A SIMULTANEOUS COMPARISON OF 3 NEONATAL PAIN SCALES DURING COMMON NICU PROCEDURES

Objective: This study evaluated neonatal pain scales during procedures commonly performed in a neonatal intensive care unit. Design: Evaluat ed were the Neonatal Infant Pain Scale (NIPS), the Comfort scale, and a new scale known as the Scale for Use in Newborns (SUN). Four procedu res were scored: intubation, intravenous catheter insertion, endotrach eal tube suctioning, and diaper changes. Scoring was done before, duri ng, and after each procedure. Thirty-three patients were tested during 68 procedures with 1,428 scale scores. Results: All scales demonstrat ed significant changes. In before-versus-during for each procedure, th e increase in pain scale score was significant for the NIPS, Comfort s cale, and SUN. All three scales also demonstrated a return to baseline (before-vs.-after) for the four procedures, except for the Comfort sc ale, which remained elevated (p <.05) following diaper change. The MPS had a significantly larger coefficient of variation (CV, 188% +/- 99% ), whereas the Comfort scale and SUN had small CVs (27% +/- 5% and 33% +/- 8%, respectively). In evaluating potential confounding influences , it was found that infants >2.5 kg on sedative or analgesic medicatio ns appeared to have procedure-related accentuation and sustained eleva tion in scale scores, whereas swaddling seemed to provide little added benefit. Conclusions: The pain scale scores identify changes in an in fant's behavior/physiologic state. It is unclear whether these changes are totally ''pain specific.'' In comparing the three scales, the SUN overall was a preferable tool because of its ease of use, scale symme try, and scoring consistency.