Neonatal Pain, Agitation, and Sedation Scale’s use, reliability, and validity: a systematic review

Abstract

The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) is recommended by the American Academy of Pediatrics to measure neonatal pain and sedation. However, little is known regarding its reliability and validity for diverse neonatal subpopulations. Twenty-nine studies were included in our review, demonstrating broad application of N-PASS and good or excellent reliability and validity for various neonatal subpopulations. Our systematic review found N-PASS to be valid and reliable for many but not all neonatal subpopulations. There is a lack of support for N-PASS reliability and validity for measuring prolonged pain and sedation in nonmechanically ventilated infants and for acute pain in postoperative infants in any gestational age category. Overall, N-PASS is a psychometrically sound and pragmatic instrument evaluating pain and sedation for most neonatal populations. Future research using N-PASS is encouraged to evaluate and report its validity and reliability, especially for neonatal subpopulations not included in this review.

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Fig. 1: PRISMA flow diagram.
Fig. 2: N-PASS validity and reliability by gestational age and infant status.

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MEM conceptualized, designed, and implemented the study, analyzed the results, and drafted the initial paper; SK provided clinical content expertise, revised the manuscript, reviewed analysis of data, and provided substantial comment and critical critique on the paper; MN helped conceptualize the study, provided clinical content expertise, revised the paper, reviewed analysis of data, and provided substantial comment and critical critique on the paper; CJS conceptualized, designed, and implemented the study, analyzed the results, and mentored the initial paper draft.

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Correspondence to Mikayla E. Morgan.

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Morgan, M.E., Kukora, S., Nemshak, M. et al. Neonatal Pain, Agitation, and Sedation Scale’s use, reliability, and validity: a systematic review. J Perinatol (2020). https://doi.org/10.1038/s41372-020-00840-7

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