Background
Methods
Sample and settings
Recruitment and data collection procedures
Measures
Sample size and power
Data analysis
Preliminary analyses
Missing values
Interrater reliability
Factor analyses
Measurement construct
Model specification
Analytical procedure
Reliability and validity of the modified BPSN
Internal consistency and corrected item-total correlation
Correlations between behavioural and physiological indicators of pain
Construct validity
Concurrent validity
Specificity and sensitivity analysis
Secondary analyses by GA-groups
Results
Missing data and sample characteristics
Gestational age groups | |||||
---|---|---|---|---|---|
Total Sample | Extremely preterm neonates | Very preterm neonates | Moderate to late preterm neonates | Full-term neonates | |
Sample, n (%) | 154 (100) | 50 (32.5) | 45 (29.2) | 38 (24.7) | 21 (13.6) |
Sex, n (%) | |||||
- Male | 87 (56.5) | 31 (62.0) | 23 (51.1) | 20 (52.6) | 13 (61.9) |
GA at birth in weeks, mean (SD) | 30.85 (4.5) | 26.23 (1.2) | 29.44 (1.0) | 34.21 (1.0) | 38. 81 (1.3) |
Birth weight in grams, mean (SD) | 1630.10 (934.3) | 851.40 (196.4) | 1285.11 (328.2) | 2093.68 (377.5) | 3384.52 (811.6) |
Number of comorbidities, mean (SD) | 5.70 (4.4) | 10.06 (4.2) | 5.44 (2.4) | 2.66 (1.4) | 1.38 (1.1) |
CRIB score, mean (SD) | 3.76 (3.9) | 7.50 (3.7) | 3.24 (2.8) | 1.05 (1.7) | 0.86 (1.6) |
Way of delivery, n (%) | |||||
- Vaginal-spontan | 36 (23.4) | 10 (20.0) | 4 (8.9) | 13 (34.2) | 9 (42.9) |
- Vaginal-operativ | 4 (2.6) | 0 (0) | 1 (2.2) | 2 (5.3) | 1 (4.8) |
- Planned c-section | 23 (14.9) | 3 (6.0) | 8 (17.8) | 7 (18.4) | 5 (23.8) |
- Emergency c-cection | 91 (59.1) | 37 (74.0) | 32 (71.1) | 16 (42.1) | 6 (28.6) |
Number of birth, mean (SD) | |||||
- Single | 104 (67.5) | 43 (86.0) | 20 (44.4) | 21 (55.3) | 20 (95.2) |
- One of twins | 44 (28.6) | 4 (8.0) | 22 (48.9) | 17 (44.7) | 1 (4.8) |
- One of triplet | 6 (3.9) | 3 (6.0) | 3 (6.7) | 0 (0) | 0 (0) |
Day of life at first measure point, mean (SD) | 3.95 (2.0) | 4.80 (2.2) | 3.56 (1.9) | 3.18 (1.0) | 4.19 (2.6) |
Results of descriptive and preliminary analysis
Rater A | Rater B | Rater C | Rater D | Rater E | ||
---|---|---|---|---|---|---|
Phase | Means t1-t5 | Means t1-t5 | Means t1-t5 | Means t1-t5 | Means t1-t5 | |
Range (Median) | Range (Median) | Range (Median) | Range (Median) | Range (Median) | ||
BPSN total-scale | Baseline | 0.89–1.14 (1.06) | 1.99–2.47 (2.21) | 1.31–1.51 (1.38) | 4.44–5.15 (4.98) | 4.66–4.97 (4.80) |
N = 81–142 | Heel Stick | 4.03–4.77 (4.14) | 5.98–6.98 (6.33) | 4.57–5.41 (4.87) | 8.15–9.53 (8.29) | 8.00–9.07 (8.52) |
