Validation of the Bernese Pain Scale for Neonates (BERN-PAIN)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT02749461|
Recruitment Status : Completed
First Posted : April 25, 2016
Last Update Posted : August 3, 2017
|Condition or disease||Intervention/treatment|
|Pain Assessment||Procedure: heel stick|
Preterm birth rates are rising worldwide, including in Europe. In 2014, Switzerland's rate of premature births reached 7.2%. Still, while significant progress in neonatal care has increased the long-term survival of preterm infants, other long-term outcomes remain problematic. As a result, affected infants commonly undergo exceedingly high numbers of painful procedures on a daily basis. For many, these treatment interventions take place at a crucial period in the development of the nociceptive and central nervous systems, i.e., at a developmental stage when repeated painful stimulus may induce both structural and functional reorganization of the nervous system and an altered pain response.
As infants are unable to communicate verbally, clinical pain assessment in neonates, particularly those delivered preterm, is highly challenging. Therefore, pain responses have to be observed according to physiological and behavioral indicators which might vary across preterm infants depending on their physiological and neurological development stages.
The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool which is already widely used in clinical settings in the German speaking areas of Europe. Recent findings suggest that pain reaction is influenced by more than noxious stimulation alone: it is assumed that contextual factors, e.g., gestational age (GA) or gender, might also impact pain reactivity.
The aims of this validation study are:
- to undertake the psychometric testing of the BPSN regarding its concurrent validity with the Premature Infant Pain Profile-Revised (PIPP-R), construct validity, interrater and intrarater reliability, specificity and sensitivity;
- to examine the variability of pain reactions related to behavioural and physiological patterns across time;
- to assess the influence of contextual factors on the variability of pain reactions across GA groups; and
- to examine the relationship between behavioural and physiological indicators across time.
This multisite psychometric measurement study of the BPSN will use repeated measures design. The study will take place in three tertiary care hospitals (Bern, Zurich and Basel) in Switzerland. To examine the impact of GA on pain reaction and its variability, the infants will be stratified into six GA groups ranging from 24 0/7 to 42 0/7. Among preterm infants with GAs up to 36 6/7 weeks, five consecutive heel sticks within the first 14 days of life will be documented. Among healthy-term infants two heel sticks within the first days after birth will be documented. For each heel stick, measurements will be recorded for each of three phases: baseline, heel stick, and recovery. All phases will be videotaped and the child's pain reaction later rated according to the BPSN by five independent raters blinded to the measurement phase. Individual contextual factors of interest for this study are documented in a standardised way in all three participating Neonatal Intensive Care Units (NICUs), and can be extracted from patient charts.
This diagnostic study is intended to validate the BPSN with consideration for contextual factors influencing neonatal pain responses. Understanding and embedding the influences of contextual factors into a final version of the BPSN-Context will help clinicians more accurately assess pain in the clinical setting, and will eventually help them minimize the pain endured by neonates, particularly preterm neonates in NICUs. For preterm infants requiring intensive care, adequate and efficient pain management is an important factor in later motor and cognitive development. The investigators hope this study will contribute to the prevention of negative long-term outcomes in this patient population.
|Study Type :||Observational|
|Actual Enrollment :||156 participants|
|Official Title:||Validation of the Bernese Pain Scale for Neonates With Consideration for Contextual Factors|
|Study Start Date :||November 2015|
|Actual Primary Completion Date :||January 2017|
|Actual Study Completion Date :||January 2017|
- Procedure: heel stick
Consecutive routine blood sampling heel sticks
- Change in pain response across time [ Time Frame: 2-5 timepoints within the first 14 days of life ]Change and variability of pain response across different time points will be measured with the BPSN
- Influence of individual contextual factors on pain response across time [ Time Frame: 2-5 within the first 14 days of life ]Time points of contextual factors documentation are determined by the clinical need for routine heel stick procedures within the first 14 days of life. These time points are not fixed before hand but are based on ongoing clinical judgement during the first 14 days of life. For each clinically determined time point for a heel stick appropriate contextual factors being relevant the day of the determined heel stick date will be extracted from patient chart.
- Psychometric testing of the BPSN [ Time Frame: 2-5 timepoints within the first 14 days of life ]Psychometric testing will be done across all the five time points for baseline, heel stick and recovery phases
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02749461
|Lawrence S. Bloomberg Faculty of Nursing and Faculties of Medicine and Dentistry, University of Toronto|
|Department of Neonatology, University Children's Hospital of Basel (UKBB)|
|Neonatology, Children's Hospital, University Hospital of Bern|
|Neonatology, University Hospital of Zurich|
|Principal Investigator:||Eva Cignacco, Prof. Dr.||Bern University of Applied Sciences|