The performance of the heart rate variability-derived Newborn Infant Parasympathetic Evaluation Index as a measure of early postoperative pain and discomfort in infants—A prospective observational study

Laura M. Verweij; Jaap T.S. Kivits; Frank Weber

doi:10.1111/pan.14188

The performance of the heart rate variability-derived Newborn Infant Parasympathetic Evaluation Index as a measure of early postoperative pain and discomfort in infants—A prospective observational study

Laura M. Verweij, Jaap T.S. Kivits, Frank Weber^*

^*Corresponding author for this work

Anesthesiology

Research output: Contribution to journal › Article › Academic › peer-review

16 Citations (Scopus)

Abstract

Background: The heart rate variability-derived 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 early postoperative setting, where assessment of pain/discomfort is usually based on discontinuous observational scoring systems or personal experience of medical staff. Aims: To investigate the performance of the NIPE as a measure of early postoperative pain and/or discomfort in infants. Methods: The potential of the NIPE to detect pain/discomfort, as assessed by two clinical scoring systems (FLACC and COMFORT-B scale), was investigated in postoperative infants (0–2 years). Results: Receiver operating curve (ROC) analyses investigating the power of the NIPE to distinguish between comfort and pain/discomfort, revealed areas under the curve (AUC) of 0.77 for the FLACC, 0.81 for the COMFORT-B score, and 0.77 for a combination of FLACC & COMFORT-B. Logistic regression analysis provided initial evidence that the NIPE is an independent predictor of a FLACC score ≥4 and/or a COMFORT-B score ≥17, though R² values were below.2. NIPE values associated with a FLACC ≥4 (48 [45–56]), a COMFORT-B score ≥17 (47 [42–53]), and a FLACC ≥4 & COMFORT-B ≥17 (47 [42–57]) were lower than NIPE values associated with a FLACC <4 (60 [53–68], 95% CI of difference −14 to −8, p <.0001), a COMFORT-B score <17 (61 [54–68], 95% CI of difference −16 to −10, p <.0001), and a FLACC <4 & COMFORT-B score <17 (60 [53–68], 95% CI of difference −15 to −8, p <.0001). We found no evidence of a predictive value of the NIPE regarding the occurrence of pain. Conclusions: The NIPE detected pain and discomfort in infants after general anesthesia with reasonable areas under the ROC curve (±0.8), whereas it was not predictive of clinically detectable pain or discomfort.

Original language	English
Pages (from-to)	787-793
Number of pages	7
Journal	Paediatric Anaesthesia
Volume	31
Issue number	7
DOIs	https://doi.org/10.1111/pan.14188
Publication status	Published - 1 Jul 2021

Bibliographical note

Funding Information:
This study was performed without funding. The authors thank the staff at the Post Anesthesia Care Unit at Erasmus MC?Sophia Children's Hospital for their kind support during the conduct of this study.

Publisher Copyright:
© 2021 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.

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title = "The performance of the heart rate variability-derived Newborn Infant Parasympathetic Evaluation Index as a measure of early postoperative pain and discomfort in infants—A prospective observational study",

abstract = "Background: The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE{\texttrademark}) Index is a continuous noninvasive tool for the assessment of pain and discomfort in infants. Little is known about its performance in the early postoperative setting, where assessment of pain/discomfort is usually based on discontinuous observational scoring systems or personal experience of medical staff. Aims: To investigate the performance of the NIPE as a measure of early postoperative pain and/or discomfort in infants. Methods: The potential of the NIPE to detect pain/discomfort, as assessed by two clinical scoring systems (FLACC and COMFORT-B scale), was investigated in postoperative infants (0–2 years). Results: Receiver operating curve (ROC) analyses investigating the power of the NIPE to distinguish between comfort and pain/discomfort, revealed areas under the curve (AUC) of 0.77 for the FLACC, 0.81 for the COMFORT-B score, and 0.77 for a combination of FLACC & COMFORT-B. Logistic regression analysis provided initial evidence that the NIPE is an independent predictor of a FLACC score ≥4 and/or a COMFORT-B score ≥17, though R2 values were below.2. NIPE values associated with a FLACC ≥4 (48 [45–56]), a COMFORT-B score ≥17 (47 [42–53]), and a FLACC ≥4 & COMFORT-B ≥17 (47 [42–57]) were lower than NIPE values associated with a FLACC <4 (60 [53–68], 95% CI of difference −14 to −8, p <.0001), a COMFORT-B score <17 (61 [54–68], 95% CI of difference −16 to −10, p <.0001), and a FLACC <4 & COMFORT-B score <17 (60 [53–68], 95% CI of difference −15 to −8, p <.0001). We found no evidence of a predictive value of the NIPE regarding the occurrence of pain. Conclusions: The NIPE detected pain and discomfort in infants after general anesthesia with reasonable areas under the ROC curve (±0.8), whereas it was not predictive of clinically detectable pain or discomfort.",

author = "Verweij, {Laura M.} and Kivits, {Jaap T.S.} and Frank Weber",

note = "Funding Information: This study was performed without funding. The authors thank the staff at the Post Anesthesia Care Unit at Erasmus MC?Sophia Children's Hospital for their kind support during the conduct of this study. Publisher Copyright: {\textcopyright} 2021 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.",

