The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) has been in clinical use for some years now. Created by neonatal advanced practice nurses, the N-PASS is unique among pain tools because it measures sedation in addition to pain. In the absence of biological markers of pain, the theoretical underpinning of the N-PASS is that infants exhibit physiologic and behavioral cues in proportion to their degree of pain or sedation. Although well-accepted and widely used by neonatal nurses, validity and reliability data for the N-PASS have just recently been published.1

In a sample of ventilated or postoperative neonates at risk for acute, prolonged pain, N-PASS scores were assigned before and 1 hour after pharmacologic intervention. In addition, convergent validity was established by assessing infants with the Premature Infant Pain Profile, another commonly used neonatal pain assessment tool. The N-PASS correlated best with the Premature Infant Pain Profile when pain scores were high rather than low. Interrater reliability and internal consistency of the N-PASS were both found to be high. Both pain and sedation scores assessed with the N-PASS changed significantly following pharmacologic intervention. The data also suggested that adding points for prematurity, based on the premise that preterm infants are inherently less able to exhibit pain behaviors, might not be warranted.1 Further research is indicated to elucidate the contribution of short gestation to observed pain and sedation responses.

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