Article Text


33 The Black Box of Pain Assessment in Extremely Premature Newborns Remains Closed
  1. M van Dijk,
  2. D Roofthooft,
  3. I Reiss
  1. Neonatal Intensive Care, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands


Background and aims In our NICU nurses assess the neonates’ pain with the validated COMFORTneo scale three times per day and additionally if they suspect pain. We treat more and more extremely premature neonates from 24 weeks gestation. In this study we explore if the COMFORTneo scale is valid for these extreme premature neonates.

Methods COMFORTneo scores and Numeric Rating Scale (NRS) scores for pain and distress from 2011 were extracted from the patient data management system. We selected scores assigned in the first 28 postnatal days and considered three gestational age groups: extreme prematures: 23.6 to 27.0 wks, prematures: 27.1 to 35.6 weeks and term borns: 36 weeks and older.

Results We retrieved 9915 scores in 638 newborns. The median number of scores per patient was 41 (IQR 28 to 55) for 76 extreme prematures; 8(IQR 3 to 18) for 329 prematures; and 3 (IQR 1 to 9) for 233 term borns. 10.0% of scores for the extreme prematures; 9.1% of scores for the prematures; and 15.8% of scores for the term borns suggested pain or distress (COMFORTneo score ≥ 14). Correlations between the COMFORTneo scale and the NRS pain ranged from 0.42 (extreme prematures) to 0.53 (prematures); those between the COMFORTneo scale and the NRS-distress 0.76 (extreme prematures) to 0.85 (term borns). Internal consistencies varied from Cronbach’s alpha 0.73 (in extreme prematures) to 0.85 (in term borns).

Conclusions The COMFORTneo scale has acceptable psychometric properties for extreme prematures but we should continue to study other assessment strategies.

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.