APN - A BEHAVIORAL ACUTE PAIN RATING-SCAL E FOR NEONATES

Aim. - This study was designed to validate a behavioral acute pain rat ing scale for term and preterm neonates (APN). Methods. - From January through June 1996, neonates requiring a heel lance or a venous punctu re for blood sampling at the intensive care unit and the nursery of Po issy Hospital were recruited into the study. After a pilot study, a pa in rating scale was developed. The scale score pain ranged from 0 to 1 0 and it evaluated three items: facial expression, limb movements, and vocal expression with ratings per item ranging from 0 to 4, 0 to 3 an d 0 to 3, respectively. Two observers evaluated independently each inf ant during a painful procedure (puncture for a blood sample) and durin g a dummy procedure (rubbing the thigh softly). Results. - Forty-two n eonates born between 25 and 41 weeks gestational age were included in the study. Medians (quartiles) of gestational age, birth weight, and c orrected postmenstrual age at time of investigation were 34 (29-39) we eks, 1,850 (1,055-3,093) g, and 35.5 (31-39) weeks, respectively. Ten infants were intubated. The scale showed to be sensitive because all p ossible scores were obtained; during painful procedures scores ranged from 1 to 10, with 95%, of scores greater than or equal to 3 while dur ing dummy procedures they ranged from 0 to 5, with 88% of scores less than or equal to 2. The medians (95% confidence interval) of scores we re for painful procedures 5 (5 to 7) and for dummy procedures 1 (0 to 1). This indicates a good specificity of the scale. High intercorrelat ion of items (internal consistency) was confirmed by a Cronbach's coef ficient alpha of 0.88. Interrater agreement was high since the Krippen dorff R test was 91.2. Conclusion. - This behavioral acute pain rating scale for newborns demonstrated a good specificity and sensitivity, i nternal consistency and inter-rater reliability. This scale could be u sed to test the analgesic effects of different therapies during painfu l procedures.