Newborn Infant Parasympathetic Evaluation Index for the Assessment of Procedural Pain in Nonanesthetized Infants: A Multicenter Pilot Study

Abstract

Objective The aim of this study is to evaluate the ability of the Newborn Infant Parasympathetic Evaluation (NIPE) index to detect the response to nociceptive stimuli in nonanesthetized infants and to compare these results to simultaneous scoring by behavioral scales. Study Design Thirty-six nonanesthetized infants admitted to neonatal/pediatric intensive care unit (N/PICUs) were enrolled to the study. Due to faulty records of the data, three patients had to be excluded. To detect pain caused by noxious stimuli, the heart-rate-variability-derived NIPE index and behavioral pain scales designed for measuring procedural pain in nonverbal children were used. Results Forty-one painful events were available for analysis. We observed in the whole group a statistically significant decrease in NIPE values at 1, 2, and 3 minutes after a painful stimulus, in comparison to the NIPE value at rest and the statistically significant differences between the minimum NIPE value within 3 minutes after the stimulus in comparison to NIPE value at rest in the whole group, as well as in the subgroups of moderate and severe pain. Receiver operating characteristic (ROC) analysis has shown the strong sensitivity and specificity of the NIPE in detecting the noxious stimuli (ROC AUC: 0.767). We also found that the stronger the sensation of pain was, the more rapidly NIPE reached its lowest value. Discussion Our study indicates that the painful procedures are associated with a significant decrease in the NIPE value within 3 minutes after a noxious stimulus. Based on our observation, the minimum value within 3 minutes from the painful procedure seems to be the most distinctive value.

Newborn infant parasympathetic evaluation for the assessment of analgosedation adequacy in infants treated by mechanical ventilation – a multicenter pilot study

“…They did not find any correlation between NIPE monitor measurements and assessments based on behavioral scales and came to the conclusion that the NIPE index is not a reliable tool for evaluation of acute pain in preterm infants [41]. From observations made by Walas et al it follows that the time points selected by Cremillieux et al may not be optimal to objectively assess the NIPE monitor [42].…”

“…it follows that the time points selected by Cremillieux et al . may not be optimal to objectively assess the NIPE monitor [ 38 ].…”

Procedural Pain Assessment in Infants Without Analgosedation: Comparison of Newborn Infant Parasympathetic Evaluation and Skin Conductance Activity - A Pilot Study

“…Similar results were also obtained by Walas et al in their pilot study on 36 non-anesthetized infants admitted to neonatal/pediatric ICUs. They have observed the statistically significant decrease in the NIPE value within 3 min after the painful stimulus, and the area under the receiver operating characteristic (ROC) curve computed between the NIPE value at rest and the minimum NIPE value over 3 min after a painful stimulus was 0.767 [95% CI 0.666; 0.868] for the whole studied group ( 24 ). In another way, Genderas et al assessing pain in hospitalized premature infants did not find a significant correlation between NIPE index and Premature Infant Pain Profile scale, however they have shown that as the NIPE index as SCR, both had high sensitivity and high negative predictive values to predict PIPP-R > 10, especially for skin-breaking painful procedures ( 25 ).…”

Sensitivity and Specificity of the Newborn Infant Parasympathetic Evaluation Index in Pain Assessment of Very Low Birth Weight Infants

“…Walas et al 17 reported that the NIPE index values fell significantly shortly after the application of painful procedures. These findings are consistent with those obtained in our study.…”