Recovery | 1.84–2.30 (2.19) | 3.08–3.40 (3.22) | 2.37–2.67 (2.46) | 5.27–6.27 (6.06) | 5.37–5.99 (5.65) | |
Subjective subscale | Baseline | 0.89–1.14 (1.06) | 1.99–2.47 (2.21) | 1.31–1.51 (1.38) | 4.44–5.15 (4.98) | 4.66–4.97 (4.80) |
N = 82–142 | Heel Stick | 2.51–2.82 (2.68) | 4.64–4.96 (4.73) | 3.00–3.35 (3.31) | 6.59–7.47 (6.84) | 6.65–7.04 (6.90) |
Recovery | 1.17–1.63 (1.45) | 2.39–2.76 (2.51) | 1.70–1.97 (1.77) | 4.59–5.60 (5.28) | 4.66–5.26 (4.94) | |
Sleeping | Baseline | 0.23–0.28 (0.23) | 0.39–0.43 (0.41) | 0.42–0.51 (0.47) | 1.04–1.28 (1.19) | 0.89–1.10 (1.05) |
N = 95–143 | Heel Stick | 0.39–0.45 (0.42) | 0.75–0.91 (0.89) | 0.55–0.63 (0.60) | 1.19–1.29 (1.23) | 1.35–1.46 (1.41) |
Recovery | 0.20–0.32 (0.30) | 0.40–0.49 (0.41) | 0.41–0.51 (0.42) | 1.02–1.31 (1.19) | 0.89–1.08 (1.06) | |
Crying | Baseline | 0.02–0.06 (0.06) | 0.04–0.09 (0.07) | 0.04–0.10 (0.06) | 0.06–0.11 (0.09) | 0.07–0.12 (0.09) |
N = 96–143 | Heel Stick | 0.21–0.30 (0.24) | 0.30–0.43 (0.36) | 0.31–0.42 (0.37) | 0.35–0.47 (0.42) | 0.36–0.48 (0.43) |
Recovery | 0.02–0.06 (0.03) | 0.03–0.10 (0.06) | 0.03–0.11 (0.07) | 0.05–0.11 (0.06) | 0.04–0.12 (0.09) | |
Consolation | Baseline | 0.02–0.06 (0.05) | 0.05–0.10 (0.09) | 0.04–0.12 (0.07) | 0.77–1.07 (0.97) | 0.03–0.12 (0.08) |
N = 96–143 | Heel Stick | 0.21–0.32 (0.21) | 0.31–0.48 (0.43) | 0.28–0.43 (0.33) | 1.19–1.48 (1.26) | 0.35–0.55 (0.46) |
Recovery | 0.00–0.07 (0.02) | 0.03–0.13 (0.06) | 0.01–0.15 (0.09) | 0.68–0.99 (0.85) | 0.02–0.14 (0.11) | |
Skin colour | Baseline | 0.02–0.06 (0.04) | 1.00–1.27 (1.11) | 0.02–0.06 (0.03) | 0.86–1.06 (0.97) | 1.51–1.67 (1.61) |
N = 96–143 | Heel Stick | 0.05–0.08 (0.07) | 1.19–1.29 (1.26) | 0.03–0.05 (0.03) | 0.99–1.36 (1.07) | 1.55–1.79 (1.69) |
Recovery | 0.00–0.06 (0.04) | 1.05–1.18 (1.13) | 0.02–0.04 (0.03) | 0.89–1.09 (1.04) | 1.48–1.69 (1.53) | |
Facial expression | Baseline | 0.16–0.29 (0.24) | 0.17–0.29 (0.19) | 0.22–0.32 (0.25) | 0.73–0.86 (0.75) | 0.83–0.89 (0.87) |
N = 95–143 | Heel Stick | 0.50–0.64 (0.61) | 0.61–0.69 (0.64) | 0.60–0.65 (0.63) | 1.01–1.13 (1.06) | 1.08–1.18 (1.12) |
Recovery | 0.19–0.33 (0.24) | 0.09–0.19 (0.17) | 1.16–0.26 (0.23) | 0.62–0.79 (0.69) | 0.80–0.89 (0.87) | |
Posture | Baseline | 0.33–0.49 (0.40) | 0.27–0.36 (0.30) | 0.45–0.49 (0.48) | 0.93–1.04 (0.99) | 1.15–1.29 (1.19) |
N = 97–143 | Heel Stick | 0.55–0.67 (0.60) | 0.69–0.80 (0.78) | 0.57–0.71 (0.70) | 1.17–1.24 (1.20) | 1.38–1.45 (1.41) |
Recovery | 0.32–0.43 (0.34) | 0.20–0.34 (0.32) | 0.37–0.46 (0.41) | 0.80–0.94 (0.87) | 1.06–1.20 (1.19) | |
