COVERS Neonatal Pain Scale: Development and Validation

Newborns and infants are often exposed to painful procedures during hospitalization. Several different scales have been validated to assess pain in specific populations of pediatric patients, but no single scale can easily and accurately assess pain in all newborns and infants regardless of gestational age and disease state. A new pain scale was developed, the COVERS scale, which incorporates 6 physiological and behavioral measures for scoring. Newborns admitted to the Neonatal Intensive Care Unit or Well Baby Nursery were evaluated for pain/discomfort during two procedures, a heel prick and a diaper change. Pain was assessed using indicators from three previously established scales (CRIES, the Premature Infant Pain Profile, and the Neonatal Infant Pain Scale), as well as the COVERS Scale, depending upon gestational age. Premature infant testing resulted in similar pain assessments using the COVERS and PIPP scales with an . For the full-term infants, the COVERS scale and NIPS scale resulted in similar pain assessments with an . The COVERS scale is a valid pain scale that can be used in the clinical setting to assess pain in newborns and infants and is universally applicable to all neonates, regardless of their age or physiological state. 1. Background The definition of pain was established by the International Association for the Study of Pain (IASP) in 1979 as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” [1]. Newborns and infants are often exposed to numerous procedures during hospitalization which can be characterized as painful. In terms of requirements for pain perception, by 20 weeks gestation, the fetal neocortex is present, and pain pathways to the brain stem and thalamus are completely myelinated by 30 weeks [2]. Pain in neonates is often underrecognized and undertreated [3]. In addition, early exposure to pain has been shown to affect the way babies respond to pain later in life [4]. It is, therefore, important for clinicians to assess and manage pain on a regular basis in order to avoid excessive exposure. Several validated and reliable pain scales exist to measure acute pain in term and preterm neonates. These scales incorporate a combination of behavioral indicators of pain (e.g., facial expression, body movements, and crying) and/or physiological indicators of pain (e.g., changes in heart rate, respiratory rate, blood pressure, oxygen saturation [SaO2], vagal tone, palmar sweating, and plasma cortisol or catecholamine levels) to assess pain in