Objective assessment of induced acute pain in neonatology with the Newborn Infant Parasympathetic Evaluation index

Cremillieux, C; Makhlouf, Ahmed; Pichot, Vincent; Trombert, Béatrice; Patural, Hugues

doi:10.1002/ejp.1191

Cited by 43 publications

(34 citation statements)

References 36 publications

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“…Therefore, we speculate that SC and PIPP‐R simply evaluate different components of pain or stress responses. Similarly, PIPP‐R was not correlated either with a novel pain measure based on heart rate variability in a prospective study of 29 newborns undergoing painful procedures . In another study performed in 61 critical children, although NFSC also increased during invasive procedures, the authors concluded that SC is not more sensitive or faster than clinical scales …”

Section: Discussionmentioning

confidence: 92%

Pain assessment during eye examination for retinopathy of prematurity screening: Skin conductance versus PIPP‐R

et al. 2019

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Aim To assess changes in skin conductance during retinopathy of prematurity screening and to study the correlation between the skin conductance and a validated pain scale. Methods Prospective observational study. Fifty‐three eye examinations were performed in 32 preterm infant candidates for retinopathy of prematurity screening. Outcome measures were changes in Premature Infant Pain Profile‐Revised (PIPP‐R) scale and number of skin conductance fluctuations. Results There was a significant increase from baseline in the number of skin conductance fluctuations and PIPP‐R during the procedure. The maximum value of number of skin conductance fluctuations was 0.64 ± 0.44 peaks/sec, and the maximum value of PIPP‐R was 10.8 ± 3.3. A correlation between the skin conductance and PIPP‐R was not found at any time during the eye examination. Repeated measures correlation analyses showed only a moderate positive correlation between PIPP‐R and number of skin conductance fluctuation values. Conclusion There were significant changes in both PIPP‐R and number of skin conductance fluctuations during retinopathy of prematurity screening, reaffirming that this procedure is painful and stressful. The number of skin conductance fluctuations and PIPP‐R are not significantly correlated, which likely reflects that these parameters evaluate different but complementary aspects of neonatal pain responses.

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Section: Discussionmentioning

confidence: 92%

Pain assessment during eye examination for retinopathy of prematurity screening: Skin conductance versus PIPP‐R

et al. 2019

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“…A lower tone (negative values) indicates the parasympathetic predominance while a higher tone and lower entropy indicate a decrease in the parasympathetic and an increase or sympathetic predominance [23]. Although there is limited research on neonatal pain and stress applying HRV measures, this is the first study investigating multi-lag T -E in a neonatal stress framework [34,35].…”

Section: Discussionmentioning

confidence: 96%

Multi-lag tone–entropy in neonatal stress

Šapina

Karmakar

Kramarić

et al. 2018

J. R. Soc. Interface.

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Heart rate variability (HRV) has been analysed using linear and nonlinear methods. In the framework of a controlled neonatal stress model, we applied tone–entropy (T–E) analysis at multiple lags to understand the influence of external stressors on healthy term neonates. Forty term neonates were included in the study. HRV was analysed using multi-lag T–E at two resting and two stress phases (heel stimulation and a heel stick blood drawing phase). Higher mean entropy values and lower mean tone values when stressed showed a reduction in randomness with increased sympathetic and reduced parasympathetic activity. A ROC analysis was used to estimate the diagnostic performances of tone and entropy and combining both features. Comparing the resting and simulation phase separately, the performance of tone outperformed entropy, but combining the two in a quadratic linear regression model, neonates in resting as compared to stress phases could be distinguished with high accuracy. This raises the possibility that when applied across short time segments, multi-lag T–E becomes an additional tool for more objective assessment of neonatal stress.

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“…Faye et al applied the NIPE algorithm to investigate high frequency heart rate variability (HRV) as an indicator of prolonged postoperative pain in full‐term neonates and found an association between pain decreased HRV, suggesting HRV as a measure of prolonged pain in this particular patient group. Cremillieux et al investigated the performance of the NIPE as an objective tool for acute pain assessment in 29 preterm neonates (mean gestational age 29.9 ± 4.2 weeks) and found no correlation between the NIPE and two validated clinical pain scales. In the present study, no premature infants were included.…”

Section: Discussionmentioning

confidence: 99%

The heart rate variability‐derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia—A prospective observational pilot study

Weber

Roeleveld

Warmenhoven

et al. 2019

Pediatric Anesthesia

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BackgroundThe heart rate variability‐derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index is a continuous noninvasive tool to assess pain and discomfort in infants <2 years. Initial studies focused on pain monitoring in the neonatal intensive care unit environment.AimsThe aim of this study was to investigate the performance of the NIPE in infants under sevoflurane anesthesia. The primary objective of this study was to compare the NIPE and heart rate as tools to help recognize the need for additional opioid drugs. Secondary objectives were the course of the NIPE and heart rate around specific standardized noxious procedural mile‐stones.MethodsNIPE and heart rate values recorded during a 120 seconds interval before the anesthetist's decision to administer additional opioid due to the perceived insufficient antinociception and during a 120 seconds interval after drug administration were analyzed by means of a repeated measures ANOVA. The same analyses were performed for datasets around per protocol administration of morphine for postoperative analgesia, performance of a caudal block and surgical incision.ResultsIn patients with a NIPE value <50, an additional opioid drug administration resulted in a rise of NIPE values, reaching a maximum increase of 5.1 (95% CI: 0.22‐9.99) units 120 seconds after drug administration (P = 0.041). There was no evidence of a change in heart rate during these two 120 seconds periods. Per protocol administration of morphine, caudal block, and surgical incision did not result in changes of the NIPE, which was around 65 units on these occasions, and heart rate.ConclusionIn infants anesthetized with sevoflurane, NIPE values <50 might be indicative of insufficient antinociception. The results of this observational pilot study might suggest that the NIPE could be a better measure of the nociception/antinociception balance than heart rate.

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Objective assessment of induced acute pain in neonatology with the Newborn Infant Parasympathetic Evaluation index

Abstract: The NIPE monitor was developed for objective pain assessment in neonates based on HFnu variations, but it does not seem reliable enough for assessing acute pain in real time in preterm neonates. Pain assessment in preterm babies still relies on pain scales.

Cited by 43 publications

References 36 publications

Pain assessment during eye examination for retinopathy of prematurity screening: Skin conductance versus PIPP‐R

Pain assessment during eye examination for retinopathy of prematurity screening: Skin conductance versus PIPP‐R

Multi-lag tone–entropy in neonatal stress

The heart rate variability‐derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia—A prospective observational pilot study

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