I'd like to discuss an old topic again. Which pain scale do you use for premature babies? And what are the consequences for you when dealing with pain in premature babies? We're currently having a discussion on this and I would be grateful for advice and discussion.

Hi we are currently using PIPP for pain score for preterm babies and NIPS for term babies. We use sucrose for procedures like rop screenings and IV cannulation. Post circumcision we use paracetamol syrup for 24 hrs. Procedures like intubation, lumbar puncture we give minimal dose of fentanyl

We usually use NIPS, but don't it well defined what to do with every score.
We use sucking and sucrose for small procedures, paracetamol for "crying babies". For continues infusion, we usually use fentanyl, but dexmedetomidine is being used more often - which I confess it concerns me a little.

Good morning,

we use the N-PASS and CONFORT-scales. Works ok, but need timely reeducation.

We use sucrose, facilitated tucking in "minor" pain situations and repetitive or continuous Fentanyl for "major" pain situations. Fentanyl for intubation and low dose S-Ketamine for LISA.

With kind regards from Mainz

Dirk

Hi Katja,

We use COMFORTNeo in all Dutch NICU's. There are national guidelines on education and (re-)validation for health care providers as well as a flowchart that guides professionals in interventions based on the sumscores. We have however never evaluated to what extend these guidelines are being followed in the 9 Dutch NICU's. COMFORTNeo has its pros and cons, as all painscales do. My personal opinion is that PIPP (-R) is the tool with the best/most evidence for acute episodic pain. PIPP(-R) has been translated in several languages.

COMFORTNeo is suited for measuring distress which can arise from stressfull situations or pain. There are concerns about the validity of COMFORTNeo in extreme preterm infants, neurologically impaired infants and infants treated with therapeutic cooling. The main problems with all pain assessment tools are that they measure pain or discomfort only a few times a day, dependant on local protocols, beliefs and or experience. Ideally, a pain assessment tool should measure continuously and unobtrusivly. It should measure emotion, not behavior. To date, this is not possible.

Concerning analgesia we use non pharmacological interventions such as sucrose combined with non-nutritive sucking, breastfeeding, containment, skin-to-skin care, facilitated tucking. Pharmacological interventions in our NICU comprise acetaminophen (preferably i.v.), morphine and fentanyl. In the Netherlands, use of EMLA is restricted to term born infants.

Best regards,

Christ-jan van Ganzewinkel, PhD

Neonatal Nurse Practitioner

Member of the Dutch National Studygroup for Pain in NICU's

NPASS tool is used in several UK neonatal networks. I think achieving regular record keeping of pain assessments remains challenging.

Common intubation induction agents commonly include fentanyl, some use proposal and some may use ketamine in specific patients. Infusions commonly morphine & fentanyl (in my experience) and it seems there is increasing interest in dexemedetomine. Non pharmacological approaches for LP. Some low doses of fentanyl used for LISA, sometimes non-pharmacological, and a report also of midazolam.