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Neonatal Pain Agitation and Sedation Scale (N-PASS) is a multidimensional scale that scores behavioral and physiologic parameters for both pain and sedation. NPASS was proficient in assessing continuous, acute, and chronic pain, and was able to distinguish distress and pain in neonates of all gestational ages.
PIPP consists of seven indicators including assessment of gestational age and behavioural state (contextual indicators), heart rate and oxygen saturation (physiological indicators), and facial actionsbrow bulge, eye squeeze, and nasolabial furrow (behavioural indicators).
Usually, the PIPP score is divided into three separate categories: a mild score of 06, a moderate score of 712, and a severe score of 1315. [22] The highest PIPP scores were noted in blood sampling, heel prick, suction, and weight measurement.
Usually, the PIPP score is divided into three separate categories: a mild score of 06, a moderate score of 712, and a severe score of 1315. [22] The highest PIPP scores were noted in blood sampling, heel prick, suction, and weight measurement.
Of the commonly used neonatal pain tools, two scales (PIPP-R and N-PASS) have metric adjustment for premature infants and only the N-PASS scale (Table 1) includes sedation as part of its scoring system. The ideal neonatal pain assessment tool accounts for physiologic measurements, behavioral cues, and gestational age.
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The premature infant pain profile (PIPP) is a validated pain scoring system for preterm neonates [2, 17]. For infants, non-verbal young children, and in patients with cognitive impairment, the face, legs, activity, crying, and consolability (FLACC) scale or the revised FLACC scale can be used [2330].
The Premature Infant Pain Profile-Revised (PIPP-R) is a well-established, valid and reliable neonatal pain assessment measure, and the accompanying PIPP-R e-Learning Module is a user-friendly on-line educational tool developed to provide clinicians with the knowledge and skills to administer this measure in practice.
FLACC scale Each item is scored on a 02 scale resulting in a maximum score of 10. The FLACC scale was originally designed and validated for use in infants and children aged 2 months to 7 years to measure postoperative pain.

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