Breathing | Heel Stick | 0.47–0.57 (0.50) | 0.32–0.65 (0.54) | 0.61–0.72 (0.65) | 0.50–0.69 (0.64) | 0.39–0.62 (0.47) |
N = 84–142 | Recovery | 0.35–0.54 (0.45) | 0.31–0.46 (0.40) | 0.40–0.63 (0.58) | 0.49–0.64 (0.53) | 0.31–0.58 (0.41) |
Raw Scores | Baseline | 26.7–27.9 (27.6) | 25.7–26.9 (25.8) | 27.8–29.5 (28.1) | 26.0–26.9 (26.6) | 28.4–30.1 (29.5) |
Breathing | Heel Stick | 28.6–29.2 (28.5) | 26.1–27.8 (27.0) | 28.2–29.9 (28.9) | 27.2–28.3 (27.5) | 29.4–30.4 (30.0) |
N = 91–142 | Recovery | 27.0–28.7 (27.7) | 25.3–27.1 (26.2) | 27.4–29.3 (28.3) | 26.4–27.4 (26.6) | 28.9–30.1 (29.7) |
Interrater reliability
Heel Stick Phase 1 | Heel Stick Phase 2 | Heel Stick Phase 3 | Heel Stick Phase 4 | Heel Stick Phase 5 | |
---|---|---|---|---|---|
ICC [95%CI] | ICC [95%CI] | ICC [95%CI] | ICC [95%CI] | ICC [95%CI] | |
Sleeping | |||||
N | 135 | 139 | 117 | 105 | 93 |
Single measures | 0.215 [0.13–0.31] | 0.267 [0.18–0.36] | 0.211 [0.13–0.30] | 0.185 [0.11–0.28] | 0.221 [0.13–0.33] |
Average measures | 0.578 [0.43–0.69] | 0.646 [0.52–0.74] | 0.572 [0.43–0.69] | 0.532 [0.37–0.66] | 0.586 [0.43–0.71] |
Crying | |||||
N | 138 | 140 | 117 | 107 | 94 |
Single measures | 0.773 [0.72–0.82] | 0.694 [0.63–0.76] | 0.721 [0.65–0.78] | 0.719 [0.65–0.78] | 0.655 [0.57–0.73] |
Average measures | 0.945 [0.93–0.96] | 0.919 [0.89–0.94] | 0.928 [0.90–0.95] | 0.927 [0.90–0.95] | 0.905 [0.87–0.93] |
Consolation | |||||
N | 140 | 140 | 117 | 108 | 94 |
Single measures | 0.453 [0.31–0.58] | 0.381 [0.22–0.53] | 0.420 [0.27–0.55] | 0.319 [0.16–0.48] | 0.257 [0.11–0.41] |
Average measures | 0.805 [0.69–0.87] | 0.755 [0.58–0.85] | 0.784 [0.65–0.86] | 0.701 [0.48–0.82] | 0.634 [0.38–0.78] |
Skin colour | |||||
N | 141 | 138 | 115 | 108 | 96 |
Single measures | 0.074 [0.02–0.14] | 0.049 [0.03–0.37] | 0.073 [0.02–0.15] | 0.045 [0.00–0.10] | 0.072 [0.01–0.15] |
Average measures | 0.285 [0.09–0.45] | 0.205 [0.03–0.37] | 0.284 [0.08–0.46] | 0.189 [0.01–0.36] | 0.280 [0.06–0.47] |
Facial expression | |||||
N | 135 | 130 | 112 | 102 | 92 |
Single measures | 0.655 [0.53–0.75] | 0.555 [0.43–0.66] | 0.558 [0.45–0.66] | 0.500 [0.37–0.62] | 0.514 [0.37–0.64] |
Average measures | 0.905 [0.85–0.94] | 0.862 [0.79–0.91] | 0.863 [0.80–0.91] | 0.833 [0.75–0.89] | 0.841 [0.74–0.90] |
Posture | |||||
N | 141 | 139 | 117 | 108 | 97 |
Single measures | 0.551 [0.38–0.68] | 0.487 [0.31–0.63] | 0.536 [0.38–0.66] | 0.400 [0.25–0.54] | 0.342 [0.21–0.48] |
Average measures | 0.860 [0.75–0.92] | 0.826 [0.69–0.89] | 0.852 [0.75–0.91] | 0.769 [0.62–0.85] | 0.722 [0.57–0.82] |
Breathing | |||||
