Skip to main content
NCBI home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2004 Nov;89(6):F537–F541. doi: 10.1136/adc.2003.032961

Postoperative pain assessment in the neonatal intensive care unit

C McNair, M Ballantyne, K Dionne, D Stephens, B Stevens
PMCID: PMC1721796  PMID: 15499150

Abstract

Objectives: To compare the convergent validity of two measures of pain (premature infant pain profile (PIPP) and crying, requires oxygen, increased vital signs, expression, and sleepless (CRIES)) in real life postoperative pain assessment in infants.

Methods: This study was a prospective, repeated measures, correlational design. Two staff nurses were randomly assigned either the PIPP or CRIES measure. An expert rater assessed each infant after surgery, and once a day using the visual analogue scale (VAS).

Setting: A level III neonatal intensive care unit in a metropolitan university affiliated paediatric hospital.

Results: Pain was assessed in 51 neonates (28–42 weeks of gestational age) after surgery. There was no significant difference in the rates of change between the pain assessment measures across time using repeated measures analysis of variance (F50,2  =  0.62, p  =  0.540), indicating correlation between the measures. Convergent validity analysis using intraclass correlation showed correlation, most evident in the first 24 hours (immediately, 4, 8, 20, and 24 hours after the operation). Correlations were more divergent at 40 and 72 hours after surgery. No significant interactions were found between gestational age and measure (F304,4  =  0.75, p  =  0.563) and surgical group and measure (F304,2  =  0.39, p  =  0.680).

Conclusions: PIPP and CRIES are valid measures that correlate with pain for the first 72 hours after surgery in term and preterm infants. Both measures would provide healthcare professionals with an objective measure of a neonatal patient's pain.

Full Text

The Full Text of this article is available as a PDF (93.0 KB).

Figure 1.

Figure 1

Open in a new tab

 Categories of neonatal surgery. NEC, Necrotising enterocolitis; TEF, tracheo-oesophageal fistula.

Figure 2.

Figure 2

Open in a new tab

 Pain scores after surgery. Values are means.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  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., Aynsley-Green A. Measuring the severity of surgical stress in newborn infants. J Pediatr Surg. 1988 Apr;23(4):297–305. doi: 10.1016/s0022-3468(88)80193-3. [DOI] [PubMed] [Google Scholar]
  3. Ballantyne M., Stevens B., McAllister M., Dionne K., Jack A. Validation of the premature infant pain profile in the clinical setting. Clin J Pain. 1999 Dec;15(4):297–303. doi: 10.1097/00002508-199912000-00006. [DOI] [PubMed] [Google Scholar]
  4. Bildner J., Krechel S. W. Increasing staff nurse awareness of postoperative pain management in the NICU. Neonatal Netw. 1996 Feb;15(1):11–16. [PubMed] [Google Scholar]
  5. Buchholz M., Karl H. W., Pomietto M., Lynn A. Pain scores in infants: a modified infant pain scale versus visual analogue. J Pain Symptom Manage. 1998 Feb;15(2):117–124. [PubMed] [Google Scholar]
  6. Franck L. S., Greenberg C. S., Stevens B. Pain assessment in infants and children. Pediatr Clin North Am. 2000 Jun;47(3):487–512. doi: 10.1016/s0031-3955(05)70222-4. [DOI] [PubMed] [Google Scholar]
  7. Gibbins Sharyn, Stevens Bonnie, Hodnett Ellen, Pinelli Janet, Ohlsson Arne, Darlington Gerarda. Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res. 2002 Nov-Dec;51(6):375–382. doi: 10.1097/00006199-200211000-00005. [DOI] [PubMed] [Google Scholar]
  8. Johnston C. C., Stremler R., Horton L., Friedman A. Effect of repeated doses of sucrose during heel stick procedure in preterm neonates. Biol Neonate. 1999 Mar;75(3):160–166. doi: 10.1159/000014092. [DOI] [PubMed] [Google Scholar]
  9. 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]
  10. Landis J. R., Koch G. G. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–174. [PubMed] [Google Scholar]
  11. 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]
  12. Stevens B., Gibbins S., Franck L. S. Treatment of pain in the neonatal intensive care unit. Pediatr Clin North Am. 2000 Jun;47(3):633–650. doi: 10.1016/s0031-3955(05)70230-3. [DOI] [PubMed] [Google Scholar]
  13. Stevens B., Johnston C., Franck L., Petryshen P., Jack A., Foster G. The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates. Nurs Res. 1999 Jan-Feb;48(1):35–43. doi: 10.1097/00006199-199901000-00006. [DOI] [PubMed] [Google Scholar]
  14. 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]
  15. Taddio Anna, Shah Vibhuti, Gilbert-MacLeod Cheryl, Katz Joel. Conditioning and hyperalgesia in newborns exposed to repeated heel lances. JAMA. 2002 Aug 21;288(7):857–861. doi: 10.1001/jama.288.7.857. [DOI] [PubMed] [Google Scholar]
  16. van Dijk Monique, Bouwmeester Nancy J., Duivenvoorden Hugo J., Koot Hans M., Tibboel Dick, Passchier Jan, de Boer Josien B. Efficacy of continuous versus intermittent morphine administration after major surgery in 0-3-year-old infants; a double-blind randomized controlled trial. Pain. 2002 Aug;98(3):305–313. doi: 10.1016/S0304-3959(02)00031-3. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES