The influence of gestational age in the psychometric testing of the Bernese Pain Scale for Neonates

Schenk, Karin; Stoffel, Liliane; Bürgin, Reto Arthur; Stevens, Bonnie; Bassler, Dirk; Schulzke, Sven; Nelle, Mathias; Cignacco Müller, Eva (2019). The influence of gestational age in the psychometric testing of the Bernese Pain Scale for Neonates BMC Pediatrics, 19(1), pp. 1-21. BioMed Central 10.1186/s12887-018-1380-8

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Background 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. Methods 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. Results 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). Conclusions 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. Trial registration The study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461. Registration date: 12 April 2016.

Item Type:

Journal Article (Original Article)

Division/Institute:

Health Professions
Health Professions > Midwifery

Name:

Schenk, Karin;
Stoffel, Liliane;
Bürgin, Reto Arthur;
Stevens, Bonnie;
Bassler, Dirk;
Schulzke, Sven;
Nelle, Mathias and
Cignacco Müller, Eva0000-0001-6773-4015

Subjects:

B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RJ Pediatrics
R Medicine > RT Nursing

ISSN:

1471-2431

Publisher:

BioMed Central

Funders:

[UNSPECIFIED] Schweizerischer Nationalfonds

Projects:

[UNSPECIFIED] Berner Schmerzscore für Neugeborene

Language:

English

Submitter:

Jean Anthony Grand-Guillaume-Perrenoud

Date Deposited:

17 Dec 2019 13:12

Last Modified:

18 Dec 2020 13:28

Publisher DOI:

10.1186/s12887-018-1380-8

Uncontrolled Keywords:

pain assessment, neonates, premature infants, psychometric testing, contextual factors, gestational age, reliability, validity

ARBOR DOI:

10.24451/arbor.7967

URI:

https://arbor.bfh.ch/id/eprint/7967

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