N | 119 | 111 | 100 | 95 | 82 |
Single measures | 0.252 [0.17–0.34] | 0.348 [0.26–0.44] | 0.334 [0.24–0.44] | 0.348 [0.25–0.45] | 0.402 [0.30–0.51] |
Average measures | 0.627 [0.51–0.72] | 0.727 [0.64–0.80] | 0.715 [0.62–0.79] | 0.727 [0.63–0.81] | 0.770 [0.68–0.84] |
Raw Scores Breathing | |||||
N | 128 | 123 | 107 | 106 | 91 |
Single measures | 0.636 [0.56–0.71] | 0.632 [0.56–0.71] | 0.674 [0.59–0.75] | 0.610 [0.53–0.69] | 0.630 [0.54–0.71] |
Average measures | 0.897 [0.87–0.92] | 0.896 [0.86–0.92] | 0.912 [0.88–0.94] | 0.887 [0.85–0.92] | 0.895 [0.86–0.93] |
Factor analyses
Item selection
Model | df | χ2 | AIC | RMSEA | CFI | TLI | SRMR |
---|---|---|---|---|---|---|---|
Baseline (7 subjective items) | 2918 | 4985 | 36,875 | 0.068 | 0.807 | 0.803 | 0.135 |
Final (Crying, Facial expression, Posture) | 472 | 648 | 13,575 | 0.049 | 0.961 | 0.957 | 0.111 |
Physiological items’ sensitivity to pain
Measurement invariance
Model | Restriction | df | ∆ RMSEA | ∆ CFI | ∆ TLI | ∆χ2 | ∆ df | p (∆χ2) |
---|---|---|---|---|---|---|---|---|
Heel stick phases of measurement points t1-t5 | WRLInv | 440 | 0 | 0.000 | 0.002 | 39 | 40 | 0.531 |
OLInv | 448 | 0 | − 0.015 | − 0.015 | 115 | 48 | 0.000 | |
All phases and measurement points | WRLInv | 4340 | 0 | −0.007 | − 0.006 | 123 | 40 | 0.000 |
OLInv | 4348 | 0 | −0.024 | − 0.025 | 343 | 48 | 0.000 |
Reliability and validity of the modified BPSN
Cronbach’s alpha and corrected item-Total correlation
Heel Stick Phase 1 | Heel Stick Phase 2 | Heel Stick Phase 3 | Heel Stick Phase 4 | Heel Stick Phase 5 | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Median (Range) | Median (Range) | Median (Range) | Median (Range) | Median (Range) | ||||||
Cronbach’s α | 0.876 (0.841–0.922) | 0.848 (0.778–0.885) | 0.845 (0.762–0.893) | 0.815 (0.725–0.884) | 0.825 (0.669–0.852) | |||||
rcor∗ | α** | rcor∗ | α** | rcor∗ | α** | rcor∗ | α** | rcor∗ | α** | |
Crying | 0.772 | 0.850 | 0.693 | 0.831 | 0.689 | 0.822 | 0.678 | 0.768 | 0.957 | 0.783 |
(0.680–0.875) | (0.801–0.916) | (0.572–0.752) | (0.711–0.881) | (0.559–0.777) | (0.705–0.881) | (0.427–0.772) | (0.689–0.880) | (0.297–0.698) | (0.761–0.846) | |
Facial expression | 0.817 | 0.773 | 0.774 | 0.736 | 0.781 | 0.703 | 0.668 | 0.696 | 0.778 | 0.653 |
(0.793–0.907) | (0.700–0.837) | (0.704–0.854) | (0.598–0.783) | (0.699–0.867) | (0.550–0.781) | (0.656–0.845) | (0.444–0.778) | (0.663–0.851) | (0.296–0.682) | |
Posture | 0.741 | 0.829 | 0.737 | 0.790 | 0.683 | 0.809 | 0.694 | 0.753 | 0.647 | 0.781 |
