Parallel assessment of prolonged neonatal distress by empathy-based and item-based scales

Abstract Objective To evaluate the association between the empathy-based Faces Pain Scale-Revised (FPS-R) and the item-based Neonatal Pain, Agitation and Sedation Scale (N-PASS) when used to assess prolonged distress in term and preterm infants. Method Sequential prospective psychometric evaluations of distress, at 4-h intervals during a 48-h time period. FPS-R and N-PASS were employed in parallel by the nurses in charge in 44 term and preterm newborn infants. Results During the overall 48-h observation period, median FPS-R declined from 6/10 to 2/10 ( p R s  = 0.786, p R s  = 0.781; 24–36 h: R s  = 0.675; 36–48 h: R s  = 0.658) while remaining significant ( p Conclusions In newborn infants serially assessed over 48 h, there is a progressive divergence between FPS-R and N-PASS. There is, however, reason to extend the use of the FPS-R also to the neonatal arena, as the rate of agreement between N-PASS and FPS-R to categorize an infant as being in distress or not remains stable. Preference of item- or empathy-based assessment may be a question of personal philosophy rather than medical science.