Research ArticleResearchQuality Improvement

COMFORTneo pain ratings were less consistent in extremely preterm infants

Advances in neonatal care : official journal of the National Association of Neonatal Nurses (PubMed)Jul 15, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In 183 paired COMFORTneo assessments, overall agreement was excellent, but interrater reliability increased from 0.41 at 24 to 26 weeks' gestation to 0.92 at 36 weeks or later, indicating less consistent scoring in extremely preterm infants.

What NurseJet pulled from the source

Twenty-one NICU nurses and 12 nursing students completed paired assessments across five gestational-age groups. Overall intraclass correlation was 0.85, but agreement was much lower in infants born at 24 to 26 weeks. Body movement had the lowest item-level agreement, while respiratory response had the highest. Students had slightly higher agreement than experienced nurses, and item characteristics explained more variation than rater differences.

Why this matters for nurses

Extremely preterm infants cannot self-report pain and may display subtle or atypical behavioral cues. NICU nurses depend on consistent assessment to communicate distress, evaluate trends, and support treatment decisions, making gestational age and team calibration clinically important.

Bedside takeaway

COMFORTneo agreement was lower in extremely preterm infants, so item-level observation, team calibration, and reassessment remain important.

How This Applies in Practice

Use this when: Assessing pain or distress in a preterm infant with the COMFORTneo scale in a neonatal intensive-care setting.

On your shift

Complete each scale item as trained and document gestational age, behavioral state, respiratory support, recent procedures, medications, and other context.
Trend repeated scores and item-level observations and seek a second trained assessment when the score conflicts with the infant's clinical picture.
Use unit calibration or refresher sessions to review difficult items and scoring in extremely preterm infants.

Keep in mind: Interrater agreement does not prove diagnostic accuracy or define a treatment threshold. Follow the neonatal pain-assessment protocol, facility policy, and patient-specific provider orders.

Key takeaways

The study analyzed 183 paired assessments by 21 NICU nurses and 12 nursing students.
Overall COMFORTneo interrater reliability was excellent at 0.85.
Reliability ranged from 0.41 at 24 to 26 weeks' gestation to 0.92 at 36 weeks or later.
Lower agreement in extremely preterm infants and variation by scale item support structured calibration and cautious interpretation.

Practice implications

Score the approved neonatal pain tool at the specified times, document contextual factors and item-level observations, and compare trends rather than relying on one number. When scores and the clinical picture conflict, repeat assessment with an experienced colleague and escalate through the neonatal pain pathway.

Limitations & cautions

This was a reliability study rather than a test of diagnostic accuracy, treatment response, or patient outcomes. The sample involved 183 paired assessments from one clinical context, subgroup sizes were unequal, and there is no objective pain reference standard, particularly for extremely preterm infants.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

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Advances in neonatal care : official journal of the National Association of Neonatal Nurses (PubMed)

Advances in neonatal care : official journal of the National Association of Neonatal Nurses (PubMed). Evaluating the Interrater Reliability of the COMFORTneo Scale in Infants: Influence of Gestational Age and Rater Experience.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42485160/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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The Canadian journal of hospital pharmacy (PubMed)Sep 9, 2026Systematic Review

A systematic review and meta-analysis of five placebo-controlled randomized trials found lower mortality with intravenous hydrocortisone among neonates with hypotension, but the evidence base included only 239 patients.

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Systematic ReviewResearchMedication SafetyAI summary · original source linked below

The fixed-effect meta-analysis found an odds ratio for all-cause mortality of 0.48 with intravenous hydrocortisone versus placebo (95% CI 0.24 to 0.96), with low statistical heterogeneity. The authors state that larger trials are needed before the finding is considered confirmed.

Key takeaways

Five randomized, placebo-controlled trials with a total of 239 neonates were included.
The pooled mortality estimate favored hydrocortisone, but the confidence interval approached no difference.
The abstract addresses mortality only and does not provide pooled adverse-event or longer-term neurodevelopmental outcomes.

Why this matters on shift

Hydrocortisone may be considered when neonatal hypotension persists despite volume and vasoactive support, but this mortality signal comes from a small evidence base and should not be presented as definitive.