(0.679–0.849) | (0.786–0.894) | (0.569–0.794) | (0.718–0.846) | (0.547–0.776) | (0.695–0.866) | (0.567–0.793) | (0.617–0.822) | (0.521–0.687) | (0.519–0.840) |
Correlations between behavioural and physiological indicators of pain
Heel Stick Phase 1 | Heel Stick Phase 2 | Heel Stick Phase 3 | Heel Stick Phase 4 | Heel Stick Phase 5 | |
---|---|---|---|---|---|
N | 144 | 140 | 118 | 109 | 97 |
Median (Range) | 0.316* (0.237–0.329*) | 0.235 (0.183–0.285) | 0.234 (0.102–0.327*) | 0.188 (0.155–0.251) | 0.305 (0.223–0.379*) |
Construct validity
Behavioural Subscale
| |||
Likelihood Ratio Test
|
χ
2
|
df
|
p
-value
|
Phases
| 864.18 | 10 | < 0.001 |
Fixed effects
|
Estimated coefficients
|
Std. Error
|
t
-value
|
Intercept | 0.265 | 0.458 | 0.579 |
Baseline phase | −1.041 | 0.069 | −15.008 |
Recovery phase | −1.134 | 0.069 | −16.040 |
Measurement point 2 | − 0.130 | 0.070 | −1.852 |
Measurement point 3 | 0.079 | 0.074 | 1.077 |
Measurement point 4 | − 0.078 | 0.076 | −1.038 |
Measurement point 5 | 0.097 | 0.079 | 1.238 |
GA at time of birth | 0.063 | 0.012 | 5.488 |
Gender (female) | −0.017 | 0.101 | −0.170 |
Measurement point 2 * Baseline | 0.251 | 0.099 | 2.538 |
Measurement point 2 * Recovery | 0.309 | 0.098 | 3.140 |
Measurement point 3 * Baseline | 0.147 | 0.104 | 1.419 |
Measurement point 3 * Recovery | 0.071 | 0.103 | 0.682 |
Measurement point 4 * Baseline | 0.308 | 0.106 | 2.919 |
Measurement point 4 * Recovery | 0.354 | 0.105 | 3.359 |
Measurement point 5 * Baseline | 0.062 | 0.109 | 0.569 |
Measurement point 5 * Recovery | 0.067 | 0.109 | 0.614 |
Item Heart rate
| |||
Likelihood Ratio Test
|
χ
2
|
df
|
p
-value
|
Phases
| 172.91 | 5 | < 0.001 |
Fixed effects
|
Estimated coefficients
|
Std. Error
|
t
-values
|
Intercept | −0.563 | 0.221 | −2.547 |
Recovery phase | −0.646 | 0.088 | −7.383 |
Measurement point 2 | 0.023 | 0.089 | 0.260 |
Measurement point 3 | −0.199 | 0.093 | −2.139 |
Measurement point 4 | −0.141 | 0.095 | −1.477 |
Measurement point 5 | 0.117 | 0.099 | 1.183 |
GA at time of birth | 0.042 | 0.007 | 6.145 |
Gender (female) | 0.003 | 0.054 | 0.051 |
Measurement point 2 * Recovery | 0.021 | 0.126 | 0.167 |
Measurement point 3 * Recovery | 0.206 | 0.131 | 1.578 |
Measurement point 4 * Recovery | 0.155 | 0.133 | 1.160 |
Measurement point 5 * Recovery | −0.032 | 0.138 | −0.231 |
Concurrent validity
Heel Stick Phase 1 | Heel Stick Phase 2 | Heel Stick Phase 3 | Heel Stick Phase 4 | Heel Stick Phase 5 | |
---|---|---|---|---|---|
N | 144 | 140 | 118 | 109 | 97 |
Median (Range) | 0.697** (0.652**-0.758**) | 0.709** (0.662**-0.735**) | 0.688** (0.649-**0.723**) | 0.666** (0.636**-0.735**) | 0.648** (0.600**-0.711**) |
