Pain assessment in the Neonate using the Bernese Pain Scale for Neonates

Background: Neonates who require treatment in the neonatal intensive care unit (NICU) are subjected to many invasive painful procedures. Aims: Assessment of pain in preterm and term neonates with or without ventilation on continuous positive airway pressure using the Bernese Pain-Scale for Neonates (BPSN). The validity and the reliability of the BPSN was established. Study design and subjects: Pain assessments (n = 288) were performed by 6 health care workers in different situations of term and preterm neonates. Each neonate (n = 12) was observed in four given situations (after feeding, while a foot was being warmed, while a routine capillary blood sample was taken and 15 min after the blood sample was taken). Pain assessments were made by two nurses at the bedside using the BPSN, the Visual-Analogue Scale (VAS) and the Premature Infant Pain Profile (PIPP). At the same time, a video sequence was made which was shown later to four different nurses to assess pain using the BPSN, the PIPP, and the VAS. Results: The construct validity of the BPSN was very good (F = 41.3, p < 0.0001). Moreover, concurrent and convergent validity of the BPSN compared to, VAS and PIPP was r = 0.86, and r = 0.91, p < 0.0001, respectively. Finally, the study demonstrated high coefficients for interrater (r = 0.86 - 0.97) and intrarater reliability (r = 0.98 - 0.99). Conclusion: The BPSN was shown to be a valid and reliable tool for assessing pain in term and preterm neonates with and without ventilation. (C) 2004 Elsevier Ireland Ltd. All rights reserved.