Abstract 1191 Poster Session II, Sunday, 5/2 (poster 32)

Background: Neurodevelopmental immaturity alters the behaviors demonstrated by premature infants in response to painful stimuli. Change in physiologic parameters alone does not appropriately assess the premature infant response to pain. Objective: To develop an observationally based tool to assess pain in premature infants. Methods: Based upon principles of developmental care theory, we developed an observational scale quantifying pain in preterm infants undergoing painful experiences. The Preterm Infant Pain Assessment (PIPA) integrates assessment of facial expression, cry/state, tone, and heart rate into a score ranging from 0 to 11. A score of 0 describes an undisturbed infant, and a score of 11 reflects an infant who is hypotonic, flaccid and bradycardic. Each parameter was scored on a Likert scale. Results: We observed 14 infants during 21 routine eye exams. Mean (+/- SD) birth weight was 1030 (+/- 303) grams, gestational age at birth of 27.9 (+/- 2.5) weeks, and postnatal age at time exam of 36.6 (+/-3) weeks. Infants were scored and heart rate recorded before (B), each minute during the exam (D) and 1 and 2 minutes after completion of the exams (P). As illustrated in the graph below, PIPA remained significantly elevated above baseline throughout the exam and during the post-exam observation period, while heart rate was significantly elevated only during the 2nd and 3rd minutes of the exams. (*p<.05) Conclusion: The PIPA provides a quantitative assessment of pain in premature infants that can be used to direct care for the individual as well as to evaluate techniques of pain management. PIPA appears to be a more sensitive measure of distress in premature infants than heart rate assessment alone. (Figure)

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