PIPP Pain Assessment & Gestational Age

dawngloves, BSN, RN · Dec 2, 2003

I think your right Tiki. Although us dinosaures are still using CRIES :rolleyes:

iceNICUnurse · Dec 3, 2003

We keep on counting like when the baby is born at 25w and is 3w old we say it is 28w and use that in the PIPP. BUT we have to take in to consideration that the score might be changing b/c of the age change.

The baby might get a lower number on the PIPP today b/c it is the day it turned 28w than it did yesterday when it was only 27w6d. Not that suddenly it is not in as much pain as yesterday.

Hope you see where I am going...it is sometimes so hard to put things in words in a language I dont use every day.

Tiki_Torch · Dec 3, 2003

Thank you so much dawngloves and iceNICUnurse!!!!

You two are the best for helping me out here!!

:kiss

Tiki_Torch · Dec 3, 2003

I think I may have found out some more information concerning how we describe the ages of babies. This information leads me to believe that instead of saying post conceptional age I should be saying corrected gestational age when talking about how old a baby is during the days and weeks after their birth.

Here is what I found on a web site which is actually a journal club for neonatologists and other neonatal health care professionals. They were reviewing an article written by neonatologist Dr. Catherine Partyka at Sinai Hospital of Baltimore. In a nutshell, this is what I gleaned:

POST-MENSTRUAL AGE (PMA) is the gestational age at birth we are most familiar with, dated by the mother's last LMP (e.g., this is a 850 g 27 3/7 week female...).

CORRECTED GESTATIONAL AGE (CGA) is the PMA plus weeks after birth (e.g., the afore-mentioned 27 weeker is 31+ weeks CGA at 4 weeks of age).

POST-CONCEPTIONAL AGE (PCA) is the weeks post conception. As you remember, this occurs two weeks after the LMP. Therefore, a term PCA is 38 weeks (rather than 40 weeks). In fact, one must add two weeks gestation to the date of fertilization to come up with the familair PMA that we all use. People use this term all the time without realizing the difference.

For complete information on this please refer to the FSN Journal Club. Dr Andrew B. Karialla reviewed this article and his entire entry along with the original journal article can be found through the following web site:

http://www.fsneo.org/JourClub/1-030.htm

Interestingly I realize that our neo's at the hospital where I work are documenting Corrected Gestational Age but naming it Post-Conceptional Age....

We learn something every day! :rolleyes:

NICU_RNwantsFL · Feb 1, 2004

Hi all -

Our PIPPS are scored like most of you indicate - for ex., an infant who was born at 28 wks. gestation but is now 4 weeks old would be considered a 32-weeker for PIPP purposes.

Our unit protocol is to assess PIPP q 8 hr., but I assess it each time I do patient care - after all, if you were working on an adult floor (where THEORETICALLY, at least, the patient could verbalize his pain level), would you only ask your patients about their pain level every 8 hours?

nurseiam · Feb 2, 2004

We use N-pass which sounds similar. It is also based on the corrected gestational age. We assess pain on admit and q 4 hours. If it was a high score you have to chart your intervention and rescore in an hour. It seems pretty self explanitory to me but it is hard for some people so we are looking for a new tool!

NICU_RNwantsFL · Feb 2, 2004

While we are all talking about pain, let me throw this question out to y'all: Does anyone out there provide pain relief (or at least pain REDUCTION) for IV sticks?

As an adult patient some years back, I recall getting some type of topical something-or-other that completely killed the pain of receiving an IV stick (wasn't a nurse then, so didn't ask what it was) -

Surely there is something to give these little ones prior to IV sticks, which I personally consider EXTREMELY painful - especially the hard sticks, probing, multiple attempts, etc. I have checked with our neo's & NNPs, but they all say nay. Same for PICCs.

What do y'all do?

gypsyatheart · Feb 2, 2004

Originally posted by NICU_RNwantsFL
While we are all talking about pain, let me throw this question out to y'all: Does anyone out there provide pain relief (or at least pain REDUCTION) for IV sticks?

As an adult patient some years back, I recall getting some type of topical something-or-other that completely killed the pain of receiving an IV stick (wasn't a nurse then, so didn't ask what it was) -

Surely there is something to give these little ones prior to IV sticks, which I personally consider EXTREMELY painful - especially the hard sticks, probing, multiple attempts, etc. I have checked with our neo's & NNPs, but they all say nay. Same for PICCs.

What do y'all do?

Absolutely! We use sweet-ease ,just dip their paci in it and let 'em suck on it a few minutes prior to and during the procedure. Most babes, even NPO, can have this, unless specifically directed that they can not.

It really helps...the sugar helps the release of endorphins, I believe, and offers pain control.