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Open Access 08-06-2024 | RESEARCH

Development of the neonatal pain response variable set: a mixed methods consensus process

Authors: Nanxi Zhu, Bingjie Long, Xinling Zhan, Lanxin Zhang, Zechuan Wang, Lianhong Wang, Yi Huang, Juan Chen, Chi Huang, Lu Xiong, Zhenyan Fu, Renli Deng

Published in: European Journal of Pediatrics

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Abstract

While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. This study aims to reach a consensus on optimal and comprehensive variables for neonatal pain assessment, leading to the development of a multidimensional neonatal pain response variable set. This study consisted of three phases: (1) A literature review was conducted to identify influencing factors and assessment indicators of neonatal pain response. (2) Panel meetings involving neonatal healthcare professionals evaluated and screened factors and indicators to develop an initial draft of the variable set. (3) Through two rounds of Delphi study achieved consensus, and determined the neonatal pain response variable set. Through a literature review and a panel meeting, the identified factors and indicators were categorized into contextual, physiological, and behavioral variables, forming an initial draft of the variable set. Sixteen professionals participated in two rounds of the Delphi study, with response rates exceeding 70%, and authority coefficients surpassing 0.7 in both rounds. The final iteration of the variable set includes 9 contextual variables, 2 physiological variables, and 5 behavioral variables.
   Conclusion: Neonatal pain response variable set developed in this study is scientific, comprehensive, and multidimensional, aligning with the characteristics of neonatal pain response and clinically applicable. The inclusion of contextual variables enhances the ability to confront the complexity of clinical environments and individual differences. It can provide a practical and theoretical basis for clinical research on neonatal pain assessment.
What is Known:
• Neonatal pain assessment relies on scales used by healthcare professionals currently. But there is no “gold standard” for neonatal pain assessment.
• While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. Most of scales overlook the clinical environment complexity individual differences in pain responses, diminishing the accuracy and applicability.
What is New:
• In addition to the commonly used physiological and behavioral variables in the scales, we have incorporated contextual variables to better address the complexity of clinical environments and individual differences in pain responses.
• Through an evidence-based approach, developed a neonatal pain response variable set comprising 9 contextual variables, 2 physiological variables, and 5 behavioral variables.
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Literature
1.
2.
go back to reference Tortora D, Severino M, Di Biase C, Malova M, Parodi A, Minghetti D, Traggiai C, Uccella S, Boeri L, Morana G, Rossi A, Ramenghi LA (2019) Early pain exposure influences functional brain connectivity in very preterm neonates. Front Neurosci 13:899CrossRefPubMedPubMedCentral Tortora D, Severino M, Di Biase C, Malova M, Parodi A, Minghetti D, Traggiai C, Uccella S, Boeri L, Morana G, Rossi A, Ramenghi LA (2019) Early pain exposure influences functional brain connectivity in very preterm neonates. Front Neurosci 13:899CrossRefPubMedPubMedCentral
3.
go back to reference Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, Saizou C, Lapillonne A, Granier M, Durand P, Lenclen R, Coursol A, Hubert P, de Saint BL, Boëlle PY, Annequin D, Cimerman P, Anand KJ, Bréart G (2008) Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 300:60–70CrossRefPubMed Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, Saizou C, Lapillonne A, Granier M, Durand P, Lenclen R, Coursol A, Hubert P, de Saint BL, Boëlle PY, Annequin D, Cimerman P, Anand KJ, Bréart G (2008) Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 300:60–70CrossRefPubMed
4.
go back to reference Kyololo OM, Stevens B, Gastaldo D, Gisore P (2014) Procedural pain in neonatal units in kenya. Arch Dis Child Fetal Neonatal Ed 99:F464-467CrossRefPubMed Kyololo OM, Stevens B, Gastaldo D, Gisore P (2014) Procedural pain in neonatal units in kenya. Arch Dis Child Fetal Neonatal Ed 99:F464-467CrossRefPubMed
5.
