What is the definition of acute episodic and chronic pain in critically ill neonates and infants? A global, four-stage consensus and validation study
Marsha Campbell-Yeo,
Mandy Daly,
Verity Pacey,
Vibhuti Shah,
Kaye Spence,
Kanwaljeet J S Anand,
Bonnie J Stevens,
Mats Eriksson,
Laura Brown,
Emre Ilhan,
Christ-jan van Ganzewinkel,
Rebecca Pillai Riddell,
Carlo Bellieni,
Celeste Johnston,
Julia Hush
Affiliations
Marsha Campbell-Yeo
Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
Mandy Daly
Irish Neonatal Health Alliance, Wicklow, Ireland
Verity Pacey
Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Vibhuti Shah
Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
Kaye Spence
Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
Kanwaljeet J S Anand
Department of Pediatrics, Pain/Stress Neurobiology Laboratory, Maternal and Child Health Research Institute, Stanford University School of Medicine, Stanford, California, USA
Bonnie J Stevens
Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Mats Eriksson
Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
Laura Brown
Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
Emre Ilhan
Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Christ-jan van Ganzewinkel
Maxima Medical Centre, Veldhoven, The Netherlands
Rebecca Pillai Riddell
Department of Psychology, Faculty of Health Sciences, York University, Toronto, Ontario, Canada
Carlo Bellieni
Department of Pediatrics, University of Siena, Siena, Italy
Celeste Johnston
Ingram School of Nursing, McGill University, Montreal, Québec, Canada
Julia Hush
Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Objectives To define and validate types of pain in critically ill neonates and infants by researchers and clinicians working in the neonatal intensive care unit (NICU) and high dependency unit (HDU).Design A qualitative descriptive mixed-methods design.Procedure/s Each stage of the study was built on and confirmed the previous stages. Stage 1 was an expert panel to develop definitions; stage 2 was a different expert panel made up of neonatal clinicians to propose clinical characteristics associated with the definitions from stage 1; stage 3 was a focus group of neonatal clinicians to provide clinical case scenarios associated with each definition and clinical characteristics; and stage 4 was a survey administered to neonatal clinicians internationally to test the validity of the definitions using the clinical case scenarios.Results In stage 1, the panel (n=10) developed consensus definitions for acute episodic pain and chronic pain in neonates and infants. In stage 2, a panel (n=8) established clinical characteristics that may be associated with each definition. In stage 3, a focus group (n=11) created clinical case scenarios of neonates and infants with acute episodic pain, chronic pain and no pain using the definitions and clinical characteristics. In stage 4, the survey (n=182) revealed that the definitions allowed an excellent level of discrimination between case scenarios that described neonates and infants with acute episodic pain and chronic pain (area under the receiver operating characteristic=0.87 and 0.89, respectively).Conclusions This four-stage study enabled the development of consensus-based and clinically valid definitions of acute episodic pain and chronic pain. There is a need to define and validate other pain types to inform a taxonomy of pain experienced by neonates and infants in the NICU and HDU.
