Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors

Background: Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates’ pain responses and may lead to inaccurate pain assessment when not appropriately considered.
Objectives: We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual fac- tors into a revised version of the BPSN.

Methods: We videotaped 154 full-term and preterm neonates of different GAs dur- ing 1–5 capillary heel sticks in their first 14 days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual fac- tors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models.

Results: Premature birth (b = −0.721), caffeine (b = −0.302), and the behavioural states quiet and awake (b = −0.283), active and asleep (b = −0.158), and quiet and asleep (b = −0.498) were associated with changes in behavioural pain scores. Premature birth (b = −0.232), mechanical ventilation (b = −0.196), and duration of the heel stick procedure (b = 0.0004) were associated with changes in physiological pain scores. Premature birth (b = −0.907), Caffeine (b = −0.402), the behavioural states quiet and awake (b = −0.274), and quiet and asleep (b = −0.459), and duration of the heel stick procedure (b = 0.001) were associated with changes in the modified BPSN total scores.

Conclusions: Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates’ pain response and should be incorporated in the re- vised BPSN to enhance clinical pain assessment in neonates with different GAs. Significance: We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.