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The Premature Infant Pain Profile-Revised (PIPP-R): Initial Validation and Feasibility

Stevens, Bonnie J. RN, PhD*,†; Gibbins, Sharyn RN, PhD*,†,‡; Yamada, Janet RN, PhD*; Dionne, Kimberley RN, MN*; Lee, Grace RN, MSc; Johnston, Céleste RN, DEd, FCAHS§,∥; Taddio, Anna PhD*,¶

doi: 10.1097/AJP.0b013e3182906aed
Original Articles

Objectives: To describe revisions to the Premature Infant Pain Profile (PIPP) and initial construct validation and feasibility of the Premature Infant Pain Profile-Revised (PIPP-R).

Methods: The PIPP was revised to enhance validity and feasibility. To validate the PIPP-R, data from 2 randomized cross-over studies were utilized to: (1) calculate and compare PIPP and PIPP-R scores in extremely low gestational age infants undergoing a painful and nonpainful event (N=52; dataset #1) and (2) calculate and compare PIPP and PIPP-R scores in assessing the effectiveness of (a) sucrose, (b) non-nutritive sucking (NNS)+sucrose, and (c) facilitated tucking+NNS+sucrose during heel lance (N=85; dataset #2). Pearson correlations between PIPP and PIPP-R scores were calculated, and Student t tests and 1-way analysis of variance were used to determine construct validity during painful and nonpainful events. To establish feasibility, a survey of 31 Neonatal Intensive Care Unit nurses was conducted.

Results: PIPP-R scores were significantly lower during nonpainful (mean, 8.3; SD=2.9) compared with painful (mean, 9.9; SD=3.1; t95=4.51, P=0.036) events in extremely low gestational age infants in dataset #1. In dataset #2, PIPP-R scores were significantly lower in infants 25 to 41 weeks gestation in the group receiving NNS+sucrose compared with the other 2 groups (F2,79=2.9, P<0.05). Overall, nurses rated the PIPP-R as feasible.

Discussion: Initial construct validation and feasibility of the PIPP-R was demonstrated. Further testing with infants of varying gestational ages, diagnoses, and pain conditions is required; as is exploration of PIPP-R in relation to other types of physiological and cognitive responses.

*The Hospital for Sick Children

Lawrence S. Bloomberg Faculty of Nursing

Leslie Dan Faculty of Pharmacy, The University of Toronto, Toronto, ON

The Credit Valley Hospital Trillium Health Centre, Mississauga, ON

§Ingram School of Nursing, McGill University, Montréal, QC

IWK Health Centre, Halifax, NS, Canada

Supported by the Canadian Institutes of Health Research (CIHR)(MOP-7884), Ottawa, ON, Canada, and Signy Hildur Eaton Chair in Paediatric Nursing Research (B.J.S.) from The Hospital for Sick Children, Toronto, ON, Canada. The authors declare no conflict of interest.

Reprints: Bonnie J. Stevens, RN, PhD, The Hospital for Sick Children, The University of Toronto, 555 University Ave., Room 4734B, Toronto, ON, Canada M5G 1X8 (e-mail:

Received July 13, 2012

Accepted March 5, 2013

© 2014 by Lippincott Williams & Wilkins