Validation of the premature infant pain profile in the clinical setting

Objective: The Premature Infant Pain Profile (PIPP) is a. 7-indicator compo site measure developed to assess acute pain in preterm and term neonates. I t has been validated in studies using synchronized videotaping of infants u ndergoing procedures. The purpose of this study was to establish (a) constr uct validity of the PIPP and (b) inter- and intrarater reliability of the P IPP prospectively in the clinical environment. Design: A randomized, crossover design was used. Setting: The study was conducted in a Level III outborn neonatal intensive care unit. Participants: A convenience sample of 43 neonates, stratified by gestationa l age, was studied. Interventions: Each infant experienced three separate, randomly ordered eve nts: baseline, a painful event, and a nonpain ev ent. Infants were videotap ed and scored at the bedside using the PIPP by the nurse caring for the inf ant and the clinical nurse specialist who had expertise in infant pain. The videotapes were later reviewed by two additional experts; one in real time and one using a second-to-second stop frame technique. Results: Repeated-measures analysis of the main effects and interactions yi elded a statistically significant main effect for event (pain, nonpain, bas eline), thus differentiating pain from nonpain and baseline events (F = 48, p = 0.0001) and establishing construct validity. Interrater reliability an alysis of individual event scores of the PIPP yielded reliability coefficie nts of 0.93-0.96. Intrarater reliability coefficients analysis for individu al events were equally high at 0.94-0.98. Conclusions: This study demonstrates that the PIPP is a pain measure with g ood construct validity and excellent inter- and intrarater reliability for the assessment of procedural pain of preterm and term infants in clinical s ettings.