Table 1
Summary of neonatal pain assessment scales.
| Assessment tool | Physiological indications | Behavioral indications | Gestational age tested | Threshold value | Types of pain tested |
|---|---|---|---|---|---|
| PIPP/PIPP-R Scale | HR and oxygen saturation | Brow bulge, eye squeeze, and nasolabial furrow | PIPP is suitable for 28–40 weeks of gestational age; PIPP-R is suitable for gestational age for 25–41 weeks | Score: 0–18 (full-term); 0–21 (preterm). ≥7 points indicate pain; >12 points indicate moderate to severe pain | Procedural pain Postoperative pain |
| N-PASS Scale | HR, RR, BP, and SaO2 | Crying/irritability, behavior state, facial expression, and extremity tone | Preterm and term infants | Score: 0–10. >3 points indicate pain; −10 to −5 indicate deep sedation; −5 to −2 denote mild sedation | Acute pain, prolonged pain, and sedation |
| NFCS | None | Brow bulge, eye squeeze, nasolabial furrow, open lips, stretch mouth (vertical), stretch mouth (horizontal), lip purse, taut tongue, and chin quiver | Preterm and term infants | Score: 0–9 (full-term); 0–10 (preterm). >3 points indicate pain | Procedural pain |
| EDIN Scale | None | Facial activity, body movements, quality of sleep, quality of contact with nurses, and consolability | Preterm infants of gestational age 25–36 weeks | Score: 0–15. ≥7 points indicate pain | Prolonged pain |
| CRIES Scale | Increased Vital Signs (HR and BP), oxygen saturation | Crying, facial expression, sleeplessness | Term infants and preterm infants of gestational age ≥32 weeks | Score: 0–10. ≥4 points indicate pain | Postoperative pain |
| COMFORT neo Scale | None | Alertness, calmness/agitation, respiratory response (in mechanically ventilated children), crying (in spontaneously breathing children), body movement, facial tension, and (body) muscle tone (observation only) | Preterm infants | Score: 6–30. ≥14 indicate pain; ≤8 indicates the risk of excessive sedation | Prolonged pain |
| COVERS Scale | HR, BP, respiration, and oxygen requirement | Crying, expression, resting, and signaling distress | Preterm and term infants | Scale: 0–12. ≥7 points indicate pain | Procedural pain |
| PAIN Scale | O2 required for Sat >95%, HR, and breathing pattern | Facial expression, cry, extremity movement, and state of arousal | Preterm and term infants (gestational age with 26–47 weeks) | Score: 0–10. ≥4 points indicate pain | Postoperative pain and procedural pain |
| NIPS Scale | Breathing patterns | Facial expression, cry, arms, legs, and state of arousal | Preterm and term infants (gestational age with 26–47 weeks) | Score: 0–7. ≥4 points indicate pain | Procedural pain |
[i] Notes: HR, heart rate; BP, blood pressure; CRIES scale, crying, requires increased oxygen administration, increased vital signs, Expression, Sleeplessness Scale; EDIN scale, Echelledela Douleur Inconfort Nouveau-ne’ (Neonatal Pain and Discomfort Scale); NIPS scale, Neonatal Infant Pain Scale; NFCS, Neonatal Facial Coding System; N-PASS Scale, Neonatal Pain, Agitation, and Sedation Scale; PAIN Scale, PAIN Assessment in Neonates Scale; PIPP/PIPP-R Scale, Premature Infant Pain Profile Scale/Premature Infant Pain Profile-revised Scale; RR, respiratory rate.