Walas Wojciech, Latka-Grot Julita, Maroszyńska Iwona, Malinowska Ewelina, Rutkowska Magdalena, Piotrowski Andrzej, Wrońska Monika, Szczapa Tomasz, Kubiaczyk Agata, Skrzypek Michał, De Jonckheere Julien, Halaba Zenon P
Paediatric and Neonatal Intensive Care Unit, University Hospital in Opole, Opole, Poland.
Department of Neonatal, Children's Memorial Health Institute, Warszawa, Poland.
Am J Perinatol. 2021 Aug;38(S 01):e224-e230. doi: 10.1055/s-0040-1709458. Epub 2020 Apr 10.
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.
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.
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.
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.
本研究旨在评估新生儿副交感神经评估（NIPE）指数检测未麻醉婴儿对伤害性刺激反应的能力，并将这些结果与行为量表的同步评分进行比较。
36名入住新生儿/儿科重症监护病房（N/PICUs）的未麻醉婴儿被纳入研究。由于数据记录有误，三名患者不得不被排除。为了检测有害刺激引起的疼痛，使用了基于心率变异性的NIPE指数和专为测量非语言儿童程序性疼痛设计的行为疼痛量表。
有41次疼痛事件可供分析。我们观察到，与静息时的NIPE值相比，在整个组中，疼痛刺激后1、2和3分钟时NIPE值有统计学意义的下降，并且在整个组以及中度和重度疼痛亚组中，刺激后3分钟内的最小NIPE值与静息时的NIPE值之间存在统计学意义的差异。受试者工作特征（ROC）分析表明，NIPE在检测有害刺激方面具有很强的敏感性和特异性（ROC曲线下面积：0.767）。我们还发现，疼痛感觉越强，NIPE达到其最低值的速度就越快。
我们的研究表明，疼痛程序与有害刺激后3分钟内NIPE值的显著下降有关。根据我们的观察，疼痛程序后3分钟内的最小值似乎是最具特征性的值。
