Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Pediatrics
Published in: European Journal of Pediatrics 7/2011

01-07-2011 | Original Paper

Assessing pain in ventilated newborns and infants: validation of the Hartwig score

Authors: Christoph Hünseler, Verena Merkt, Mandy Gerloff, Frank Eifinger, Angela Kribs, Bernhard Roth

Published in: European Journal of Pediatrics | Issue 7/2011

Login to get access

Abstract

The Hartwig score was designed to assess pain in ventilated newborns and infants. It comprises the acceptance of mechanical ventilation and the reaction to endotracheal suctioning (grimacing, gross motor movements, eye-opening). The aim of this study was to validate the Hartwig score in terms of concurrent validity, internal consistency, inter-rater correlation and to define a cut-off value with respect to the need for analgesic therapy. Fifty-four video recordings of 28 ventilated newborns and infants up to 10 months old during endotracheal suctioning were assessed by two neonatologists and two nurses using the Hartwig score, Comfort scale and a visual analogue scale (VAS) in respect to pain. Statistical analysis was done with SPSS 12.0. Comparison of the Hartwig score with the VAS resp. Comfort scale, as according to Bland–Altman, gave a mean of the differences of 0.77 resp. 0.15. A cut-off value of 12.1 to discriminate pain requiring treatment had a sensitivity of 88.9% and a specificity of 100%. Cronbach's alpha of item correlation of the total score was 0.872, deleting the weakest item improved internal consistency to 0.895. Inter-rater correlation was found to be 0.934. Conclusion The Hartwig score showed satisfactory agreement with the VAS and good agreement with the Comfort scale. It is a reliable tool for assessing pain in ventilated newborns and infants. The cut-off value was found to be at 13 points.
Literature
1.
Ambuel B, Hamlett KW, Marx CM et al (1992) Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol 17:95–109PubMedCrossRef
2.
3.
Anand KJ, Sippell WG, Aynsley-Green A (1987) Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. Lancet 1:62–66PubMedCrossRef
4.
Aretz S, Licht C, Roth B (2004) Endogenous distress in ventilated full-term newborns with acute respiratory failure. Biol Neonate 85:243–248PubMedCrossRef
5.
Bland JM, Altman DJ (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedCrossRef
6.
Brunow de Carvalho W, Lucas da Silva PS, Paulo CS et al (1999) Comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation. Sao Paulo Med J 117:192–196PubMed
7.
Bucholz M, Karl HW, Pomietto M, Lynn AM (1998) Pain scores in infants: a modified infant pain scale versus visual analogue. J Pain Symptom Manage 15:117–124
8.
Büttner W, Finke W (2000) Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Paediatr Anaesth 10:303–318PubMedCrossRef
9.
Charmandari E, Kino T, Souvatzoglou E et al (2003) Pediatric stress: hormonal mediators and human development. Horm Res 59:161–179PubMedCrossRef
10.
Cignacco E, Mueller R, Hamers JP et al (2004) Pain assessment in the neonate using the Bernese Pain Scale for Neonates. Early Hum Dev 78:125–131PubMedCrossRef
11.
Crellin D, Sullivan TP, Babl FE et al (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting. Paediatr Anaesth 17:720–733PubMedCrossRef
12.
Curley MA, Harris SK, Fraser KA et al (2006) State Behavioral Scale: a sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatr Crit Care Med 7:107–114PubMedCrossRef
13.
Dyke MP, Kohan R, Evans S (1995) Morphine increases synchronous ventilation in preterm infants. J Paediatr Child Health 31:176–179PubMedCrossRef
14.
Ghai B, Makkar JK, Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment. Paediatr Anaesth 18:462–477PubMedCrossRef
15.
Hartwig S, Roth B, Theisohn M (1991) Clinical experience with continuous intravenous sedation using midazolam and fentanyl in the paediatric intensive care unit. Eur J Pediatr 150:784–788PubMedCrossRef
16.
Hummel P, Puchalski M, Creech SD et al (2008) Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol 28:55–60PubMedCrossRef
17.
Ista E, van Dijk M, Tibboel D et al (2005) Assessment of sedation levels in pediatric intensive care patients can be improved by using the COMFORT “behavior” scale. Pediatr Crit Care Med 6:58–63PubMedCrossRef
18.
Peters JW, Schouw R, Anand KJ et al (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood? Pain 114:444–454PubMedCrossRef
19.
Simons SH, van Dijk M, Anand KS et al (2003) Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 157:1058–1064PubMedCrossRef
20.
Simons SH, van Dijk M, van Lingen RA et al (2005) Randomised controlled trial evaluating effects of morphine on plasma adrenaline/noradrenaline concentrations in newborns. Arch Dis Child Fetal Neonatal Ed 90:F36–F40PubMedCrossRef
21.
Stevens B, Johnston C, Petryshen P et al (1996) Premature infant pain profile: development and initial validation. Clin J Pain 12:13–22PubMedCrossRef
22.
Taddio A, Katz J, Ilersich AL et al (1997) Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 349:599–603PubMedCrossRef
23.
van Dijk M, de Boer J, Koot HM et al (2001) The association between physiological and behavioral pain measures in 0- to 3-year-old infants after major surgery. J Pain Symptom Manage 22:600–609PubMedCrossRef
Metadata
Title
Assessing pain in ventilated newborns and infants: validation of the Hartwig score
Authors
Christoph Hünseler
Verena Merkt
Mandy Gerloff
Frank Eifinger
Angela Kribs
Bernhard Roth
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
European Journal of Pediatrics / Issue 7/2011
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-010-1354-9

Other articles of this Issue 7/2011

European Journal of Pediatrics 7/2011 Go to the issue

Short Report

Shock: an unusual presentation of Kawasaki disease

Original Paper

Down syndrome patients with pulmonary hypertension have elevated plasma levels of asymmetric dimethylarginine

Original Paper

Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B12, folate levels, and lipid profiles in epileptic children treated with valproic acid

Original Paper

Management of pulmonary hypertension in Down syndrome

Correspondence

Heavy alcohol consumption in children and adolescents: characteristics and gender differences

Original Paper

Detection of Mycoplasma pneumoniae in different respiratory specimens