Which neonatal pain scale is effective for measuring pain in infants less than 25 weeks' gestation?

• A. CRIES
• B. Neonatal Infant Pain Scale (NIPS)
• C. Neonatal Infant Pain, Agitation and Sedation Scale (NPASS)
• D. Premature Infant Pain Profile (PIPP)

Answer: (C)

In extremely preterm infants, pain assessment is challenging because their nervous system is immature and their responses to noxious stimuli can be blunted or confounded by sedation. A tool that captures both pain indicators and the infant’s overall state—agitation and sedation—provides a more accurate read of what's happening. The Neonatal Pain, Agitation and Sedation Scale does exactly this: it evaluates pain cues while also rating agitation and sedation, so you can distinguish true pain from a subdued or sedated state. It has been validated across the prematurity spectrum, including very early gestational ages, making it appropriate for infants less than 25 weeks. Other scales depend more on facial cues or behavioral signs that may be limited in extremely preterm infants and don’t separately account for sedation or agitation, which can mislead pain interpretation in this population.