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Validation of a neonatal pain scale adapted to the new practices in caring for preterm newborns
  1. Christophe Milesi1,
  2. Gilles Cambonie1,
  3. Aurelien Jacquot1,
  4. Eric Barbotte2,
  5. Renaud Mesnage1,
  6. Florence Masson1,
  7. Odile Pidoux1,
  8. Felicie Ferragu1,
  9. Pierre Thevenot3,
  10. Jean-Bernard Mariette4,
  11. Jean-Charles Picaud5
  1. 1CHU de Montpellier, Neonatologie (Pediatrie 2), Hopital Arnaud de Villeneuve, Montpellier, France
  2. 2CHU de Montpellier, Departement d’Information Medicale, Hopital Arnaud de Villeneuve, Montpellier, France
  3. 3CHU de Perpignan, Neonatologie, Hopital de Perpignan, Perpignan, France
  4. 4CHU de Nimes, Neonatologie, Hopital Caremeau de Nimes, Nimes, France
  5. 5CHU de Lyon, Service de Neonatologie, Hopital de la Croix Rousse, Lyon, France
  1. Correspondence to Jean-Charles Picaud, Neonatologie, Hopital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France; jean-charles.picaud{at}


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 In a prospective, multicentre study, 24–40-week-old neonates were videotaped during a painful procedure (heel prick). Three investigators then scored the pain using FANS and a previously validated scale: DAN (Douleur aiguë du Nouveau-né). FANS is based on assessment of limb movement, cry and autonomic reaction. Reliability was assessed by inter-rater agreement and internal consistency (Cronbach's α). 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, 53 preterms of 32 (30–35) gestational weeks and 1500 (1000–2200) g were observed. Cronbach's α was 0.72. The ICC was 0.92 (0.9–0.98) for inter-rater 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 preterm newborns when facial expression is not accessible.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed

  • Patient consent Obtained.