Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Correlation of clinical pain scores with cerebral oxygenation in preterm neonates during acute painful procedures: a prospective observational study

Journal of Perinatology volume 43, pages 584–589 (2023)Cite this article

Subjects

Abstract

Objective

The present study evaluated the correlation of Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile-Revised (PIPP-R), with changes in cerebral oxygenation (ΔcrSO2; measured by near-infrared spectroscopy) in preterm infants during acute painful procedures (heel lance and venepuncture).

Study design

Prospective observational study.

Methods

Sixty-four stable preterm (28–36 weeks) neonates were videotaped. NIPS and PIPP-R scores were assessed on video-recordings by two independent assessors. The primary outcome was correlation of ΔcrSO2 with NIPS and PIPP-R scores.

Results

Moderate to strong correlations were observed between ΔcrSO2 and NIPS, and ΔcrSO2 and PIPP-R (r = 0.71 and 0.78 during heel lance and r = 0.66 and 0.75 during venepuncture, respectively). NIPS score was found easy to understand and perform by the bedside nurses, and took lesser time as compared to PIPP-R during both the procedures.

Conclusion

Both pain scores, NIPS and PIPP-R, had good correlation with ΔcrSO2 during acute painful procedures.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Videography of the study procedure.
Fig. 2: Study flow.
Fig. 3: Correlation of ΔcrSO2 with pain scores.

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Johnston C, Barrington KJ, Taddio A, Carbajal R, Filion F. Pain in Canadian NICUs: have we improved over the past 12 years? Clin J Pain. 2011;27:225–32.

    Article  PubMed  Google Scholar 

  2. Cruz MD, Fernandes AM, Oliveira CR. Epidemiology of painful procedures performed in neonates: A systematic review of observational studies. Eur J Pain. 2016;20:489–98.

    Article  CAS  PubMed  Google Scholar 

  3. Johnston CC, Stevens BJ. Experience in a neonatal intensive care unit affects pain response. Pediatrics. 1996;98:925–30.

    Article  CAS  PubMed  Google Scholar 

  4. Brummelte S, Grunau RE, Chau V, Poskitt KJ, Brant R, Vinall J, et al. Procedural pain and brain development in premature newborns. Ann Neurol. 2012;71:385–96.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Anand KJ, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior? Biol Neonate. 2000;77:69–82.

    Article  CAS  PubMed  Google Scholar 

  6. Taddio A, Katz J. The effects of early pain experience in neonates on pain responses in infancy and childhood. Paediatr Drugs. 2005;7:245–57.

    Article  PubMed  Google Scholar 

  7. Schenk K, Stoffel L, Bürgin R, Stevens B, Bassler D, Schulzke S, et al. The influence of gestational age in the psychometric testing of the Bernese Pain Scale for Neonates. BMC Pediatr. 2019;19:20.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Olsson E, Ahl H, Bengtsson K, Vejayaram DN, Norman E, Bruschettini M, et al. The use and reporting of neonatal pain scales: a systematic review of randomized trials. Pain. 2021;162:353–60.

    Article  PubMed  Google Scholar 

  9. Stevens BJ, Gibbins S, Yamada J, Dionne K, Lee G, Johnston C, et al. The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. Clin J Pain. 2014;30:238–43.

    Article  PubMed  Google Scholar 

  10. Obiedat H, Al-Maaitah EI. Critique of the use of neonatal infant pain scale (NIPS). NeonatPediatr Med. 2020;6:186.

    Google Scholar 

  11. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12:59–66.

    CAS  PubMed  Google Scholar 

  12. Slater R, Fitzgerald M, Meek J. Can cortical responses following noxious stimulation inform us about pain processing in neonates? Semin Perinatol. 2007;31:298–302.

    Article  PubMed  Google Scholar 

  13. Slater R, Cantarella A, Franck L, Meek J, Fitzgerald M. How well do clinical pain assessment tools reflect pain in infants? PLoS Med. 2008;5:e129.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Schiller CJ. Clinical utility of two neonatal pain assessment measures. Doctoral dissertation, University of Toronto. 1999.

  15. Bembich S, Davanzo R, Brovedani P, Clarici A, Massaccesi S, Demarini S. Functional neuroimaging of breastfeeding analgesia by multichannel near-infrared spectroscopy. Neonatology. 2013;104:255–9.

    Article  CAS  PubMed  Google Scholar 

  16. Shah VS, Ohlsson A. Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database Syst Rev. 2011;10:CD001452.

    Google Scholar 

  17. Xie W, Wang X, Huang R, Chen Y, Guo X. Assessment of four pain scales for evaluating procedural pain in premature infants undergoing heel blood collection. Pediatr Res. 2021;89:1724–31.

    Article  PubMed  Google Scholar 

  18. Suraseranivongse S, Kaosaard R, Intakong P, Pornsiriprasert S, Karnchana Y, Kaopinpruck J, et al. A comparison of postoperative pain scales in neonates. Br J Anaesth. 2006;97:540–4.

    Article  CAS  PubMed  Google Scholar 

  19. Sarhangi F, Mollahadi M, Ebadi A, Matinzadeh ZK, Tadrisi SD. Validity and reliability of neonatal infant pain scale in neonatal intensive care units in Iran (2010). Pak J Med Sci. 2011;27:1087–91.

    Google Scholar 

Download references

Acknowledgements

We wish to convey our sincere thanks to the neonatologists and NICU staff members at All India Institute of Medical Sciences, Rishikesh for participating in the study.

Author information

Authors and Affiliations

  1. Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Sourabh Kumar, Mayank Priyadarshi, Poonam Singh, Bhrajishna Pallapothu, Suman Chaurasia & Sriparna Basu

Authors
  1. Sourabh Kumar
    View author publications

    Search author on:PubMed Google Scholar

  2. Mayank Priyadarshi
    View author publications

    Search author on:PubMed Google Scholar

  3. Poonam Singh
    View author publications

    Search author on:PubMed Google Scholar

  4. Bhrajishna Pallapothu
    View author publications

    Search author on:PubMed Google Scholar

  5. Suman Chaurasia
    View author publications

    Search author on:PubMed Google Scholar

  6. Sriparna Basu
    View author publications

    Search author on:PubMed Google Scholar

Contributions

SK recruited patients, collected and analyzed the data, and drafted the initial manuscript; MP and SB supervised data collection and analysis of data and did critical revision and finalization of the manuscript; PS, BP, and SC contributed to the study design, data analysis and interpretation; and All authors approved the final manuscript as submitted.

Corresponding author

Correspondence to Sriparna Basu.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The study protocol was approved by the Institute’s Ethics Committee of AIIMS Rishikesh, Uttarakhand, India (Ref No: AIIMS/IEC/21/35, dated 09/01/2021).

Consent to participate

Written informed consent was obtained from the parent of each subject before enrollment.

Consent for publication

Patients signed informed consent regarding publishing their data and photographs.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, S., Priyadarshi, M., Singh, P. et al. Correlation of clinical pain scores with cerebral oxygenation in preterm neonates during acute painful procedures: a prospective observational study. J Perinatol 43, 584–589 (2023). https://doi.org/10.1038/s41372-022-01543-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-022-01543-x

This article is cited by

Search

Advanced search

Quick links