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BioMed Research International
Volume 2017, Article ID 9253710, 8 pages
Research Article

EDIN Scale Implemented by Gestational Age for Pain Assessment in Preterms: A Prospective Study

NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy

Correspondence should be addressed to G. Cavallaro; ti.illagaignam@orallavac.omocaig

Received 29 August 2016; Revised 11 December 2016; Accepted 28 December 2016; Published 8 February 2017

Academic Editor: Jonathan Muraskas

Copyright © 2017 G. Raffaeli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Chronic neonatal pain can lead to long-term adverse effects on the immature brain. EDIN scale for prolonged pain might not be fully suitable for premature infants. We aimed to test a modified EDIN scale, adding postmenstrual age (PMA) as a sixth item (EDIN6). Methods. In a two-phase prospective study, pain was assessed in all neonates admitted in our NICU. In 1 EDIN was applied; in 2 EDIN6 with additional scores of 2, 1, and 0, respectively, for 25–32, 33–37, and >37 weeks PCA was tested. Scores > 6 suggested pain. The nursing staff was given a questionnaire to evaluate EDIN and EDIN6. Results. A total of 15960 pain assessments were recorded (8693 in 1; 7267 in 2). With EDIN6, cumulative detection of pain almost tripled (117/7267 versus 52/8693, ). Main differences were found among less mature categories (50/1472 versus 17/1734, in PCA 25–32; 26/2606 versus 10/4335, in PMA 33–37; 41/3189 versus 25/2624, in PMA > 37). Adequacy of pain assessment in lower PMA was judged “medium-high” in 13,4% of nurses in 1 and 71,4% in 2. Conclusions. EDIN6 may allow improved evaluation of pain in preterm infants.