Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
Neonatalogy, Children's Hospital, University Hospital of Bern, Bern, Switzerland.
BMC Pediatr. 2019 Jan 15;19(1):20. doi: 10.1186/s12887-018-1380-8.
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.
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.
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).
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.
The study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461 . Registration date: 12 April 2016.
评估新生儿的疼痛具有挑战性，因为不同胎龄的足月和早产新生儿对疼痛的反应差异很大。我们通过对代表所有胎龄的大量新生儿进行测试，验证了伯尔尼新生儿疼痛量表（BPSN）的有效性。
在这项前瞻性多中心验证性研究中，我们评估了 154 名胎龄为 24 2/7 至 41 4/7 周的新生儿，评估结果基于他们生命最初 14 天内 1-5 次毛细血管足跟采血。从每个足跟采血中，我们生成了三个视频序列：基线；足跟采血；和恢复。五位盲法护士根据 BPSN 对新生儿的疼痛反应进行评分。我们探讨了 BPSN 的潜在因素结构、评分者间信度、与早产儿疼痛概况修订版（PIPP-R）的同时效度、结构效度、敏感性和特异性，以及行为和生理指标之间的关系。我们将胎龄和性别视为个体背景因素。
因素分析得出的模型中，以下行为最能反映数据：哭泣；面部表情；和姿势。与基线和恢复阶段相比，足跟采血阶段这些行为项目的疼痛评分平均增加了 1 分以上（p<0.001）。在生理项目中，心率比氧饱和度对疼痛更敏感。与恢复期相比，足跟采血时的心率平均高 0.646 分（p<0.001）。胎龄随疼痛评分增加而增加：每增加一周胎龄，行为疼痛评分的平均增加量为 0.063 分（SE=0.01，t=5.49）；平均心率增加 0.042 分（SE=0.01，t=6.15）。敏感性和特异性分析表明，截断值应随胎龄增加而增加。改良后的 BPSN 与 PIPP-R 具有良好的同时效度（r=0.600-0.758，p<0.001）。改良后的行为子量表与心率项目之间的相关性较低（r=0.102-0.379）。
包括面部表情、哭泣、姿势和心率的改良 BPSN 是一种可靠且有效的评估足月和早产儿急性疼痛的工具，但我们的研究结果表明，为不同胎龄组添加不同的截断值将提高 BPSN 的临床实用性。
该研究在 Clinical Trial gov 数据库中进行了回顾性注册。研究 ID 号：NCT 02749461。注册日期：2016 年 4 月 12 日。
