Measurement of pain-like response to various NICU
stimulants for high-risk infants
, Yonghoon Jun
Department of Nursing, College of Medicine, Inha University, 253 Yonghyun-dong, Nam-ku, Incheon, 402-751, Korea
Department of Pediatrics, College of Medicine, Inha University, 253 Yonghyun-dong, Nam-ku, Incheon, 402-751, Korea
Accepted 31 May 2006
Background: Infants during neonatal intensive care are invariably exposed to various procedural
and environmental stimuli in which the pain-like responses may vary depending on the nature of
the stimuli and the infants’ condition.
Aim: To examine firstly the pain-like responses to frequent stimulants in the neonatal intensive
care unit (NICU) using CRIES, FLACC and PIPP, and secondly the clinical feasibility and validity of
using these pain measurements for high-risk infants.
Study design and subjects: In a correlational study of 110 premature infants receiving neonatal
intensive care, the pain-like responses to 274 observations of 8 types of frequently applied
stimulant, classified into three categories according to the degree of invasiveness, were
observed using CRIES, FLACC and PIPP.
Results: There was a significant difference in response scores among the three categories for
CRIES and PIPP. In post-hoc Scheffe´ test, category A had the highest response scores. The
response scores from CRIES and FLACC were lower for the premature infants than for the full-
term infants in both categories A and B, whereas the PIPP scores were higher for the premature
infants than for the term infants in category C.
Conclusions: Full-term infants tended to express more distinct pain-like responses to invasive
procedures or direct contacts than premature infants did. However, PIPP may be more sensitive
to evaluate the negative effects of environmental auditory stimulants, particularly for
premature infants receiving neonatal intensive care. Further study to refine these instruments
may increase the clinical feasibility of pain measurements in high-risk infants.
D 2006 Elsevier Ireland Ltd. All rights reserved.
0378-3782/$ - see front matter D 2006 Elsevier Ireland Ltd. All rights reserved.
Abbreviations: CRIES, Cry, Requires O
for oxygen saturation (SpO
) above 95, Increased vital signs and BP, Expression, and Sleeplessness
index; FLACC, Face, Legs, Activity, Cry, and Consolability; PIPP, Premature Infants Pain Profile; NICU, Neonatal Intensive Care Units.
* Corresponding author. Tel.: +82 32 860 8207; fax: +82 32 874 5880.
E-mail addresses: firstname.lastname@example.org (Y. Ahn)8 email@example.com (Y. Jun).
Tel.: +82 32 890 3517.
Early Human Development (2007) 83, 255 —262
available at www.sciencedirect.com