Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220065-en
Brazilian Journal of Pain
Original Article

Reliability and internal consistency in the assessment of neonatal pain in preterm infants during tracheal aspiration: prospective study

Confiabilidade e consistência interna na avaliação da dor neonatal de prematuros durante o procedimento de aspiração traqueal: estudo prospectivo

Nayara Rodrigues Gomes de Oliveira; Cibelle Kayenne Martins Roberto Formiga; Bruna Abreu Ramos; Rafaela dos Santos Noleto; Nayara Nubia de Sousa Moreira; Waldemar Naves do Amaral

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Abstract

BACKGROUND AND OBJECTIVES: Inadequate pain assessment in preterm infants (PI) is a persistent problem. Currently, a precise pain assessment is one of the main challenges for health professionals in the intensive care units (NICU). The objective of this study was to verify the correlation between the Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Prole - Revised (PIPP-R), internal consistency, and inter-evaluator reliability on pain assessment during aspiration in PI.
METHODS: Prospective observational study with low birth weight PI (< 2500 g), hemodynamically stable, minimal or no sedation, under mechanical ventilation, continuous positive airway pressure, nasal cannula oxygen, or ambient air, and needing aspiration during hospitalization in the neonatal intensive care unit in the period from 2019 to 2020.. PI were evaluated during three different aspiration procedures: without intervention (1), using gentle touch (2), and using sucrose (3). NIPS and PIPP-R instruments were applied, while internal consistency was determined using Cronbach’s alpha, reliability using the intraclass correlation coefficient, and concurrent validity using Spearman’s correlation coefficient.
RESULTS: Fifty PIs requiring tracheal aspiration were evaluated. NIPS and PIPP-R showed high (Cronbach α: 0.824) and moderate (Cronbach α: 0.655) internal consistency. Inter-e- valuation reliability was excellent in all aspiration procedures for NIPS (1: 0.991, 2: 0.987, and 3: 0.993) and PIPP-R (1: 0.997, 2: 0.986, and 3: 0.977). Concurrent validity was observed only for aspiration without intervention.
CONCLUSION: Although NIPS may have better clinical utility than PIPP-R, both instruments presented good internal consistency and inter-evaluator reliability and may be used for assessing pain during aspiration in PI.

HIGHLIGHTS
• Reliability measures between two scales to assess pain in preterm infants.
• NIPS and PIPP-R scales were sensitive in identifying pain.
• High reliability on the NIPS scale and moderate reliability on the PIPP-R scale.  

Keywords

Pain, Pain Measurement, Preterm Infant.

Resumo

JUSTIFICATIVA E OBJETIVOS: A avaliação inadequada da dor em recém-nascidos prematuros (RNPT) é um problema persistente. A avaliação precisa da dor é um dos principais desafios para profissionais de saúde nas Unidades de Terapia Intensiva Neonatais (UTIN). O objetivo deste estudo foi verificar a associação entre a Escala de Dor Neonatal (Neonatal Infant Pain Scale - NIPS) e o Perfil da Dor do Bebê Prematuro - Revisado (Premature Infant Pain Profile Revised - PIPP-R), assim como a consistência interna e a confiabilidade inter-avaliadores na aferição da dor durante a aspiração do RNPT. 
MÉTODOS: Estudo transversal prospectivo com RNPT de baixo peso ao nascer (<2500 g), hemodinamicamente estáveis, com mínima ou nenhuma sedação, sob ventilação mecânica, apresentando pressão positiva contínua nas vias aéreas, oxigênio na cânula nasal ou ar ambiente, e precisando de aspiração durante a internação na UTIN no período de 2019 a 2020. Os RNPT foram avaliados durante três diferentes procedimentos de aspiração: sem intervenção (1), toque gentil (2) e administração de sacarose (3). Os instrumentos NIPS e PIPP-R foram aplicados durante a avaliação. A consistência interna foi determinada pelo alfa de Cronbach, a confiabilidade pelo coeficiente de associação intraclasse e a validade concorrente pelo teste de associação de Spearman.
RESULTADOS: Foram avaliados 50 RNPT que necessitaram de aspiração traqueal. A NIPS e a PIPP-R mostraram consistência interna alta (Cronbach α: 0,824) e moderada (Cronbach α: 0,655), respectivamente. A confiabilidade inter-avaliadores foi excelente em todos os procedimentos de aspiração para NIPS (1: 0,991, 2: 0,987 e 3: 0,993) e PIPP-R (1: 0,997, 2: 0,986, e 3: 0,977). A validade concorrente foi observada apenas para aspiração sem intervenção. 
CONCLUSÃO: Embora a NIPS possa ter melhor utilidade clínica do que o PIPP-R, ambos os instrumentos apresentaram boa consistência interna e confiabilidade inter-avaliadores, e podem ser usados para avaliar a dor durante a aspiração em RNPT.
DESTAQUES
• Medidas de confiabilidade entre duas escalas para avaliar a dor em bebês prematuros.
• As escalas NIPS e PIPP-R foram sensíveis para a identificação da dor.
• Alta confiabilidade para a escala NIPS e confiabilidade moderada para a escala PIPP-R.

Palavras-chave

Dor, Medição da Dor, Recém-Nascido Prematuro. 

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Submitted date:
08/16/2022

Accepted date:
12/05/2022

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