• A L Pereira, R Guinsburg, M F de Almeida, A C Monteiro, A M dos Santos, and B I Kopelman.
• Department of Pediatrics, Universidade Federal de São Paulo/Escolaxs Paulista de Medicina, Brazil. dpn@mandic.com.br
• Sao Paulo Med J. 1999 Mar 4;117(2):72-80.

ContextThe subjectivity of pain causes enormous difficulties in evaluating neonatal pain with a single, practical and easy-to-apply tool. Pain evaluation in the neonatal period should be performed by valid, safe, useful and feasible methods.ObjectiveTo evaluate the validity of the Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS), heart rate (HR) and O2 saturation (O2 sat) for neonatal pain assessment.DesignProspective, double-blind randomized trial.SettingA secondary level maternity hospital.Participants70 healthy neonates requiring bilirubin dosage were randomly assigned to receive a venous puncture (P: n = 33, BW 3.2 kg, SD 0.6; GA 39 wk, SD 1; 59 h of life, SD 25) or an alcohol swab friction (F: n = 37; BW 3.1 kg, SD 0.5; GA 39 wk, SD 1; 52 h of life, SD 17).InterventionAll measurements were taken prior to (PRE), during (TO), and 1 (T1), 3(T3), 5(T5) and 10(T10) minutes after the procedure.MeasurementsA neonatologist evaluated NFCS, NIPS, HR and O2 sat by pulse oxymetry.ResultsMedian NFCS and NIPS results at T0, T1 and T3 were higher in P group, compared to F. More P neonates presented NFCS > 2 and/or NIPS > 3 at T0, T1 and T3. HR was lower in P group at T1. Average O2 sat was above 90% during the whole study period in both groups.ConclusionNFCS and NIPS are suitable instruments for neonatal pain evaluation. Heart rate and O2 saturation can be used only as auxiliary methods.

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