Comparative Analysis of Three Pain Scales for Evaluation of Procedural Pain in Neonates: A Cross-sectional Study

Introduction: Neonates frequently undergo painful procedures in the Neonatal Intensive Care Unit (NICU), necessitating reliable Pain Assessment Tools (PAT). While various pain scales exist, no single tool is universally accepted due to differences in validity and clinical applicability. Aim: To compare the validity and internal consistency of Neonatal Infant Pain Scale (NIPS), Premature Infant Pain Profile Assessment Revised (PIPP-R), Douleur Aigue Nouveau-né (DAN) scale, for assessing procedural pain in neonates before, during and after a heel prick procedure. Materials and Methods: A cross-sectional study was conducted among 60 term neonates in a rural teaching hospital. The neonates underwent a heel prick procedure and pain scores were assessed using NIPS, DAN and PIPP-R at four time points: baseline, 30 seconds, two minutes and four minutes postprocedure. Construct validity was evaluated using repeated measures Analysis of Variance (ANOVA), concurrent validity by Pearson correlation and internal consistency by Cronbach’s alpha. Coefficient of variation was analysed to assess scale precision. Results: All three pain scales demonstrated peak pain scores at 30 seconds postheel prick, with a subsequent decline over time. NIPS and DAN exhibited high concurrent validity (r=0.939 at 30s, r=0.860 at 2 minutes). Cronbach’s alpha for NIPS, DAN and PIPP-R at 30 seconds was 0.808, 0.919 and 0.805, respectively, indicating high internal consistency. The removal of physiological parameters (heart rate, SpO2 ) from PIPP-R significantly improved its internal consistency (Cronbach’s alpha increased from 0.805 to 0.917 at 30s and from 0.822 to 0.906 at 2 minutes), whereas using only physiological parameters yielded low or negative alpha values. PIPP-R had the lowest coefficient of variation, indicating the highest precision, while DAN had the highest. Conclusion: NIPS and DAN have good concurrent validity between them. PIPP-R had the least coefficient of variation and hence most precise. DAN has high internal consistency across the timelines.