COVERS Neonatal Pain Scale: Development and Validation

Table 1

COVERS Scale.

	0	1	2
Crying	No	High pitched or visibly crying	Inconsolable or difficult to soothe
Oxygen requirement	None	<30%	>30%
	At baseline O2	↑<20%	↑>20%
	Breathing comfortably	Change in breathing pattern	Significant change in breathing pattern
Vital signs	HR &/or BP WNL for age or at baseline	HR &/or BP ↑<20% of baseline	HR &/or BP ↑>20% of baseline
	No apnea or bradycardia or at baseline	↑ in frequency of apnea & bradycardia	↑in frequency and severity of apnea & bradycardia
Expression	None/facial muscles relaxed	Grimace, min-mod brow bulge, eye squeeze, nasolabial furrow	Grimace/grunt, mod-max row bulge eye squeeze, nasolabial furrow
Resting	Sleeping most of time	Wakes at frequent intervals—fussy	Constantly awake (even when not disturbed)
Signaling distress	Relaxed	Arms/legs flexed or extended, “time-out signals”	Flailing, arching