Neonatal Pain Assessment.

Pain is now dubbed "the fifth vital sign".(1) Assessment of neonatal pain should consider vital signs, oxygen needs, arousal/state of consciousness, facial expression, irritability and crying and tone. AAP also includes vagal tone, palmar sweating, and plasma cortisol or catecholamine concentrations as physiological indicators of pain.(2) Assessment should consider the baby's gestational age, medications, current status and if there is a change from baseline. Term baby's may demonstrate an increase in heart rate and activity where as preemies are more likely to become lethargic and lack a response to pain although they are still experiencing pain.(1) Some sick term infants or infants who have suffered repeated pain may also show a lack of a response to pain even though they are feeling it. Paralyzed or neurologically depressed infants will lack the typical behavioral responses to pain.(2)

There are several tools available for objectively scoring neonatal pain such as the Neonatal/Infant Pain Scale (NIPS) and the Neonatal Pain, Agitation and Sedation Scale (NPASS). AWHONN states that use of a tool should be based upon its 1) validity in measuring pain differentially from other conditions; 2) reliability in repeated testing or when performed by different people; and 3) clinical utility - the ease and practicality with which it can used in the clinical setting.(1) Protocols should be established so that the frequency with which tools are used and the interventions called for in response to their results are consistent amongst caregivers. It should be remembered that tools and protocols may not meet the needs of all infants. The 'whole baby' should be considered as an individual and in the context of their given situation, which may mean looking beyond the information provided by pain scales and protocols.