Sensitivity and specificity
Cut-off points | AUC | ||||
---|---|---|---|---|---|
Heel stick phase | N | 0.5 | 1.5 | 2.5 | [95% CI] |
t1
| 144 | ||||
Sensitivity | 0.926 |
0.853
| 0.724 | 0.863 | |
Specificity | 0.515 |
0.662
| 0.857 | [0.800–0.926] | |
t2
| 140 | ||||
Sensitivity | 0.908 |
0.811
| 0.667 | 0.825 | |
Specificity | 0.442 |
0.597
| 0.805 | [0.756–0.894] | |
t3
| 118 | ||||
Sensitivity | 0.874 |
0.769
| 0.631 | 0.812 | |
Specificity | 0.424 |
0.672
| 0.858 | [0.734–0.890] | |
t4
| 109 | ||||
Sensitivity | 0.870 |
0.750
| 0.574 | 0.812 | |
Specificity | 0.484 |
0.685
| 0.876 | [0.730–0.894] | |
t5
| 97 | ||||
Sensitivity | 0.869 |
0.794
| 0.646 | 0.812 | |
Specificity | 0.383 |
0.670
| 0.879 | [0.722–0.902] |
Results of the psychometric testing of the BPSN separated by GA-groups
Interrater reliability
Extremely Preterm Neonates | Very Preterm Neonates | Moderate to Late Preterm Neonates | Full-term Neonates | |
---|---|---|---|---|
Heel Stick Phases t1-t5 Range (Median) | Heel Stick Phases t1-t5 Range (Median) | Heel Stick Phases t1-t5 Range (Median) | Heel Stick Phases t1-t5 Range | |
Sleeping | ||||
N | 41–47 | 32–44 | 20–34 | 14–20 |
Single measures | 0.175–0.310 (0.260) | 0.145–0.356 (0.198) | 0.090–0.289 (0.160) | 0.155–0.225 |
Average measures | 0.515–0.692 (0.637) | 0.459–0.734 (0.553) | 0.330–0.670 (0.487) | 0.478–0.592 |
Crying | ||||
N | 40–47 | 33–44 | 21–35 | 14–20 |
Single measures | 0.622–0.794 (0.701) | 0.538–0.786 (0.716) | 0.564–0.783 (0.702) | 0.619–0.680 |
Average measures | 0.892–0.951 (0.921) | 0.854–0.948 (0.926) | 0.866–0.948 (0.922) | 0.890–0.914 |
Consolation | ||||
N | 40–47 | 33–44 | 21–35 | 14–20 |
Single measures | 0.227–0.281 (0.257) | 0.216–0.565 (0.390) | 0.374–0.598 (0.469) | 0.389–0.684 |
Average measures | 0.595–0.661 (0.634) | 0.579–0.866 (0.761) | 0.749–0.881 (0.815) | 0.761–0.915 |
Skin colour | ||||
N | 41–48 | 34–44 | 21–36 | 13–19 |
Single measures | 0.010–0.058 (0.051) | 0.002–0.104 (0.062) | 0.057–0.166 (0.069) | 0.071–0.080 |
Average measures | 0.049–0.236 (0.211) | 0.011–0.367 (0.248) | 0.230–0.498 (0.271) | 0.276–0.302 |
Facial expression | ||||
N | 41–46 | 31–40 | 20–34 | 13–19 |
Single measures | 0.392–0.514 (0.436) | 0.498–0.698 (0.526) | 0.438–0.748 (0.601) | 0.616–0.817 |
Average measures | 0.763–0.841 (0.794) | 0.832–0.921 (0.847) | 0.796–0.937 (0.883) | 0.889–0.957 |
Posture | ||||
N | 42–48 | 34–44 | 21–35 | 14–20 |
Single measures | 0.333–0.479 (0.420) | 0.369–0.501 (0.472) | 0.286–0.685 (0.519) | 0.576–0.795 |
