PAIN EXPRESSION IN THE PREMATURE-INFANT

Background. - Assessing pain in premature babies is difficult because of their limited capacities to communicate. The aim of this study was to recognize manifestations of acute and chronic pain or, on the contr ary, of well-being state, and to validate a ''pain scale'' for prematu re babies. Population and methods. - Premature babies less than 28 day s of age (most of them less than 32 weeks of gestational age) were car efully observed during their stay in a neonatal intensive care unit by nurses, physicians, physiotherapists and a psychiatrist. All signs an d symptoms were collected during situations a priori painful and compa red to the behavior of the well-being states. Photographs and videofil ms were also analysed. Results. - Five items, scored from 0 to 4, were established, based on facial activity, movements and posture of the b ody, quality of sleep, relationship with the examiner, and efficacy of measures of comforting. These items permitted to describe four patter ns corresponding to 1: well-being status, 2: acute pain, 3 and 4: dura ble pain or discomfort either through clinical picture of irritability or motionlessness. A strict concordance of scores for the five items between the different examiners was found in 80% of the 50 babies stud ied. The sensibility of the scale (studied in 12 babies) appeared accu rate (77% of variation of the scores during hospitalization). Conclusi ons. - An objective assessment of pain and discomfort in premature bab ies can be made using a ''pain scale'' useful for care and therapeutic decisions.