A Neonatal Facial Image Scoring System (NFISS) for pain response studies

Kee Hsin Chen, Susanna Chang, Tzu-Chien Hsiao, Yueh Chih Chen, Chii Wann Lin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


The aim of this study was to establish a scoring system, Neonatal Facial Image Scoring System (NFISS), for investigating the pain responses in neonates during routine venipuncture. We collected 1998 facial images from 19 infants during the first phase of this study and identified twelve features of the facial image: normalized scale for NFISS (scale from 0-15), including brow bulge (0-2), vertical brow furrowing (0-1) and short distance (0-1), brow lowering (0-1), eyes close (0-1), bulging eyes (0-2), eye-eye furrowing (0-1), cheek bulge (0-1), nasal-labial furrowing (0-2), mouth open and stretch (0-1), lip purse (0-1) and taut tongue (0-1). During the second evaluation phase, with 2770 images from 31 newborn infants (average age: 2.85°". 027 days), the pain responses were graded on the NFISS scale. Two peak score values during a time course of baseline-venipuncture-recovery (3-3-10 min) were found with needle piercing and needle withdrawal. The reliability of the score analysis was evaluated using 492 randomly selected images out of the 2770 images. The results for intrascorer (author, one week interval) and inter-scorer (author and one experienced nurse) has correlation coefficients of 0.916 and 0.826, respectively.

Original languageEnglish
Pages (from-to)79-85
Number of pages7
JournalBiomedical Engineering - Applications, Basis and Communications
Issue number2
StatePublished - 25 Apr 2005


  • Neonatal
  • Neonatal Facial Image Scoring System (NFISS)
  • Pain response
  • Venipuncture


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