go back to reference Pölkki T, Korhonen A, Laukkala H (2018) Nurses’ perceptions of pain assessment and management practices in neonates: a cross-sectional survey. Scand J Caring Sci 32:725–733CrossRefPubMed Pölkki T, Korhonen A, Laukkala H (2018) Nurses’ perceptions of pain assessment and management practices in neonates: a cross-sectional survey. Scand J Caring Sci 32:725–733CrossRefPubMed
6.
go back to reference Cong X, Delaney C, Vazquez V (2013) Neonatal nurses’ perceptions of pain assessment and management in NICUs: a national survey. Adv Neonatal Care 13:353–360CrossRefPubMed Cong X, Delaney C, Vazquez V (2013) Neonatal nurses’ perceptions of pain assessment and management in NICUs: a national survey. Adv Neonatal Care 13:353–360CrossRefPubMed
7.
go back to reference Maitre NL, Stark AR, McCoy Menser CC, Chorna OD, France DJ, Key AF, Wilkens K, Moore-Clingenpeel M, Wilkes DM, Bruehl S (2017) Cry presence and amplitude do not reflect cortical processing of painful stimuli in newborns with distinct responses to touch or cold. Arch Dis Child Fetal Neonatal Ed 102:F428-f433CrossRefPubMed Maitre NL, Stark AR, McCoy Menser CC, Chorna OD, France DJ, Key AF, Wilkens K, Moore-Clingenpeel M, Wilkes DM, Bruehl S (2017) Cry presence and amplitude do not reflect cortical processing of painful stimuli in newborns with distinct responses to touch or cold. Arch Dis Child Fetal Neonatal Ed 102:F428-f433CrossRefPubMed
8.
go back to reference Kappesser J, Kamper-Fuhrmann E, de Laffolie J, Faas D, Ehrhardt H, Franck LS, Hermann C (2019) Pain-specific reactions or indicators of a general stress response?: investigating the discriminant validity of 5 well-established neonatal pain assessment tools. Clin J Pain 35:101–110CrossRefPubMed Kappesser J, Kamper-Fuhrmann E, de Laffolie J, Faas D, Ehrhardt H, Franck LS, Hermann C (2019) Pain-specific reactions or indicators of a general stress response?: investigating the discriminant validity of 5 well-established neonatal pain assessment tools. Clin J Pain 35:101–110CrossRefPubMed
9.
go back to reference Olsson E, Ahl H, Bengtsson K, Vejayaram DN, Norman E, Bruschettini M, Eriksson M (2021) The use and reporting of neonatal pain scales: a systematic review of randomized trials. Pain 162:353–360CrossRefPubMed Olsson E, Ahl H, Bengtsson K, Vejayaram DN, Norman E, Bruschettini M, Eriksson M (2021) The use and reporting of neonatal pain scales: a systematic review of randomized trials. Pain 162:353–360CrossRefPubMed
10.
go back to reference Eccleston C, Fisher E, Howard RF, Slater R, Forgeron P, Palermo TM, Birnie KA, Anderson BJ, Chambers CT, Crombez G, Ljungman G, Jordan I, Jordan Z, Roberts C, Schechter N, Sieberg CB, Tibboel D, Walker SM, Wilkinson D, Wood C (2021) Delivering transformative action in paediatric pain: a lancet child & adolescent health commission. Lancet Child Adolesc Health 5:47–87CrossRefPubMed Eccleston C, Fisher E, Howard RF, Slater R, Forgeron P, Palermo TM, Birnie KA, Anderson BJ, Chambers CT, Crombez G, Ljungman G, Jordan I, Jordan Z, Roberts C, Schechter N, Sieberg CB, Tibboel D, Walker SM, Wilkinson D, Wood C (2021) Delivering transformative action in paediatric pain: a lancet child & adolescent health commission. Lancet Child Adolesc Health 5:47–87CrossRefPubMed
11.
go back to reference Sposito NPB, Rossato LM, Bueno M, Kimura AF, Costa T, Guedes DMB (2017) Assessment and management of pain in newborns hospitalized in a neonatal intensive care unit: a cross-sectional study. Rev Lat Am Enfermagem 25:e2931CrossRefPubMedPubMedCentral Sposito NPB, Rossato LM, Bueno M, Kimura AF, Costa T, Guedes DMB (2017) Assessment and management of pain in newborns hospitalized in a neonatal intensive care unit: a cross-sectional study. Rev Lat Am Enfermagem 25:e2931CrossRefPubMedPubMedCentral
12.
go back to reference Anand KJS, Eriksson M, Boyle EM, Avila-Alvarez A, Andersen RD, Sarafidis K, Polkki T, Matos C, Lago P, Papadouri T, Attard-Montalto S, Ilmoja ML, Simons S, Tameliene R, van Overmeire B, Berger A, Dobrzanska A, Schroth M, Bergqvist L, Courtois E, Rousseau J, Carbajal R (2017) Assessment of continuous pain in newborns admitted to NICUs in 18 European countries. Acta Paediatr 106:1248–1259CrossRefPubMed Anand KJS, Eriksson M, Boyle EM, Avila-Alvarez A, Andersen RD, Sarafidis K, Polkki T, Matos C, Lago P, Papadouri T, Attard-Montalto S, Ilmoja ML, Simons S, Tameliene R, van Overmeire B, Berger A, Dobrzanska A, Schroth M, Bergqvist L, Courtois E, Rousseau J, Carbajal R (2017) Assessment of continuous pain in newborns admitted to NICUs in 18 European countries. Acta Paediatr 106:1248–1259CrossRefPubMed
13.
