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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
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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251861/ https://www.ncbi.nlm.nih.gov/pubmed/33811710 http://dx.doi.org/10.1111/pan.14188 |
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author | Verweij, Laura M. Kivits, Jaap T. S. Weber, Frank |
author_facet | Verweij, Laura M. Kivits, Jaap T. S. Weber, Frank |
author_sort | Verweij, Laura M. |
collection | PubMed |
description | 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 R (2) 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. |
format | Online Article Text |
id | pubmed-8251861 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82518612021-07-07 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 Paediatr Anaesth Research Reports 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 R (2) 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. John Wiley and Sons Inc. 2021-05-06 2021-07 /pmc/articles/PMC8251861/ /pubmed/33811710 http://dx.doi.org/10.1111/pan.14188 Text en © 2021 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Research Reports Verweij, Laura M. Kivits, Jaap T. S. Weber, Frank 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 |
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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Research Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251861/ https://www.ncbi.nlm.nih.gov/pubmed/33811710 http://dx.doi.org/10.1111/pan.14188 |
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