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Table A.1 Neonatal Pain Scales

Scale

Assessment

Parameters Age level (GA) Pain stimulus Reliability Data Scoring Clinical Utility

Neonatal Infant

Pain Scale

(NIPS)

Behavioral 28–38 weeks Procedural Interrater reliability

>0.92

0–7 with intervention suggested for

pain scores ≥4

• Easy and fast to use

Neonatal Infant

Pain, Agitation

and Sedation

Scale (NPASS)

Physiologic,

Behavioral,

Contextual

23–40 weeks Acute, sedation,

postoperative,

ventilated

Interrater reliability

>0.85

0–10 pain

0–10 sedation

Intervention

suggested for

pain scores >3

• Combined pain and

sedation scale

• First neonatal combined pain and sedation scale; includes a

premature pain assessment that adds to score

based on GA

CRIES Behavioral,

Physiologic

32–60 weeks Postoperative Interrater reliability

>0.72

0–10 with intervention suggested for

pain score >4

• Easy to use

Premature Infant

Pain Profile

(PIPP)

Physiologic,

Behavioral,

Contextual

Term and preterm neonates

Postoperative,

Procedural

Inter- and intrarater

reliability >0.93

Score ≥12 indicated moderate to severe

pain

• Not fast to use

• Scoring of infant

occurs 15 seconds

immediately before

event and 30 seconds

immediately after event

• Modified PIPP scale

has been developed for

easier use.

• Limited use in the

intubated, paralyzed,

and extremely premature neonate.

Scale for Use in

the Newborn

(SUN)

Behavioral,

Physiologic

Term and preterm neonates

0–28

Average baseline scores

10–14.

• Not an easy scale compared to NIPS

Neonatal Facial

Coding System

(NFCS)

Behavioral 25 weeks to term

neonates

Procedural Inter- and intrarater

reliability >0.85

• Established as a scale

to assess pain in newborns and infants

COVERS

Neonatal Pain

Scale

Physiologic,

Behavioral

27–40 weeks Designed to assess

the needs of all

infants in the

NICU

Interrater reliability

of >0.84 in preterm neonates

and >0.95 in

term neonates

0–18 • Cannot be used in paralyzed neonates.

• Criteria used for scoring

is applicable to a wider

range of infants (e.g.,

visible crying in the

intubated neonate as a

behavioral response,

looks at a change in

need of oxygen).

Appendix A

Chapter 6