Average measures | 0.714–0.821 (0.783) | 0.745–0.834 (0.817) | 0.667–0.916 (0.839) | 0.872–0.951 |
Breathing | ||||
N | 36–41 | 29–37 | 17–35 | 9–14 |
Single measures | 0.019–0.378 (0.287) | 0.313–0.507 (0.371) | 0.158–0.419 (0.314) | 0.171–0.317 |
Average measures | 0.090–0.752 (0.669) | 0.695–0.837 (0746) | 0.485–0.783 (0.696) | 0.508–0.699 |
Breathing Raw Scores | ||||
N | 39–45 | 32–40 | 19–35 | 11–14 |
Single measures | 0.508–0.680 (0.618) | 0.530–0.637 (0.587) | 0.655–0.780 (0.681) | 0.558–0.664 |
Average measures | 0.838–0.914 (0.890) | 0.850–0.898 (0.876) | 0.905–0.947 (0.914) | 0.863–0.908 |
Internal consistency of the modified behavioural BPSN subscale
Cronbach’s Alpha | |||||
---|---|---|---|---|---|
Heel Stick Phase 1 Median (Range) | Heel Stick Phase 2 Median (Range) | Heel Stick Phase 3 Median (Range) | Heel Stick Phase 4 Median (Range) | Heel Stick Phase 5 Median (Range) | |
Extremely preterm neonates | 0.819 (0.813–0.894) | 0.821 (0.695–0.862) | 0.760 (0.720–0.883) | 0.796 (0.690–0.841) | 0.830 (0.691–0.840) |
N = 42–48 | |||||
Very preterm neonates | 0.908 (0.833–0.915) | 0.835 (0.787–0.868) | 0.800 (0.705–0.878) | 0.794 (0.624–0.902) | 0.824 (0.708–0.841) |
N = 32–44 | |||||
Moderate to late preterm neonates | 0.836 (0.736–0.932) | 0.863 (0.724–0.930) | 0.892 (0.844–0.924) | 0.872 (0.765–0.896) | 0.774 (0.576–0.871) |
N = 20–36 | |||||
Full-term neonates | 0.909 (0.906–0.964) | 0.832 (0.813–0.932) | |||
N = 13–20 |
Correlations between behavioural and physiological indicators of pain
Concurrent validity
Sensitivity and specificity
Heel Stick Phases of Measurement Points t1-t5 | ||||
---|---|---|---|---|
AUC | Cut-off | Sensitivity | Specificity | |
Range (Median) | points | Range (Median) | Range (Median) | |
Extremely Preterm Neonates | 0.707–0.878 (0.801) | |||
N = 42–48 |
0.5
|
0.734–0.875 (0.839)
|
0.398–0.562 (0.538)
| |
1.5 | 0.637–0.765 (0.666) | 0.691–0.853 (0.713) | ||
2.5 | 0.410–0.594 (0.494) | 0.901–0.970 (0.945) | ||
Very Preterm Neonates | 0.810–0.930 (0.852) | |||
N = 34–44 | 0.5 | 0.849–0.970 (0.905) | 0.284–0.606 (0.439) | |
1.5
|
0.745–0.901 (0.811)
|
0.638–0.728 (0.680)
| ||
2.5 | 0.596–0.785 (0.648) | 0.864–0.977 (0.902) | ||
Moderate to Late Preterm Neonates | 0.874–0.941 (0.927) | |||
N = 21–37 | 1.5 | 0.900–0.990 (0.970) | 0.564–0.660 (0.581) | |
2.5
|
0.763–0.950 (0.897)
|
0.705–0.832 (0.787)
| ||
3.5 | 0.532–0.763 (0.675) | 0.879–0.975 (0.933) | ||
Full-term Neonates | 0.893–0.906 | |||
N = 14–20 | 2.5 | 0.942–0.959 | 0.419–0.664 | |
3.5
|
0.807–0.888
|
0.808–0.824
| ||
4.5 | 0.714–0.831 | 0.836–0.896 | ||
5.5 | 0.423–0.751 | 0.892–0.969 |