Bedside takeaway

Treat the mortality signal as promising but preliminary, and follow local NICU monitoring and escalation protocols.

Nursing implications

When hydrocortisone is ordered for refractory neonatal hypotension, continue close hemodynamic and medication monitoring and follow the NICU's dosing, glucose, electrolyte, and escalation protocols.

Limitations & cautions

Abstract-only summary. Only five trials and 239 neonates were pooled; the abstract does not report gestational-age subgroups, dosing differences, adverse events, or neurodevelopmental outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

The Canadian journal of hospital pharmacy (PubMed). Effect of IV Hydrocortisone on Mortality among Neonates with Hypotension: A Systematic Review and Meta-analysis of Randomized, Placebo-Controlled Trials.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

World journal of critical care medicine (PubMed)Sep 9, 2026Research Article

A pre-post study of non-shockable in-hospital cardiac arrests found that allowing nurses to administer the first adrenaline dose under protocol shortened treatment time, without improving return of spontaneous circulation or survival.

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Research ArticleResearchWorkflowQuality ImprovementAI summary · original source linked below

Across 450 arrests, adrenaline within two minutes increased from 46.0% before the protocol to 74.3% after it, and median time to the first dose fell from four minutes to two. Return of spontaneous circulation rates were similar, and timely administration was not independently associated with return of spontaneous circulation.

Key takeaways

The comparison included 162 pre-intervention and 288 post-intervention cardiac-arrest events.
Time to return of spontaneous circulation was shorter after implementation, but overall return-of-spontaneous-circulation rates did not differ significantly.
Timely adrenaline was associated with faster return of spontaneous circulation in combined data but did not improve survival.

Why this matters on shift

The study suggests that a formally authorized nurse-led resuscitation workflow can reduce a process delay, while showing that faster medication delivery alone did not translate into better survival in this observational comparison.

Bedside takeaway

Know the local first-dose authority and rehearse rapid team activation and reversible-cause assessment.

Nursing implications

Know who is authorized to give first-dose adrenaline during a code, rehearse the local non-shockable-arrest workflow, and prioritize rapid team activation and reversible-cause assessment within facility protocol.

Limitations & cautions

Abstract-only summary. This was a nonrandomized pre-post study spanning different time periods; other changes in staffing or resuscitation practice could have influenced results, and survival did not improve.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

World journal of critical care medicine (PubMed). Impact of nurse empowerment for early adrenaline administration for in-hospital cardiac arrest resuscitation: A pre-post intervention study.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Journal of midwifery & women's health (PubMed)Sep 7, 2026Research Article

A retrospective analysis of US natality data found no statistically significant yearly difference in neonatal mortality between freestanding birth centers and hospitals among term, singleton, vertex births without major medical risk factors from 2015 through 2024.

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Research ArticleResearchPatient EducationAI summary · original source linked below

Adjusted neonatal-mortality odds for freestanding birth centers fluctuated around 1.0 across the 10-year study period. No individual year showed a statistically significant difference from hospital births, including 2020 and 2021 when birth-center volume increased.

Key takeaways

The analysis was restricted to births meeting selected low-risk criteria.
The study found no evidence that higher birth-center use during the pandemic years increased neonatal mortality.
The observational design cannot establish that birth setting itself caused the mortality pattern.

Why this matters on shift

The findings add national outcome data for counseling and systems planning around freestanding birth-center care for appropriately selected low-risk pregnancies.

Bedside takeaway

Apply local eligibility, surveillance, escalation, and transfer protocols when caring for planned low-risk birth-center patients.

Nursing implications

Keep eligibility, surveillance, escalation, and transfer decisions anchored to local birth-center criteria and maternal-newborn protocols.

Limitations & cautions

Abstract-only summary. The study used retrospective vital-record data, was limited to selected low-risk births, and cannot exclude residual differences between people who delivered in birth centers and hospitals.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of midwifery & women's health (PubMed). Neonatal Mortality Risk Among Births in Freestanding Birth Centers, 2015 to 2024.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Small neonatal trials suggest hydrocortisone may reduce mortality in refractory hypotension

A nurse-led protocol shortened time to adrenaline during non-shockable in-hospital arrests

Low-risk birth-center births showed no higher neonatal mortality in a 10-year analysis