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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...

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Autores principales: Verweij, Laura M., Kivits, Jaap T. S., Weber, Frank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
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.
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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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