Reliability and internal consistency in the assessment of neonatal pain in preterm infants during tracheal aspiration: prospective study

ABSTRACT

BACKGROUND AND OBJECTIVES:

Inadequate pain assessment in preterm infants (PI) is a persistent problem. Currently, a precise pain assessment is one of the main challenges for health professionals in the intensive care units (NICU). The objective of this study was to verify the correlation between the Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Prole - Revised (PIPP-R), internal consistency, and inter-evaluator reliability on pain assessment during aspiration in PI.

METHODS:

Prospective observational study with low birth weight PI (< 2500 g), hemodynamically stable, minimal or no sedation, under mechanical ventilation, continuous positive airway pressure, nasal cannula oxygen, or ambient air, and needing aspiration during hospitalization in the neonatal intensive care unit in the period from 2019 to 2020.. PI were evaluated during three different aspiration procedures: without intervention (1), using gentle touch (2), and using sucrose (3). NIPS and PIPP-R instruments were applied, while internal consistency was determined using Cronbach’s alpha, reliability using the intraclass correlation coefficient, and concurrent validity using Spearman’s correlation coefficient.

RESULTS:

Fifty PIs requiring tracheal aspiration were evaluated. NIPS and PIPP-R showed high (Cronbach α: 0.824) and moderate (Cronbach α: 0.655) internal consistency. Inter-e- valuation reliability was excellent in all aspiration procedures for NIPS (1: 0.991, 2: 0.987, and 3: 0.993) and PIPP-R (1: 0.997, 2: 0.986, and 3: 0.977). Concurrent validity was observed only for aspiration without intervention.

CONCLUSION:

Although NIPS may have better clinical utility than PIPP-R, both instruments presented good internal consistency and inter-evaluator reliability and may be used for assessing pain during aspiration in PI.

Keywords:
Pain; Pain Measurement; Preterm Infant

HIGHLIGHTS

Reliability measures between two scales to assess pain in preterm infants.

NIPS and PIPP-R scales were sensitive in identifying pain.

High reliability on the NIPS scale and moderate reliability on the PIPP-R scale.