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O-114 Validation Of The Neonatal Pain, Agitation And Sedation Scale For The Assessment Of Sedation In Neonatal Intensive Care Patients
  1. V Giordano1,
  2. P Deindl1,
  3. S Kuttner1,
  4. T Waldhör2,
  5. T Werther1,
  6. C Czaba1,
  7. A Berger1,
  8. A Pollak1,
  9. M Weninger1,
  10. M Oliscahr1
  1. 1Department of Pediatrics and Adolescent Medicine. Division of Neonatology Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
  2. 2Department of Epidemiology Center for Public Health, Medical University of Vienna, Vienna, Austria


Background Implementation of sedation protocols based on regular sedation assessment using item-based scales can improve sedative treatment in children. There is a lack of validated tools to assess sedation in neonates.

Objective To validate the Neonatal Pain, Agitation and Sedation Scale (N-PASS) for the assessment of sedation in preterm and term neonates.

Methods The Nurse Interpretation of Sedation Score (NISS) was used to validate the N-PASS with regard to neonatal sedation. Paired assessments of both the N-PASS and the NISS were performed in 50 sedated neonates from 23 to 44 weeks’ postmenstrual age.

Results A total set of 503 paired observations were included into analysis. The median N-PASS scores were significantly different for the three NISS categories (over-sedation (-8), adequate sedation (-2), under-sedation (0); p <.0001). Inter-observer agreement for the N-PASS sedation subscale was excellent (linearly weighted Cohen’s Kappa:. 93), as was the internal consistency estimated by a Cronbach’s alpha of 0.88, which increased to.90 when the vital sign item was excluded from the N-PASS. There was no risk of under-sedation in patients with an N-PASS score <-5 and no risk of over-sedation with an N-PASS score > -2. The N-PASS reliably detected over-sedation. Detection of under-sedation was markedly improved by simultaneous assessment of N-PASS pain scores which were significantly different in patients being considered adequately sedated vs. inadequately sedated (median N-PASS pain subscale score: 2 vs. 5).

Conclusion The N-PASS meets the requirements of a valid clinical tool to assess sedation in neonates and may facilitate the use of sedation algorithms in the neonatal intensive care unit.

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