Luo, F., Zhu, H., Mei, L., Shu, Q., Cheng, X., Chen, X., Zhao, Y., Chen, S., & Pan, Y. (2023/10//). Evaluation of procedural pain for neonates in a neonatal intensive care unit: a single-centre study. BMJ Paediatrics Open, 7(1)https://doi.org/10.1136/bmjpo-2023-002107
This peer reviewed article provides an overview of the Neonatal Infant Pain Scale (NIPS) and how to apply the ratings. This particular scale is most used in the NICU world to quantify pain in this population. NIPS takes into account the facial expression, crying, limb activity, arousal state and respiratory indications of neonates between 28-38 weeks gestation. This scale is most useful for identifying acute pain, such as venipunctures, heel sticks and postoperative pain. There is a scoring range from 0-7 where 0 is no pain and 7 is severe pain. The use of this pain scale can help nurses and providers to manage pain effectively for the patient and to identify that the infant is in pain and needs some sort of intervention, whether that is pharmacological or non-pharmacological interventions.
Meesters, N. J., Dilles, T., van Rosmalen, J., van den Bosch, Gerbrich E., Simons, S. H. P., & van Dijk, M. (2023/05//). COMFORTneo scale: a reliable and valid instrument to measure prolonged pain in neonates? Journal of Perinatology, 43(5), 595-600. https://doi.org/10.1038/s41372-023-01628-1
This peer reviewed article provides an overview of the COMFORTneo scale so it can be used to reliably and validly assess pain in NICU patients. The COMFORTneo consists of 7 behavioral items (alertness, calmness/agitation, respiratory response, crying, body movement, facial tension and muscle tone), of which 6 items should be scored (respiratory response or crying depends on the presence of invasive ventilation). A score of 14 and higher is considered a sign of distress and pain. A score below 9 suggests that it might be possible to decrease the opioid or sedative dose. This is a great tool for nurses to use to communicate their findings with the provider to provide interventions needed to help the infant feel less pain.
Morgan, M. E., Stephanie, K., Michelle, N., & Shuman, C. J. (2020/12//). Neonatal Pain, Agitation, and Sedation Scale’s use, reliability, and validity: a systematic review. Journal of Perinatology, 40(12), 1753-1763. https://doi.org/10.1038/s41372-020-00840-7
This peer reviewed article provides an overview of the Neonatal Pain Assessment & Sedation Scale (NPASS) and how to apply the ratings. NPASS is a scale that is used as a pain and sedation tool that includes five domains: crying, behavior, facial expression, extremity tone and vital signs. Scores are between 0-10 and the higher the score the greater the pain. The sedation portion is also graded from -10 to 0 scale where the lower the number the deeper level of sedation the neonate is experiencing. This tool is a great tool for nurses to implement for their postoperative patients and for infants who may have some neurological issues. Also if the infant is on certain medications that can cause sedation, this scoring tool will be used. This tool is also helpful for nurses who are noticing trends in vital signs and scores that show that the level of sedation may be too much for the infant or too little where more or less intervention may be needed.
Wandimu, M. M., Addis, B. M., & Mengistu, B. G. (2024). Nurses′ knowledge and practice about neonatal pain management in public hospitals in West Oromia, Ethiopia, 2022: multi-centered cross-sectional study. BMC Nursing, 23, 1-11. https://doi.org/10.1186/s12912-024-01972-3
This peer reviewed article provides the data from a study where NICU nurses answered questions about pain management. This article provides the data on how familiar the nursing community is with pain scales, if they are confident in their understanding on how to rate pain for the patient, and if they were familiar with best management practices for pain. The evidence in the article shows that when there is an increase in the nurses’ knowledge and practice, it can promote successful pain assessments and managements for this specific population. In addition, this article does reference another article where two thirds of nurses did not recognize or use a pain assessment tool to manage the pain of these neonates, which had detrimental effects on the newborns. This in turn allowed hospitals to recognize there was a lack of education and training for nurses in regards to recognizing pain and pain management and allowed for utilizing a known pain assessment tool to be implemented into everyday practice. This reference can be utilized to explain the importance for utilization of a pain management scale to the nursing population.