The newborn infant parasympathetic evaluation in pediatric and neonatology: a literature review

Recher, Morgan; Boukhris, Mohamed Riadh; Jeanne, M.; Storme, Laurent; Leteurtre, Stéphane; Sabourdin, Nada; Jonckheere, Julien De

doi:10.1007/s10877-021-00670-8

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…However, studies evaluating the validity of NIPE are scarce and report contradictory results. 40 Regarding analgesic therapy, the EUROPAIN study found that acetaminophen, morphine, fentanyl, and midazolam were the most used analgosedatives. 32 Our study shows that these medications are also commonly used in patients with NEC.…”

Section: Discussionmentioning

confidence: 99%

Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey

et al. 2023

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Background Necrotizing enterocolitis (NEC) is a highly painful intestinal complication in preterm infants that requires adequate pain management to prevent short- and long-term effects of neonatal pain. There is a lack of international guidelines for pain management in NEC patients. Therefore, this study aims to describe current pain management for NEC patients in European neonatal intensive care units (NICUs). Methods An online survey was designed and conducted to assess current practices in pain management for NEC patients in European NICUs. The survey was distributed via neonatal societies, digital platforms, and professional contacts. Results Out of the 259 responding unique European NICUs from 36 countries, 61% had a standard protocol for analgesic therapy, 73% assessed pain during NEC, and 92% treated NEC patients with intravenous analgosedatives. There was strong heterogeneity in the used pain scales and initial analgesic therapy, which mainly included acetaminophen (70%), fentanyl (56%), and/or morphine (49%). A third of NICU representatives considered their pain assessment adequate, and half considered their analgesic therapy adequate for NEC patients. Conclusions Various pain scales and analgesics are used to treat NEC patients in European NICUs. Our results provide the first step towards an international guideline to improve pain management for NEC patients. Impact This study provides an overview of current pain management practices for infants with necrotizing enterocolitis (NEC) in European neonatal intensive care units. Choice of pain assessment tools, analgosedatives, and dosages vary considerably among NICUs and countries. A third of NICU representatives were satisfied with their current pain assessment practices and half of NICU representatives with their analgesic therapy practices in NEC patients in their NICU. The results of this survey may provide a first step towards developing a European pain management consensus guideline for patients with NEC.

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Section: Discussionmentioning

confidence: 99%

Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey

et al. 2023

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“…The NIPE was initially introduced in neonatology in order to assess comfort and pain in non-anesthetized term and preterm neonates 11. Two previous studies investigated NIPE index in anesthetized children 6 7.…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of a pediatric nociception monitor in children under sevoflurane anesthesia

Lebrun

Boccara

Cailliau³

et al. 2022

Reg Anesth Pain Med

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IntroductionIntraoperative monitoring of nociception has recently made substantial progress in adult anesthesia. In contrast, pediatric data are scarce. Newborn-Infant Parasympathetic Evaluation (NIPE index, Mdoloris Medical Systems, Loos, France) is the first nociception index specifically designed for young children. It is a dimensionless index comprised between 0 and 100. Two previous studies suggested that NIPE could indeed ‘detect’ nociception in anesthetized children. The objective of our study was to investigate if NIPE allowed to detect and to provide a quantitative assessment of nociception in children.MethodsChildren were anesthetized with sevoflurane, and received a bolus of alfentanil (10 µg/kg before intubation). Before surgical incision, each participant received three tetanic stimulations (5 s, 100 Hertz) with a 5 min interval, in a randomized order: 10, 30 and 60 milliamps. NIPE and heart rate variations were assessed after each stimulation.ResultsThirty children (2.4±1.6 years) were included. Mean delay between alfentanil and the first stimulation was 19±4 min. Mean baseline NIPE was 75±10. NIPE variation after the stimulations was significant at 10, 30 and 60 mA (linear mixed regression model, p<0.001). The intensity of stimulation significantly influenced the amplitude of NIPE variation (linear mixed regression model p<0.001), but had no statistically significant effect on heart rate variation (p=0.52).DiscussionNIPE might allow a quantitative assessment of nociception in young children in these anesthetic conditions. This study provides a basis for future research investigating the potential benefits of NIPE-guided intraoperative analgesia in pediatric anesthesia.Trial registration numberNCT04381637.

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“…Our study did reveal a decrease in the NIPE index after acute painful procedures were performed, for all three GA strata. In the published works and reviews, 6,19 the reliability and adequate cutoff points of the NIPE index have not been sufficiently defined in the population of newborns and even more so in that of VLBW newborns.…”

Section: Discussionmentioning

confidence: 99%

“…In other studies, the relationships evidenced between pain scales for newborns and the NIPE index are very heterogeneous. Recher et al 6 conducted a systematic review of studies conducted in this context, using a wide range of procedures. The authors conclude that clinical studies are heterogeneous in their methodology and outcomes, and that no clear conclusion can be drawn from the existing literature.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Objective This article describes the results of a study investigating the sensitivity and specificity of the Newborn Infant Parasympathetic Evaluation (NIPE) index for detecting the physiological changes resulting from nociception in painful procedures in very low birth weight (VLBW) infants. Study Design A prospective observational study was carried on of 44 newborns at 23 to 32 weeks' gestational age. The sensitivity and specificity of the NIPE index are analyzed using a receiver operating characteristic curve. Most of the painful procedures performed were skin-lancing and venipunctures. Nonpainful procedures consist of no intervention, with an interval of at least 1 hour with painful procedures in each newborn. Results The accuracy of the NIPE index to diagnose mild nociceptive stimulation in VLBW newborns is 73.2%. Conclusion The NIPE index is a useful technique for assessing nociceptive stimulation in newborns, presenting less observer-dependent variability than other pain assessment scales. Key Points

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The newborn infant parasympathetic evaluation in pediatric and neonatology: a literature review

Cited by 10 publications

References 23 publications

Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey

Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey

Quantitative assessment of a pediatric nociception monitor in children under sevoflurane anesthesia

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

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