Background and aims Premature Infant Pain Profile (PIPP) has been studied and validated in intensive care units but seldom in neonates with ventilatory support. The aim of the study was to assess PIPP (feasibility, inter-rater reproductibility, easiness) while endotracheal suctionning in ventilated newborns in order to use it later for pain treatment monitoring.

Methods Prospective study done in a level III neonatal intensive care unit, from 2013 march 5th to 2013 April 25th. 25 newborns with invasive mechanically ventilatory support were involved and they were filmed during the procedure. Four observators noted individually PIPPscale for each baby: the patient’s nurse and a department’s resident in the room and, an NIDCAP experienced paediatrician and the resident making the study, after viewing the video. The inter-rater agreement was assessed by the Cohen’s Kappa coefficient.

Results 100% of the PIPP scales were done. The global inter-rater agreement was poor, with a kappa coefficient at 0,303 (0,035–0,571) and especially for the mimic items. 33% of the nurses found the PIPP scale difficult to use. Mean PIPP during endotracheal suctionning varied from 8.7 to 9.3.

Conclusions Pain assessment by PIPP scale was poorly reproducible and hard to nurse’s use in the ventilated newborns. Neonatal pain and sedation protocol guided by PIPP scale seems us to be difficult to implement in intubated neonates.