Simultaneous comparison of three neonatal pain scales during common newborn intensive care unit procedures

This study evaluated three neonatal pain scales during four procedures commonly performed in a neonatal intensive care unit. The four procedures were intubation, intravenous catheter insertion, endotracheal tube suctioning, and diaper changes. Pain scales were scored before, during and after each procedure. All scales demonstrated significant score changes in the before vs. during categories for each procedure. The three scales also demonstrated a return to (baseline vs. after) for the four procedures, except for the COMFORT scale which remained elevated following diaper change. The NIPS scale had a large coefficient of variation (CV). The COMFORT scale and SUN scale had small CVs. Pain scale scores do identify changes in an infant's behavior/physiologic state during common NICU procedures, but it is unclear whether these changes are totally 'pain specific.' In comparing the three scales, the SUN scale overall was a preferable tool because of its ease of use, scale symmetry and scoring consistency.