go back to reference Ishak S, Nfe F, Zakaria Sz S, Adli A, Jaafar R (2019) Neonatal pain: Knowledge and perception among pediatric doctors in Malaysia. Pediatr Int Offic J Japan Pediatr Soc 61:67–72 Ishak S, Nfe F, Zakaria Sz S, Adli A, Jaafar R (2019) Neonatal pain: Knowledge and perception among pediatric doctors in Malaysia. Pediatr Int Offic J Japan Pediatr Soc 61:67–72
14.
go back to reference Maxwell LG, Fraga MV, Malavolta CP (2019) Assessment of pain in the newborn: an update. Clin Perinatol 46:693–707CrossRefPubMed Maxwell LG, Fraga MV, Malavolta CP (2019) Assessment of pain in the newborn: an update. Clin Perinatol 46:693–707CrossRefPubMed
16.
go back to reference Ilhan E, Pacey V, Brown L, Spence K, Galea C, Adams R, Hush JM (2021) Exploration and validation of behavioral pain measures and physiological pain measures factor structure extracted from the pain assessment tool item scores for infants admitted to neonatal intensive care. Clin J Pain 37:397–403CrossRefPubMed Ilhan E, Pacey V, Brown L, Spence K, Galea C, Adams R, Hush JM (2021) Exploration and validation of behavioral pain measures and physiological pain measures factor structure extracted from the pain assessment tool item scores for infants admitted to neonatal intensive care. Clin J Pain 37:397–403CrossRefPubMed
17.
go back to reference Kassab M, Hamadneh S, Nuseir K, ALmomani B, Hamadneh J (2018) Factors associated with infant pain severity undergoing immunization injections. J Pediatr Nurs 42:e85–e90CrossRefPubMed Kassab M, Hamadneh S, Nuseir K, ALmomani B, Hamadneh J (2018) Factors associated with infant pain severity undergoing immunization injections. J Pediatr Nurs 42:e85–e90CrossRefPubMed
18.
go back to reference Ying GY, Li H, Duan ZQ, Pan XP (2012) Evaluation of screening methods for health statistics indicators. China Health Care Manag 29:465–467 Ying GY, Li H, Duan ZQ, Pan XP (2012) Evaluation of screening methods for health statistics indicators. China Health Care Manag 29:465–467
19.
go back to reference Grime MM, Wright G (2016) Delphi method. Wiley StatsRef: Statistics Reference Online, pp 1–6 Grime MM, Wright G (2016) Delphi method. Wiley StatsRef: Statistics Reference Online, pp 1–6
20.
go back to reference Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J Adv Nurs 32:1008–1015CrossRefPubMed Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J Adv Nurs 32:1008–1015CrossRefPubMed
21.
go back to reference Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K (2020) The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain 161:1976–1982CrossRefPubMedPubMedCentral Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K (2020) The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain 161:1976–1982CrossRefPubMedPubMedCentral
22.
go back to reference Relland LM, Gehred A, Maitre NL (2019) Behavioral and physiological signs for pain assessment in preterm and term neonates during a nociception-specific response: a systematic review. Pediatr Neurol 90:13–23CrossRefPubMed Relland LM, Gehred A, Maitre NL (2019) Behavioral and physiological signs for pain assessment in preterm and term neonates during a nociception-specific response: a systematic review. Pediatr Neurol 90:13–23CrossRefPubMed
23.
go back to reference Chinese Medical Doctors Association Neonatologists Branch, Chinese Journal of Contemporary Pediatrics Editorial Board (2020) Expert consensus on neonatal pain assessment and analgesic management. Chin J Contemp Pediatr, vol 22, 2020th edn. pp 923–930 Chinese Medical Doctors Association Neonatologists Branch, Chinese Journal of Contemporary Pediatrics Editorial Board (2020) Expert consensus on neonatal pain assessment and analgesic management. Chin J Contemp Pediatr, vol 22, 2020th edn. pp 923–930
24.
go back to reference Salekin MS, Zamzmi G, Hausmann J, Goldgof D, Kasturi R, Kneusel M, Ashmeade T, Ho T, Sun Y (2021) Multimodal neonatal procedural and postoperative pain assessment dataset. Data Brief 35:106796CrossRefPubMedPubMedCentral Salekin MS, Zamzmi G, Hausmann J, Goldgof D, Kasturi R, Kneusel M, Ashmeade T, Ho T, Sun Y (2021) Multimodal neonatal procedural and postoperative pain assessment dataset. Data Brief 35:106796CrossRefPubMedPubMedCentral
Metadata
Title
Development of the neonatal pain response variable set: a mixed methods consensus process
Authors
Nanxi Zhu
Bingjie Long
Xinling Zhan
Lanxin Zhang
Zechuan Wang
Lianhong Wang
Yi Huang
Juan Chen
Chi Huang
Lu Xiong
Zhenyan Fu
Renli Deng
Publication date
08-06-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-024-05559-7