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The performance of the heart rate variability-derived Newborn Infant Parasympathetic Evaluation Index as a measure of early postoperative pain and discomfort in infants—A prospective observational study. / Verweij, Laura M.; Kivits, Jaap T.S.; Weber, Frank.
In: Paediatric Anaesthesia, Vol. 31, No. 7, 01.07.2021, p. 787-793.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The performance of the heart rate variability-derived Newborn Infant Parasympathetic Evaluation Index as a measure of early postoperative pain and discomfort in infants—A prospective observational study

AU - Verweij, Laura M.

AU - Kivits, Jaap T.S.

AU - Weber, Frank

N1 - Funding Information: This study was performed without funding. The authors thank the staff at the Post Anesthesia Care Unit at Erasmus MC?Sophia Children's Hospital for their kind support during the conduct of this study. Publisher Copyright: © 2021 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.

PY - 2021/7/1

Y1 - 2021/7/1

N2 - Background: The heart rate variability-derived 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 early postoperative setting, where assessment of pain/discomfort is usually based on discontinuous observational scoring systems or personal experience of medical staff. Aims: To investigate the performance of the NIPE as a measure of early postoperative pain and/or discomfort in infants. Methods: The potential of the NIPE to detect pain/discomfort, as assessed by two clinical scoring systems (FLACC and COMFORT-B scale), was investigated in postoperative infants (0–2 years). Results: Receiver operating curve (ROC) analyses investigating the power of the NIPE to distinguish between comfort and pain/discomfort, revealed areas under the curve (AUC) of 0.77 for the FLACC, 0.81 for the COMFORT-B score, and 0.77 for a combination of FLACC & COMFORT-B. Logistic regression analysis provided initial evidence that the NIPE is an independent predictor of a FLACC score ≥4 and/or a COMFORT-B score ≥17, though R2 values were below.2. NIPE values associated with a FLACC ≥4 (48 [45–56]), a COMFORT-B score ≥17 (47 [42–53]), and a FLACC ≥4 & COMFORT-B ≥17 (47 [42–57]) were lower than NIPE values associated with a FLACC <4 (60 [53–68], 95% CI of difference −14 to −8, p <.0001), a COMFORT-B score <17 (61 [54–68], 95% CI of difference −16 to −10, p <.0001), and a FLACC <4 & COMFORT-B score <17 (60 [53–68], 95% CI of difference −15 to −8, p <.0001). We found no evidence of a predictive value of the NIPE regarding the occurrence of pain. Conclusions: The NIPE detected pain and discomfort in infants after general anesthesia with reasonable areas under the ROC curve (±0.8), whereas it was not predictive of clinically detectable pain or discomfort.

AB - Background: The heart rate variability-derived 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 early postoperative setting, where assessment of pain/discomfort is usually based on discontinuous observational scoring systems or personal experience of medical staff. Aims: To investigate the performance of the NIPE as a measure of early postoperative pain and/or discomfort in infants. Methods: The potential of the NIPE to detect pain/discomfort, as assessed by two clinical scoring systems (FLACC and COMFORT-B scale), was investigated in postoperative infants (0–2 years). Results: Receiver operating curve (ROC) analyses investigating the power of the NIPE to distinguish between comfort and pain/discomfort, revealed areas under the curve (AUC) of 0.77 for the FLACC, 0.81 for the COMFORT-B score, and 0.77 for a combination of FLACC & COMFORT-B. Logistic regression analysis provided initial evidence that the NIPE is an independent predictor of a FLACC score ≥4 and/or a COMFORT-B score ≥17, though R2 values were below.2. NIPE values associated with a FLACC ≥4 (48 [45–56]), a COMFORT-B score ≥17 (47 [42–53]), and a FLACC ≥4 & COMFORT-B ≥17 (47 [42–57]) were lower than NIPE values associated with a FLACC <4 (60 [53–68], 95% CI of difference −14 to −8, p <.0001), a COMFORT-B score <17 (61 [54–68], 95% CI of difference −16 to −10, p <.0001), and a FLACC <4 & COMFORT-B score <17 (60 [53–68], 95% CI of difference −15 to −8, p <.0001). We found no evidence of a predictive value of the NIPE regarding the occurrence of pain. Conclusions: The NIPE detected pain and discomfort in infants after general anesthesia with reasonable areas under the ROC curve (±0.8), whereas it was not predictive of clinically detectable pain or discomfort.

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JO - Paediatric Anaesthesia

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ER -

The performance of the heart rate variability-derived Newborn Infant Parasympathetic Evaluation Index as a measure of early postoperative pain and discomfort in infants—A prospective observational study

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