Background: Neonatal pain assessment generally requires access to facial expression. Improved neonatology practices, such as greater protection against bright lights and non-invasive mask ventilation, have made facial observation more difficult.
Objective: To validate a “faceless” acute neonatal pain scale (FANS), which does not depend on facial expression.
Methods: Prospective, multicentric study, we videotaped 24- to 40-week-old neonates during a painful procedure (heel prick). Three investigators then scored the pain using FANS and a validated scale: DAN (Douleur aiguë du Nouveau-né). FANS is based on assessment of limb movement, cry and autonomic reaction. Reliability was assessed by interrater agreement and internal consistency (Cronbach’s alpha). Validity was evaluated by agreement between scales [intraclass correlation coefficient (ICC)]. The Wilcoxon test evaluated the FANS score differences between conditions. Results are expressed as medians [25th and 75th percentiles]. Ranges are presented for outcome parameters.
Results: From April 2006 to September 2007, we observed 53 preterms of 32 [30-35] gestational weeks and 1500 [1000-2200] g. Cronbach’s alpha was 0.72. ICC was 0.92 [0.9-0.98] for interrater agreement and 0.88 [0.76-0.93] for agreement between scales.
Conclusion: FANS, which is reliable and valid, is the first scale to score pain in the preterm newborn when facial expression is not accessible.
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