The Influence of Postmenstrual Age and Neurological Impairments on the Modified Pain Assessment Tool Score in Infants Admitted to Neonatal Intensive Care: A Retrospective Medical Record Review

Overview

Journal Paediatr Neonatal Pain

Specialty Pediatrics

Date 2025 Feb 14

PMID 39950151

Authors

Jamie Murray

Jeremy Lam

Jeewan Jyoti

Kaye Spence

Himanshu Popat

Emre Ilhan

Affiliations

Soon will be listed here.

Abstract

Repetitive and prolonged experience of pain by infants in neonatal intensive care units (NICUs) may adversely affect growth and alter pain responses. The degree of infant prematurity and/or presence of neurological impairment (NI) may impact an infant's ability to behaviorally respond to pain. This study aimed to determine whether the scores on the mPAT, a widely used pain assessment tool, is impacted by postmenstrual age (PMA) at assessment, irrespective of neurological impairment. Data from medical records were collected on infants admitted to the NICU who underwent a pain assessment with the modified Pain Assessment Tool (mPAT) between March 2019 and September 2021. Total mPAT, behavioral, and physiological pain scores were independently analyzed using logistic regression to detect differences based on PMA categories (< 33 weeks, 33-36 weeks, ≥ 37 weeks) and presence of NI. Significant differences were indicated when < 0.05. Of 204 infants sampled, 62% were male, and 71% were born at term-age (i.e., ≥ 37 wks). Thirty-six (18%) infants had a queried or confirmed NI and 28 (14%) infants were postsurgical. Logistic regression analysis showed that neither PMA nor presence of NI predicted pain for total mPAT scores ( (3) = 3.9, > 0.05) or physiological scores ( (3) = 2.7, > 0.05). Higher behavioral scores were 3.7 times (OR 0.27, 95% CI 0.10-0.77, = 0.01) more likely in extremely-to-very preterm (< 33 weeks) infants when compared to term (≥ 37 weeks) infants. The mPAT may be suitable for clinicians to utilize when assessing infants in NICUs regardless of PMA or NI status. The higher behavioral responses in younger infants require further investigation in a future prospective study.

References

Spence K, Gillies D, Harrison D, Johnston L, Nagy S . A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs. 2005; 34(1):80-6. DOI: 10.1177/0884217504272810. View

Motheral B, Brooks J, Clark M, Crown W, Davey P, Hutchins D . A checklist for retrospective database studies--report of the ISPOR Task Force on Retrospective Databases. Value Health. 2003; 6(2):90-7. DOI: 10.1046/j.1524-4733.2003.00242.x. View

Howard V, Thurber F . The interpretation of infant pain: physiological and behavioral indicators used by NICU nurses. J Pediatr Nurs. 1998; 13(3):164-74. DOI: 10.1016/s0882-5963(98)80075-4. View

Bouza H . The impact of pain in the immature brain. J Matern Fetal Neonatal Med. 2009; 22(9):722-32. DOI: 10.3109/14767050902926962. View

Grunau R, Holsti L, Peters J . Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006; 11(4):268-75. DOI: 10.1016/j.siny.2006.02.007. View

Faye P, De Jonckheere J, Logier R, Kuissi E, Jeanne M, Rakza T . Newborn infant pain assessment using heart rate variability analysis. Clin J Pain. 2010; 26(9):777-82. DOI: 10.1097/ajp.0b013e3181ed1058. View

Holsti L, Grunau R, Whifield M, Oberlander T, Lindh V . Behavioral responses to pain are heightened after clustered care in preterm infants born between 30 and 32 weeks gestational age. Clin J Pain. 2006; 22(9):757-64. PMC: 1851898. DOI: 10.1097/01.ajp.0000210921.10912.47. View

Lemeshow S, Hosmer Jr D . A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982; 115(1):92-106. DOI: 10.1093/oxfordjournals.aje.a113284. View

Debillon T, Zupan V, Ravault N, Magny J, Dehan M . Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2001; 85(1):F36-41. PMC: 1721270. DOI: 10.1136/fn.85.1.f36. View

10.

OSullivan A, Rowley S, Ellis S, Faasse K, Petrie K . The Validity and Clinical Utility of the COVERS Scale and Pain Assessment Tool for Assessing Pain in Neonates Admitted to an Intensive Care Unit. Clin J Pain. 2015; 32(1):51-7. DOI: 10.1097/AJP.0000000000000228. View

11.

Picheansathian W, Woragidpoonpol P, Baosoung C . Positioning of Preterm Infants for Optimal Physiological Development: a systematic review. JBI Libr Syst Rev. 2016; 7(7):224-259. DOI: 10.11124/01938924-200907070-00001. View

12.

Lim Y, Godambe S . Prevention and management of procedural pain in the neonate: an update, American Academy of Pediatrics, 2016. Arch Dis Child Educ Pract Ed. 2017; 102(5):254-256. DOI: 10.1136/archdischild-2016-311066. View

13.

Morison S, Grunau R, Oberlander T, Whitfield M . Relations between behavioral and cardiac autonomic reactivity to acute pain in preterm neonates. Clin J Pain. 2002; 17(4):350-8. PMC: 1852479. DOI: 10.1097/00002508-200112000-00010. View

14.

Ilhan E, Pacey V, Brown L, Spence K, Galea C, Adams R . Exploration and Validation of Behavioral Pain Measures and Physiological Pain Measures Factor Structure Extracted From the Pain Assessment Tool Item Scores for Infants Admitted to Neonatal Intensive Care. Clin J Pain. 2021; 37(6):397-403. DOI: 10.1097/AJP.0000000000000931. View

15.

Devsam B, Kinney S . The clinical utility of the pain assessment tool in ventilated, sedated, and muscle-relaxed neonates. Aust Crit Care. 2020; 34(4):333-339. DOI: 10.1016/j.aucc.2020.09.005. View

16.

Anand K . Defining pain in newborns: need for a uniform taxonomy?. Acta Paediatr. 2017; 106(9):1438-1444. PMC: 5601230. DOI: 10.1111/apa.13936. View

17.

Gibbins S, Stevens B, McGrath P, Dupuis A, Yamada J, Beyene J . Changes in physiological and behavioural pain indicators over time in preterm and term infants at risk for neurologic impairment. Early Hum Dev. 2008; 84(11):731-8. DOI: 10.1016/j.earlhumdev.2008.05.004. View

18.

Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C . Determining behavioural and physiological responses to pain in infants at risk for neurological impairment. Pain. 2006; 127(1-2):94-102. DOI: 10.1016/j.pain.2006.08.012. View

19.

Green G, Hartley C, Hoskin A, Duff E, Shriver A, Wilkinson D . Behavioural discrimination of noxious stimuli in infants is dependent on brain maturation. Pain. 2018; 160(2):493-500. PMC: 6343955. DOI: 10.1097/j.pain.0000000000001425. View

20.

Grunau R . Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013; 4(4):e0025. PMC: 3820298. DOI: 10.5041/RMMJ.10132. View