Validation of a neonatal pain scale adapted to the new practices in caring for preterm newborns

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.