The influence of gestational age in the psychometric testing of the Bernese Pain Scale for Neonates.
- Schenk K Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland. karin.schenk@bfh.ch.
- Stoffel L Neonatalogy, Children's Hospital, University Hospital of Bern, Bern, Switzerland.
- Bürgin R Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
- Stevens B Lawrence S. Bloomberg Faculty of Nursing and Faculties of Medicine and Dentistry, University of Toronto, Toronto, ON, Canada.
- Bassler D Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
- Schulzke S Department of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
- Nelle M Neonatalogy, Children's Hospital, University Hospital of Bern, Bern, Switzerland.
- Cignacco E Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
- 2019-01-17
Published in:
- BMC pediatrics. - 2019
Contextual factors
Gestational age
Neonates
Pain assessment
Premature infants
Psychometric testing
Reliability
Validity
Blood Specimen Collection
Female
Gestational Age
Humans
Infant, Newborn
Male
Pain
Pain Measurement
Prospective Studies
Psychometrics
English
BACKGROUND
Assessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs.
METHODS
In this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1-5 capillary heel sticks in their first 14 days of life. From each heel stick, we produced three video sequences: baseline; heel stick; and, recovery. Five blinded nurses rated neonates' pain responses according to the BPSN. The underlying factor structure of the BPSN, interrater reliability, concurrent validity with the Premature Infant Pain Profile-Revised (PIPP-R), construct validity, sensitivity and specificity, and the relationship between behavioural and physiological indicators were explored. We considered GA and gender as individual contextual factors.
RESULTS
The factor analyses resulted in a model where the following behaviours best fit the data: crying; facial expression; and, posture. Pain scores for these behavioural items increased on average more than 1 point during the heel stick phases compared to the baseline and recovery phases (p < 0.001). Among physiological items, heart rate was more sensitive to pain than oxygen saturation. Heart rate averaged 0.646 points higher during the heel stick than the recovery phases (p < 0.001). GA increased along with pain scores: for every additional week of gestation, the average increase of behavioural pain score was 0.063 points (SE = 0.01, t = 5.49); average heart rate increased 0.042 points (SE = 0.01, t = 6.15). Sensitivity and specificity analyses indicated that the cut-off should increase with GA. Modified BPSN showed good concurrent validity with the PIPP-R (r = 0.600-0.758, p < 0.001). Correlations between the modified behavioural subscale and the item heart rate were low (r = 0.102-0.379).
CONCLUSIONS
The modified BPSN that includes facial expression, crying, posture, and heart rate is a reliable and valid tool for assessing acute pain in full-term and preterm neonates, but our results suggest that adding different cut-off points for different GA-groups will improve the BPSN's clinical usefulness.
TRIAL REGISTRATION
The study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461 . Registration date: 12 April 2016.
Assessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs.
METHODS
In this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1-5 capillary heel sticks in their first 14 days of life. From each heel stick, we produced three video sequences: baseline; heel stick; and, recovery. Five blinded nurses rated neonates' pain responses according to the BPSN. The underlying factor structure of the BPSN, interrater reliability, concurrent validity with the Premature Infant Pain Profile-Revised (PIPP-R), construct validity, sensitivity and specificity, and the relationship between behavioural and physiological indicators were explored. We considered GA and gender as individual contextual factors.
RESULTS
The factor analyses resulted in a model where the following behaviours best fit the data: crying; facial expression; and, posture. Pain scores for these behavioural items increased on average more than 1 point during the heel stick phases compared to the baseline and recovery phases (p < 0.001). Among physiological items, heart rate was more sensitive to pain than oxygen saturation. Heart rate averaged 0.646 points higher during the heel stick than the recovery phases (p < 0.001). GA increased along with pain scores: for every additional week of gestation, the average increase of behavioural pain score was 0.063 points (SE = 0.01, t = 5.49); average heart rate increased 0.042 points (SE = 0.01, t = 6.15). Sensitivity and specificity analyses indicated that the cut-off should increase with GA. Modified BPSN showed good concurrent validity with the PIPP-R (r = 0.600-0.758, p < 0.001). Correlations between the modified behavioural subscale and the item heart rate were low (r = 0.102-0.379).
CONCLUSIONS
The modified BPSN that includes facial expression, crying, posture, and heart rate is a reliable and valid tool for assessing acute pain in full-term and preterm neonates, but our results suggest that adding different cut-off points for different GA-groups will improve the BPSN's clinical usefulness.
TRIAL REGISTRATION
The study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461 . Registration date: 12 April 2016.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s12887-018-1380-8
- PMID 30646872
- Persistent URL
- https://folia.unifr.ch/global/documents/242213
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