{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:47:00Z","timestamp":1790192820599,"version":"4.1.0"},"reference-count":74,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T00:00:00Z","timestamp":1586131200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["SNF 320030_159573"],"award-info":[{"award-number":["SNF 320030_159573"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates\u2019 pain responses and may lead to inaccurate pain assessment when not appropriately considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We videotaped 154 full\u2010term and preterm neonates of different GAs during 1\u20135 capillary heel sticks in their first 14\u00a0days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Premature birth (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.721), caffeine (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.302), and the behavioural states quiet and awake (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.283), active and asleep (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.158), and quiet and asleep (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.498) were associated with changes in behavioural pain scores. Premature birth (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.232), mechanical ventilation (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.196), and duration of the heel stick procedure (<jats:italic>b<\/jats:italic>\u00a0=\u00a00.0004) were associated with changes in physiological pain scores. Premature birth (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.907), Caffeine (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.402), the behavioural states quiet and awake (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.274), and quiet and asleep (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u22120.459), and duration of the heel stick procedure (<jats:italic>b<\/jats:italic>\u00a0=\u00a00.001) were associated with changes in the modified BPSN total scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates\u2019 pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.1555","type":"journal-article","created":{"date-parts":[[2020,3,14]],"date-time":"2020-03-14T09:03:34Z","timestamp":1584176614000},"page":"1107-1118","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4356-3551","authenticated-orcid":false,"given":"Karin","family":"Schenk","sequence":"first","affiliation":[{"name":"Division of Midwifery Department of Health Professions Bern University of Applied Sciences Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Stoffel","sequence":"additional","affiliation":[{"name":"Neonatalogy, Children\u2019s Hospital University Hospital of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reto","family":"B\u00fcrgin","sequence":"additional","affiliation":[{"name":"Division of Midwifery Department of Health Professions Bern University of Applied Sciences Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Stevens","sequence":"additional","affiliation":[{"name":"Lawrence S. Bloomberg Faculty of Nursing and Faculties of Medicine and Dentistry University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Bassler","sequence":"additional","affiliation":[{"name":"Department of Neonatology University Hospital Zurich and University of Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Schulzke","sequence":"additional","affiliation":[{"name":"Department of Neonatology University Children\u2019s Hospital Basel UKBB Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Nelle","sequence":"additional","affiliation":[{"name":"Department of Neonatology University Hospital Zurich and University of Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Cignacco","sequence":"additional","affiliation":[{"name":"Division of Midwifery Department of Health Professions Bern University of Applied Sciences Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015\u20104271"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fmi099"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2006.05.022"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03520110033025"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13936"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13810"},{"key":"e_1_2_9_8_1","first-page":"129","article-title":"Determinants of preamture infant pain responses to heel sticks","volume":"36","author":"Badr L. K.","year":"2010","journal-title":"Pediatric Nursing"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.5812\/aapm.33193"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v067.i01"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095\u20105108(02)00011\u20108"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00112\u2010012\u20102680\u2010y"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0170828"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001340051157"},{"key":"e_1_2_9_15_1","first-page":"484","article-title":"Routine procedures in NICUs: Factors influencing pain assessment and ranking by pain intensity","volume":"138","author":"Cignacco E.","year":"2008","journal-title":"Swiss Med Weekly"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2004.04.001"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887\u2010017\u20100914\u20109"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/anc.0b013e3182a41452"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.14222"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304\u20103959(93)90162\u2010I"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009281.pub3"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.0867\u201017.2017"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2019.04.003"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304\u20103959(89)90172\u20103"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552\u20106909.2008.00292.x"},{"key":"e_1_2_9_26_1","volume-title":"An R Companion to Applied Regression","author":"Fox J.","year":"2011"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2007.12.007"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1159\/000105520"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2014.01.005"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004703\u2010200112000\u201000009"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001425"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304\u20103959(87)90073\u2010X"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2004.10.020"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2006.02.007"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.107.1.105"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2019.05.008"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/1099800414531448"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1198\/106186006X133933"},{"key":"e_1_2_9_39_1","unstructured":"Hothorn T. &Zeileis A.(2014).partykit: A Modular Toolkit for Recursive Partytioning in R.Working Papers in Economics and Statistics Research Platform Empirical and Experimental Economics Universit\u00e4t Innsbruck 2014;10."},{"key":"e_1_2_9_40_1","first-page":"175","article-title":"Psychometric Evaluation of the Neonatal Pain, Agitation, and Sedation (N\u2010PASS) Scale in Infants and Children up to Age 36 Months","volume":"43","author":"Hummel P.","year":"2017","journal-title":"Pediatr Nurs"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211861"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.10.008"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552\u20106909.1999.tb02167.x"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20108749.1996.tb15101.x"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cub.2017.10.063"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v082.i13"},{"key":"e_1_2_9_47_1","first-page":"353","volume-title":"Oxford Textbook of Paediatric Pain","author":"Lee G. Y.","year":"2014"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.14777"},{"key":"e_1_2_9_49_1","volume-title":"Classical and modern regression with applications","author":"Myers R.","year":"1990"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11135\u2010006\u20109018\u20106"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1155\/2009\/410725"},{"key":"e_1_2_9_52_1","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2017"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.2217\/pmt.13.61"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2007.07.003"},{"key":"e_1_2_9_55_1","volume-title":"Multiple Imputation for Nonresponse in Surveys","author":"Rubin D. B.","year":"2008"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887\u2010018\u20101380\u20108"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa054065"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001123"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpain.2011.01.002"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1532\u20102149.2012.00182.x"},{"key":"e_1_2_9_61_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780195152968.001.0001"},{"key":"e_1_2_9_62_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e3182906aed"},{"key":"e_1_2_9_63_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006199\u2010199407000\u201000007"},{"key":"e_1_2_9_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304\u20103959(94)90053\u20101"},{"key":"e_1_2_9_65_1","volume-title":"Health mesasurement scales, a practical guide to their development and use","author":"Streiner D. L.","year":"2015"},{"key":"e_1_2_9_66_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.7.857"},{"key":"e_1_2_9_67_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511610806"},{"key":"e_1_2_9_68_1","doi-asserted-by":"publisher","DOI":"10.3922\/j.psns.2012.1.03"},{"key":"e_1_2_9_69_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001201"},{"key":"e_1_2_9_70_1","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2014.16"},{"key":"e_1_2_9_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cophys.2019.04.011"},{"key":"e_1_2_9_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.03.035"},{"key":"e_1_2_9_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2016.03.005"},{"key":"e_1_2_9_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2009.01.001"},{"key":"e_1_2_9_75_1","volume-title":"Linear models and linear mixed effects models in R with linguistic applications","author":"Winter B.","year":"2013"}],"container-title":["European Journal of Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fejp.1555","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejp.1555","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ejp.1555","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejp.1555","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T08:15:45Z","timestamp":1706948145000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejp.1555"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,6]]},"references-count":74,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1002\/ejp.1555"],"URL":"https:\/\/doi.org\/10.1002\/ejp.1555","archive":["Portico"],"relation":{},"ISSN":["1090-3801","1532-2149"],"issn-type":[{"value":"1090-3801","type":"print"},{"value":"1532-2149","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,6]]},"assertion":[{"value":"2019-03-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-04-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}