Lingual laser frenotomy in newborns with ankyloglossia: a prospective cohort study

Table 3 C.R.I.E.S. scale

Parameter	Definition	0 points	1 point	2 points
C	Crying	absent or low pitched	high pitched, easily consolable	high pitched, inconsolable
R	Requires oxygen to reach saturation over 95%	No	< 30% oxygen	≥ 30% oxygen
I	Increased vital signs	similar to baseline	up to 20% of baseline	over 20% of baseline
E	Facial expression	not grimaced	grimaced	grimaced with not cry vocalization grunt
S	Sleeplessness	constantly asleep	frequently awake	constantly awake

C.R.I.E.S. scale is composed of five items scoring from 0 to 2 points for each, thus measuring pain from 0 to 10 points. “C” means “crying”, which can be absent or low pitched (0 points), high pitched – as characteristic of pain – but easily consolable (1 point), or inconsolable (2 points). “R” means “requires oxygen to reach saturation over 95%” because of dyspnea induced by intense crying; the need for oxygen may be absent (0 points), < 30% (1 point), or ≥ 30% (2 points). “I” indicates an “increase in vital signs” – heart rate (HR) and blood pressure – compared to baseline; authors relied only on HR in the current study. Vital signs can be steady (0 points), increased < 20% than baseline (1 point), or increased ≥ 20% (2 points). “E” indicates “facial expression” of the newborn: the most frequently associated with pain is “grimace”; the latter is composed of brow lowering, eyes squeezed shut, deepening of the nasolabial furrow, open lips and/or mouth; grimace may be absent (0 points), alone (1 point), associated to not-cry vocalization grunt (2 points). “S” indicates the degree of “sleeplessness” distinguishing when the newborn is constantly asleep (0 points), frequently awake (1 point), or constantly awake (2 points)
Abbreviation: C.R.I.E.S. Cry—Requires Oxygen—Increased Vital Signs—Facial Expression – Sleeplessness, HR Heart Rate

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