Measurement of pain in premature infants with a gestational age between 28 to 37 weeks: Validation of the adapted COMFORT scale

The aim of our study was to test the reliability and validity of the adapted COMFORT scale in premature infants with a gestational age between 28 to 37 weeks using the VAS as comparison. Two nurses made paired observations before and after the heel puncture for routine neonatal metabolic screening. They completed the adapted COMFORT scale and VAS for 57 premature infants, divided into five gestational age groups. The interrater reliability for the COMFORT scale, given by a linearly weighted kappa ranged from 0.62 to 0.84. The intraclass coefficient for the total COMFORT score was 0.85 (95% CI 0.76–0.91) in the pre-test and 0.93 (95% CI 0.89–0.96) in the post-test. The items of the COMFORT scale had a high internal consistency. No significant differences in distress and pain in the various gestational age subgroups were observed. The adapted COMFORT scale is a valid and reliable instrument to measure distress and pain in premature infants.