SCALES FOR ASSESSING PAIN IN NEWBORNS: AN INTEGRATIVE REVIEW FOR NURSING PRACTICE AND REHABILITATION SPECIALISTS

Underestimation and inadequate pain management in neonates remain significant challenges in clinical practice, despite current evidence supporting their capacity for pain perception. Objective pain assessment is critical, with nurses playing a key role in its detection and management in this vulnerable population. Rehabilitation strategies should also account for pain severity. Valid and reliable pain assessment scales are essential tools for nurses in clinical practice, as specialized pain monitoring equipment is costly and often insufficiently available in hospital settings. Aim. This study aimed to analyze the validity and reliability of scales used in nursing practice and rehabilitation for the objective assessment of pain in term and preterm neonates. Materials and Methods. This study was conducted as an integrative literature review, following the methodology of Whittemore and Knafl (2005). A systematic search was performed in international databases, including PubMed, Scopus, ScienceDirect, Embase, LILACS, BVS (Virtual Health Library), and Google Scholar. The search encompassed publications from 1990 to 2023, with emphasis on the period 2010–2023. Keywords included "neonatal pain," "pain assessment," "pain scale," "newborn," "preterm," "PIPP," "nursing assessment," along with their Spanish and Portuguese equivalents, combined with logical operators AND/OR. Original full-text studies describing or validating neonatal pain scales were included in the analysis. Out of 84 selected articles, 22 met the inclusion criteria after deduplication and full-text reading. Data were extracted into a standardized table, and source quality was assessed using STROBE or PRISMA criteria. The research adhered to the provisions of GCP (1996), the Council of Europe Convention on Human Rights and Biomedicine (April 4, 1997), the World Medical Association's Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects (1964-2008), and Order No. 690 of the Ministry of Health of Ukraine (September 23, 2009) as amended by Order No. 523 (July 12, 2012). Additionally, an survey was conducted among 25 nurses regarding the use of pain assessment scales in the neonatal intensive care unit of the Municipal Enterprise “Regional Medical Center of Family Health” (DRC). Each scale was applied for one week. Survey validity was assessed through parallel pain intensity monitoring using the Newborn Infant Pain Evaluation (NIPE) device with dedicated software (MDoloris Medical Systems, France). The review identified both unidimensional and multidimensional instruments for assessing acute and prolonged pain in preterm and term neonates. The most frequently described validated scales included PIPP (Premature Infant Pain Profile), NIPS (Neonatal Infant Pain Scale), CRIES (Crying, Requires oxygen, Increased vital signs, Expression, Sleeplessness), NFCS (Neonatal Facial Coding System), and N-PASS (Neonatal Pain, Agitation, and Sedation Scale). The selection of an appropriate pain assessment scale for neonates should consider the infant's gestational age, pain type and duration, and clinical context. Each scale has specific advantages and limitations, highlighting the importance of healthcare professionals, particularly nurses, having comprehensive knowledge of these instruments. The review provides a conceptual framework for more effective implementation of these tools in clinical practice. It was found that 56% of nurses preferred the CRIES and PIPP scales. The concordance with pain intensity monitoring indicators using the NIPE device was sufficiently high for the CRIES scale, with Kendall's rank correlation coefficient (τ) values of τ=0.7 for CRIES and τ=0.5 for PIPP (p<0.05). For the NFCS and N-PASS scales, correlation with NIPE device measurements also showed strong direct correlation (τ=0.6 and 0.8 respectively; p<0.05). These scales were preferred by 44% of nurses. The NIPS scale was considered most convenient by the majority of nurses (76%), demonstrating moderate correlation with the NIPE device measurements (τ=0.4, p<0.05). Conclusions. None of the analyzed scales constitutes a universal "gold standard" for all clinical scenarios. The optimal instrument selection depends on multiple criteria, including gestational age, clinical context, and healthcare providers' expertise. This necessitates that nursing professionals possess comprehensive knowledge and demonstrate adaptability in clinical application. The collected data establish a foundation for developing evidence-based clinical guidelines and standardized protocols for pain scale implementation in neonatal care. Future research should investigate the efficacy of combined scale approaches and the development of adaptive assessment tools capable of dynamic adjustment according to neonatal clinical status.