS INDUCED BY BLOOD SAMPLING IN C-REACTIVE PROTEIN TEST: AN OBSERVATIONAL CROSS-SECTIONAL STUDY

Background: C-reactive protein test is one of clinical assessments to minimize risks of infection in infants. However, its procedure may cause pain. Pain in the infants may result in negative metabolic behavior, physiology and metabolic response.&#x0D; Objective: This study was to describe the infant's pain response by administering a combination of breastfeeding and an effleurage massage on the blood sampling procedure of C-reactive protein examination. &#x0D; Methods: This was a descriptive observational cross-sectional study. There were 30 infants selected using consecutive sampling technique, which 15 samples assigned in an intervention group (combination of breastfeeding and effleurage massage) and a control group. Premature Infant Pain Profile (PIPP) instrument was used to measure pain. Univariate analysis was performed with the aim to describe data in mean and median.&#x0D; Results: The average of pain response at one-minute observation in the combination of breastfeeding and effleurage massage group was 7.47 ± 1.356, and the average of pain response in the control group was 10.80 ± 1.897. The average pain at five-minutes observation in the intervention group was 3.53 ± 1.922 and control group was 6.00 ± 1.852. &#x0D; Conclusions: Pain responses in the combination of breastfeeding and effleurage massage group were lower than the pain response in the control group.

Factors Associated With Infant Pain Severity Undergoing Immunization Injections

PurposeFactors influencing infants' behavioral and vocal (cry) response to painful stimuli are explored to improve pain management plans for infants undergoing immunizations. Design and MethodsAn observational study design was used. Pain responses of 60 to 75 days-old infants (44% male vs 56% female) undergoing two-month immunization injections were videotaped and coded using the Modified Behavioral Pain Scale (MBPS), and duration of total crying time during injection was recorded. The influences of five factors (gender, caregiver attendance, previous experience of nociception (circumcision), mode of delivery), and weight (birth and current) were examined at baseline, during and post-immunization. ResultsHigher birth weight was the most significant factor that reduced pain responses during (p = 0.001) and post-immunization (p = 0.03). A higher birth weight reduced full lung crying (p = 0.04), which reflects crying during injection as compared to total crying time. Vaginal delivery had a significant effect on behavioral pain responses of infants only post-immunization (p = 0.006). Parent's presence in the immunization room significantly reduced total crying time (p = 0.03). Uncircumcised male infants had a significant reduction in behavioral pain responses during immunization (p = 0.01) compared to circumcised infants. ConclusionsThe literature well supports the acknowledgement of early pain experience and its psychological consequences. Knowing and controlling for each of mentioned factors early in life during every painful procedure could improve coping mechanisms of infants for any painful procedures later in life. Practice ImplicationsControl of certain factors during early life experiences can modify pain of immunization.

Effect of music intervention on pain responses in premature infants undergoing placement procedures of peripherally inserted central venous catheter: A randomized controlled trial

IntroductionPremature infants are highly sensitive to pain because of their immature and vulnerable nervous systems, which lead to peripherally inserted central venous catheter (PICC) difficulty. The objective of this study was to investigate the application of a music intervention (MI) during PICC placement procedures in premature infants. MethodsA randomized controlled trial was conducted on sixty premature infants (gestational age of 28 weeks to 36 weeks). Infants hospitalized to receive PICC puncture and meeting the study entry criteria were randomly assigned to an MI group (n = 30) or a control group (n = 30). The effects of MI were assessed by determination of heart rate, blood oxygen saturation, pain rating, cortisol concentration and operating time during PICC placement procedures in both groups. Furthermore, pain level was identified using premature infant pain profile. ResultsThere was no statistically significant difference between the two groups in terms of heart rate, blood oxygen saturation and pain score before intervention (P > 0.05). During PICC placement procedures, a significant increase in term of blood oxygen saturation (P < 0.05) and reductions in terms of heart rate (P < 0.05) and cortisol accumulation were observed in the group receiving music intervention compared with the control group. Furthermore, MI led to a significant reduction in pain score (mean difference: 3.4, 95% confidence interval: [2.0, 4.8]), and remarkably decreased the time needed for PICC placement in the MI group compared to control group. ConclusionsDuring PICC placement procedures for premature infants, MI significantly reduced stress hormone levels, physiological parameters and behavioral response of pain.

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

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.