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Am J Perinatol 2021; 38(S 01): e224-e230
DOI: 10.1055/s-0040-1709458
Original Article

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

Wojciech Walas
1   Paediatric and Neonatal Intensive Care Unit, University Hospital in Opole, Opole, Poland
,
Julita Latka-Grot
2   Department of Neonatal, Children's Memorial Health Institute, Warszawa, Poland
,
Iwona Maroszyńska
3   Department of Intensive Care and Congenital Malformations of Newborns and Infants, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
,
Ewelina Malinowska
3   Department of Intensive Care and Congenital Malformations of Newborns and Infants, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
,
Magdalena Rutkowska
4   Department of Neonatology, Institute of Mother and Child, Warszawa, Poland
,
Andrzej Piotrowski
5   Department of Anaesthesiology and Intensive Care, Children's Memorial Health Institute, Warszawa, Poland
,
Monika Wrońska
5   Department of Anaesthesiology and Intensive Care, Children's Memorial Health Institute, Warszawa, Poland
,
Tomasz Szczapa
6   Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznań University of Medical Sciences, Poznań, Poznań, Poland
,
Agata Kubiaczyk
6   Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznań University of Medical Sciences, Poznań, Poznań, Poland
,
Michał Skrzypek
7   Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
,
Julien De Jonckheere
8   Clinical Investigation Center-Technological Innovation (CIC-IT) 1403, University Hospital Center (UHC) Lille, Lille, France
,
Zenon P. Halaba 
9   Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
› Author Affiliations Funding None.
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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.

Keywords

procedural pain - pain monitoring - newborn infant parasympathetic evaluation - behavioral scales - infant


Publication History

Received: 24 September 2019

Accepted: 26 February 2020

Article published online:
10 April 2020

© 2020. Thieme. All rights reserved.

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