Weber Frank, Langen Emma, Kerbusch Thomas, Bokhorst Eric
Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Neonatal and Pediatric Intensive Care, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Paediatr Anaesth. 2025 Mar;35(3):232-238. doi: 10.1111/pan.15050. Epub 2024 Dec 7.
The heart rate variability-based Newborn Infant Parasympathetic Evaluation (NIPE) Index is a continuous noninvasive tool for the assessment of pain and discomfort in infants. Little is known about its performance in the pediatric intensive care unit (PICU) setting, where assessment of pain/discomfort is usually based on discontinuous observational scoring systems or personal experience of medical staff.
Evaluation of the performance of NIPE as an indicator of procedural pain and/or discomfort in conscious mechanically ventilated PICU patients.
Procedural pain/discomfort was simultaneously assessed during pain- or stressful procedures by two validated discontinuous clinical scoring systems (FLACC and COMFORT-B scale) and the NIPE.
NIPE values, FLACC- and COMFORT-B scores were recorded in 17 infants with a mean age of 1.2 (range 0.8-5.9) months. NIPE values associated with positive FLACC- (≥ 4; indicative of pain) and/or COMFORT-B (≥ 17, indicative of discomfort) scores were lower (p < 0.001) than when associated with negative FLACC (< 4) and/or COMFORT-B (< 17) scores with 95% CI's of a difference of -14 to -11 (FLACC), -13 to -11 (COMFORT-B) and -14 to -11 (FLACC and COMFORT-B), with significant interindividual variability in NIPE values. Logistic regression analyses revealed odds ratios between 0.84 and 0.85; the adjacent receiver operating curve analyses showed areas under the curve between 0.83 and 0.88. NIPE data recording failure occurred during 49.3% of the periods with a FLACC ≥ 4% and 40.7% with a COMFORT-B ≥ 17.
The NIPE detects procedural pain and discomfort in conscious mechanically ventilated infants with an accuracy comparable to established clinical scoring systems. However, because of significant interindividual variability of NIPE values and frequent data recording failure associated with patient movement, we believe it is premature to recommend its use in conscious infants.
基于心率变异性的新生儿副交感神经评估（NIPE）指数是一种用于评估婴儿疼痛和不适的连续无创工具。对于其在儿科重症监护病房（PICU）环境中的表现知之甚少，在该环境中，疼痛/不适的评估通常基于不连续的观察评分系统或医护人员的个人经验。
评估NIPE作为意识清醒的机械通气PICU患者程序性疼痛和/或不适指标的性能。
在疼痛或应激性操作过程中，通过两种经过验证的不连续临床评分系统（FLACC和COMFORT - B量表）和NIPE同时评估程序性疼痛/不适。
记录了17例平均年龄为1.2（范围0.8 - 5.9）个月婴儿的NIPE值、FLACC和COMFORT - B评分。与阳性FLACC（≥4；表示疼痛）和/或COMFORT - B（≥17；表示不适）评分相关的NIPE值低于（p < 0.001）与阴性FLACC（<4）和/或COMFORT - B（<17）评分相关的NIPE值，差异的95%置信区间为 - 14至 - 11（FLACC）、 - 13至 - 11（COMFORT - B）和 - 14至 - 11（FLACC和COMFORT - B），NIPE值存在显著的个体间差异。逻辑回归分析显示优势比在0.84至0.85之间；相邻的受试者工作特征曲线分析显示曲线下面积在0.83至0.88之间。在FLACC≥4%的时间段内，49.3%出现NIPE数据记录失败；在COMFORT - B≥17的时间段内，40.7%出现NIPE数据记录失败。
NIPE在意识清醒的机械通气婴儿中检测程序性疼痛和不适的准确性与既定的临床评分系统相当。然而，由于NIPE值存在显著的个体间差异以及与患者活动相关的频繁数据记录失败，我们认为现在推荐在意识清醒的婴儿中使用它还为时过早。
