Reliability and Validity of the Neonatal Pain, Agitation, and Sedation Scale in Mechanically Ventilated Neonates: A Systematic Review.
- 1Department of Medicine, National and Kapodistrian University of Athens, Athens, GRC.
- 2First Department of Anesthesiology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC.
- 3Department of Midwifery, University of West Attica, Athens, GRC.
Abstract
Accurate assessment of pain, agitation, and sedation in mechanically ventilated neonates is fundamental to neonatal intensive care but remains challenging because neonates cannot self-report pain, and behavioral and physiological responses are influenced by illness severity, medication exposure, and developmental maturity. This systematic review evaluated the reliability, validity, and clinical utility of the Neonatal Pain, Agitation and Sedation Scale (N-PASS) in mechanically ventilated neonates. The review was conducted in accordance with the PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and CINAHL were systematically searched from each database's inception through March 2026, with supplementary screening of reference lists. Primary quantitative studies evaluating the N-PASS in mechanically ventilated neonates or reporting separate data for this population were eligible. Owing to methodological heterogeneity, the findings were synthesized narratively, and the risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Four studies conducted in India, China, Iran, and Egypt met the inclusion criteria. The available evidence indicated high to excellent inter-rater reliability and moderate to good internal consistency, while the findings supported the convergent, criterion, and discriminant validity of the N-PASS in mechanically ventilated neonates. Evidence also supports its clinical utility for routine assessment of pain, agitation, and sedation in neonatal intensive care. Nevertheless, the evidence base remains limited and heterogeneous, particularly with respect to the sedation component and the discrimination of intermediate levels of sedation. Further well-designed multi-center studies involving larger and more homogeneous populations are warranted to strengthen the evidence supporting the use of the N-PASS in mechanically ventilated neonates.
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BibTeX
@article{sotiropoulou2026reliability,
title = {{Reliability and Validity of the Neonatal Pain, Agitation, and Sedation Scale in Mechanically Ventilated Neonates: A Systematic Review.}},
author = {Niki Sotiropoulou and Kassiani Theodoraki and Antigoni Sarantaki and Angeliki Bolou and Vikentia Harizopoulou and Athanasia Tsaroucha and Dimitra Metallinou},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116730},
url = {https://europepmc.org/article/MED/42924017},
note = {CC BY},
}
RIS
TY - JOUR
TI - Reliability and Validity of the Neonatal Pain, Agitation, and Sedation Scale in Mechanically Ventilated Neonates: A Systematic Review.
AU - Niki Sotiropoulou
AU - Kassiani Theodoraki
AU - Antigoni Sarantaki
AU - Angeliki Bolou
AU - Vikentia Harizopoulou
AU - Athanasia Tsaroucha
AU - Dimitra Metallinou
PY - 2026
DA - 2026/09/22
JO - Cureus
DO - 10.7759/cureus.116730
UR - https://europepmc.org/article/MED/42924017
AB - Accurate assessment of pain, agitation, and sedation in mechanically ventilated neonates is fundamental to neonatal intensive care but remains challenging because neonates cannot self-report pain, and behavioral and physiological responses are influenced by illness severity, medication exposure, and developmental maturity. This systematic review evaluated the reliability, validity, and clinical utility of the Neonatal Pain, Agitation and Sedation Scale (N-PASS) in mechanically ventilated neonates. The review was conducted in accordance with the PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and CINAHL were systematically searched from each database's inception through March 2026, with supplementary screening of reference lists. Primary quantitative studies evaluating the N-PASS in mechanically ventilated neonates or reporting separate data for this population were eligible. Owing to methodological heterogeneity, the findings were synthesized narratively, and the risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Four studies conducted in India, China, Iran, and Egypt met the inclusion criteria. The available evidence indicated high to excellent inter-rater reliability and moderate to good internal consistency, while the findings supported the convergent, criterion, and discriminant validity of the N-PASS in mechanically ventilated neonates. Evidence also supports its clinical utility for routine assessment of pain, agitation, and sedation in neonatal intensive care. Nevertheless, the evidence base remains limited and heterogeneous, particularly with respect to the sedation component and the discrimination of intermediate levels of sedation. Further well-designed multi-center studies involving larger and more homogeneous populations are warranted to strengthen the evidence supporting the use of the N-PASS in mechanically ventilated neonates.
SN - 2168-8184
ER -