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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2001 Jul;85(1):F36–F41. doi: 10.1136/fn.85.1.F36

Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants

T Debillon, V Zupan, N Ravault, J Magny, M Dehan, H ABU-SAAD
PMCID: PMC1721270  PMID: 11420320

Abstract

OBJECTIVE—To develop and validate a scale suitable for use in clinical practice as a tool for assessing prolonged pain in premature infants.
METHODS—Pain indicators identified by observation of preterm infants and selected by a panel of experts were used to develop the EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale). A cohort of preterm infants was studied prospectively to determine construct validity, inter-rater reliability, and internal consistency of the scale.
RESULTS—The EDIN scale uses five behavioural indicators of prolonged pain: facial activity, body movements, quality of sleep, quality of contact with nurses, and consolability. The validation study included 76 preterm infants with a mean gestational age of 31.5weeks. Inter-rater reliability was acceptable, with a κ coefficient range of 0.59-0.74. Internal consistency was high: Cronbach's α coefficients calculated after deleting each item ranged from 0.86 to 0.94. To establish construct validity, EDIN scores in two extreme situations (pain and no pain) were compared, and a significant difference was observed.
CONCLUSIONS—The validation data suggest that the EDIN is appropriate for assessing prolonged pain in preterm infants. Further studies are warranted to obtain further evidence of construct validity by comparing scores in less extreme situations.



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Selected References

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  1. Abu-Saad H. H., Bours G. J., Stevens B., Hamers J. P. Assessment of pain in the neonate. Semin Perinatol. 1998 Oct;22(5):402–416. doi: 10.1016/s0146-0005(98)80056-6. [DOI] [PubMed] [Google Scholar]
  2. Anand K. J., Hickey P. R. Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. N Engl J Med. 1992 Jan 2;326(1):1–9. doi: 10.1056/NEJM199201023260101. [DOI] [PubMed] [Google Scholar]
  3. Anand K. J., Hickey P. R. Pain and its effects in the human neonate and fetus. N Engl J Med. 1987 Nov 19;317(21):1321–1329. doi: 10.1056/NEJM198711193172105. [DOI] [PubMed] [Google Scholar]
  4. Andrews K., Fitzgerald M. The cutaneous withdrawal reflex in human neonates: sensitization, receptive fields, and the effects of contralateral stimulation. Pain. 1994 Jan;56(1):95–101. doi: 10.1016/0304-3959(94)90154-6. [DOI] [PubMed] [Google Scholar]
  5. Barker D. P., Rutter N. Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child Fetal Neonatal Ed. 1995 Jan;72(1):F47–F48. doi: 10.1136/fn.72.1.f47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Barker D. P., Rutter N. Stress, severity of illness, and outcome in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed. 1996 Nov;75(3):F187–F190. doi: 10.1136/fn.75.3.f187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Barrier G., Attia J., Mayer M. N., Amiel-Tison C., Shnider S. M. Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system. Intensive Care Med. 1989;15 (Suppl 1):S37–S39. doi: 10.1007/BF00260883. [DOI] [PubMed] [Google Scholar]
  8. Craig K. D., Whitfield M. F., Grunau R. V., Linton J., Hadjistavropoulos H. D. Pain in the preterm neonate: behavioural and physiological indices. Pain. 1993 Mar;52(3):287–299. doi: 10.1016/0304-3959(93)90162-I. [DOI] [PubMed] [Google Scholar]
  9. Dixon S., Snyder J., Holve R., Bromberger P. Behavioral effects of circumcision with and without anesthesia. J Dev Behav Pediatr. 1984 Oct;5(5):246–250. [PubMed] [Google Scholar]
  10. Gauvain-Piquard A, Rodary C, Rezvani A, Serbouti S. The development of the DEGR(R): A scale to assess pain in young children with cancer. Eur J Pain. 1999 Jun;3(2):165–176. doi: 10.1053/eujp.1999.0118. [DOI] [PubMed] [Google Scholar]
  11. Grunau R. V., Craig K. D. Pain expression in neonates: facial action and cry. Pain. 1987 Mar;28(3):395–410. doi: 10.1016/0304-3959(87)90073-X. [DOI] [PubMed] [Google Scholar]
  12. Grunau R. V., Craig K. D. Pain expression in neonates: facial action and cry. Pain. 1987 Mar;28(3):395–410. doi: 10.1016/0304-3959(87)90073-X. [DOI] [PubMed] [Google Scholar]
  13. Johnston C. C., Stevens B. J. Experience in a neonatal intensive care unit affects pain response. Pediatrics. 1996 Nov;98(5):925–930. [PubMed] [Google Scholar]
  14. Johnston C. C., Stevens B., Yang F., Horton L. Developmental changes in response to heelstick in preterm infants: a prospective cohort study. Dev Med Child Neurol. 1996 May;38(5):438–445. doi: 10.1111/j.1469-8749.1996.tb15101.x. [DOI] [PubMed] [Google Scholar]
  15. Krechel S. W., Bildner J. CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth. 1995;5(1):53–61. doi: 10.1111/j.1460-9592.1995.tb00242.x. [DOI] [PubMed] [Google Scholar]
  16. Lago P., Benini F., Agosto C., Zacchello F. Randomised controlled trial of low dose fentanyl infusion in preterm infants with hyaline membrane disease. Arch Dis Child Fetal Neonatal Ed. 1998 Nov;79(3):F194–F197. doi: 10.1136/fn.79.3.f194. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Lawrence J., Alcock D., McGrath P., Kay J., MacMurray S. B., Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993 Sep;12(6):59–66. [PubMed] [Google Scholar]
  18. McIntosh N., Van Veen L., Brameyer H. The pain of heel prick and its measurement in preterm infants. Pain. 1993 Jan;52(1):71–74. doi: 10.1016/0304-3959(93)90116-7. [DOI] [PubMed] [Google Scholar]
  19. Melzack R., Wall P. D. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971–979. doi: 10.1126/science.150.3699.971. [DOI] [PubMed] [Google Scholar]
  20. Papile L. A., Tyson J. E., Stoll B. J., Wright L. L., Donovan E. F., Bauer C. R., Krause-Steinrauf H., Verter J., Korones S. B., Lemons J. A. A multicenter trial of two dexamethasone regimens in ventilator-dependent premature infants. N Engl J Med. 1998 Apr 16;338(16):1112–1118. doi: 10.1056/NEJM199804163381604. [DOI] [PubMed] [Google Scholar]
  21. Quinn M. W., Wild J., Dean H. G., Hartley R., Rushforth J. A., Puntis J. W., Levene M. I. Randomised double-blind controlled trial of effect of morphine on catecholamine concentrations in ventilated pre-term babies. Lancet. 1993 Aug 7;342(8867):324–327. doi: 10.1016/0140-6736(93)91472-x. [DOI] [PubMed] [Google Scholar]
  22. Stevens B. J., Johnston C. C., Horton L. Factors that influence the behavioral pain responses of premature infants. Pain. 1994 Oct;59(1):101–109. doi: 10.1016/0304-3959(94)90053-1. [DOI] [PubMed] [Google Scholar]
  23. Stevens B., Johnston C., Petryshen P., Taddio A. Premature Infant Pain Profile: development and initial validation. Clin J Pain. 1996 Mar;12(1):13–22. doi: 10.1097/00002508-199603000-00004. [DOI] [PubMed] [Google Scholar]
  24. Taddio A., Katz J., Ilersich A. L., Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997 Mar 1;349(9052):599–603. doi: 10.1016/S0140-6736(96)10316-0. [DOI] [PubMed] [Google Scholar]

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