Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2008 Jan;24(1):83-8.
doi: 10.1097/AJP.0b013e318158c5e5.

Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) scale

Liisa Holsti  1 , Ruth E Grunau, Tim F Oberlander, Horacio Osiovich
Affiliations
Randomized Controlled Trial

Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) scale

Liisa Holsti et al. Clin J Pain. 2008 Jan.

Abstract

Objectives: To evaluate the ability of the Behavioral Indicators of Infant Pain (BIIP) scale to discriminate between skin-breaking and nonskin breaking procedures, and to identify sensitized pain responses in preterm infants in the neonatal intensive care unit (NICU).

Methods: Sixty-nine infants born between 24 and 32 weeks gestational age were assessed at 32 weeks postconceptional age during blood collection on one day (procedure A), and then on another day during blood collection preceded by a diaper change (procedure B). Procedure order was randomized. Outcome measures were changes in BIIP coded from continuous bedside video recordings and changes in heart rate (HR).

Results: During blood collection (procedure A), BIIP scores (P<0.0001) and mean HR (P<0.0001) were higher than during the diaper change and higher when the infants had had a preceding diaper change (procedure B vs. procedure A) (P<0.03). HR changed from baseline to the stressors for each procedure. No differences in mean HR were observed during Lance phase between the procedure A and the B blood collection; however, HR remained elevated significantly during the Recovery phase when blood collection was preceded by the diaper change (P<0.03).

Discussion: The BIIP scale is reliable, accurate, and valid assessment for measuring acute pain in preterm infants in the NICU. This assessment combines the relatively most specific, anatomically based, theoretically derived indicators; and it allows evaluation of behavioral and physiologic pain responses separately.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Time line and analysis of procedures.
See this image and copyright information in PMC

References

    1. Slater R, Cantarella A, Gallella S, et al. Cortical pain responses in human infants. J Neurosci. 2006;26:3662–3666. - PMC - PubMed
    1. Bartocci M, Bergqvist LL, Langercrantz H, et al. Pain activates cortical areas in the preterm newborn brain. Pain. 2006;122:109–117. - PubMed
    1. Grunau RE, Oberlander TF, Whitfield MF, et al. Demographic and therapeutic determinants of pain reactivity in very low birth weight neonates at 32 weeks’ postconceptional age. Pediatrics. 2001;107:105–112. - PubMed
    1. Morison SJ, Holsti L, Grunau RE, et al. Are there developmentally distinct motor indicators of pain in preterm infants? Early Hum Dev. 2003;72:131–146. - PubMed
    1. Rahman W, Fitzgerald M, Aynsley-Green A, et al. The effects of neonatal exposure to inflammation and/or morphine on neuronal responses and morphine analgesia in adult rats. In: Jensen TS, Turner JA, Weisenfeld-Halling Z, editors. Progress in Pain Research and Management. Vol. 8. Seattle, WA: IASP Press; 1997. pp. 738–794.

Publication types