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The newborn infant parasympathetic evaluation in pediatric and neonatology: a literature review

  • Review Paper
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Purpose

The Newborn Infant Parasympathetic Evaluation (NIPE) is a heart rate variability-based technology for assessing pain and comfort in neonates and infants under 2-years-old. This review aims to investigate the clinical utility of the NIPE.

Methods

Two investigators screened Pubmed/Medline and Google Scholar for relevant studies, independently. One investigator extracted data, which were reviewed by a second investigator.

Results

The NIPE was used during/after painful stimuli (6 studies), in the context of general anaesthesia (2 studies), and for comfort assessment (6 studies). A) Evaluation of procedural pain/distress: 2 studies reported that the mean-NIPE could be used for reliable monitoring of prolonged pain, and one study reported the association between instant-NIPE and pain after a stimulus but the instant-NIPE represents the NIPE average over 3 min. Two studies found no correlation between the NIPE and comfort behavior/pain scales, but they mainly differed in patients’ gestational age and evaluation methodology. B) There are only 2 studies for the evaluation of nociception during surgery under general anaesthesia with contradictory results. C) Studies assessing neonates’ comfort reported increased NIPE scores during skin-to-skin contact and during facilitated tucking associated with a human voice. No effect on NIPE scores of facilitated tucking during echocardiography was reported in preterm infants. One study reported significantly different NIPE scores with 2 surfactant therapy protocols. Overall, study populations were small and heterogeneous.

Conclusion

The results regarding NIPE’s performances differ between studies. Given the limited number of studies and the heterogeneous outcomes, more studies are required to confirm the NIPE usefulness in the different clinical settings.

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Abbreviations

AD:

Assisted deliveries

ANI:

Analgesia Nociception Index

AUC:

Area Under the Curve

CBS:

Comfort Behavioral Scale

DAN:

Douleur Aiguë du Nouveau-né (Neonatal Acute Pain)

EDIN:

Echelle de Douleur et d’Inconfort du Nouveau Né (Neonatal Pain and discomfort scale)

FLACC:

Face, Legs, Activity, cry, Consolability Scale

GA:

Gestational age

HF:

High frequency

HR:

Heart rate

HRV:

Heart rate variability

INSURE:

Intubate, surfactant, extubate

JN:

Jet nebulizer

MBP:

Mean blood pressure

MIST:

Minimally invasive surfactant therapy

NHF:

Nebulizer integrated in the high flow nasal cannulas

NIPE:

Newborn infant parasympathetic evaluation

NIPEi:

Instant-NIPE

NIPEm:

Mean-NIPE

NPE:

Neonatologist-performed echocardiography

NIPS:

Neonatal Infant Pain Scale

PICU:

Pediatric intensive care units

PIPP-R:

Premature infant pain profile-revised

ROC:

Receiver operating characteristic

SD:

Spontaneous deliveries

SSC:

Skin-to-skin contact

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Acknowledgements

This manuscript received no external funding.

Funding

The authors have no financial relationships relevant to this article to disclose.

Author information

Authors and Affiliations

  1. ULR 2694– METRICS: Evaluation des technologies de santé et des pratiques médicales, University of Lille, 59000, Lille, France

    Morgan Recher, Mohamed Riadh Boukhris, Laurent Storme, Stéphane Leteurtre & Julien De jonckheere

  2. CHU Lille, Department of Pediatric Intensive Care, Jeanne de Flandre Hospital, 59000, Lille, France

    Morgan Recher & Stéphane Leteurtre

  3. CHU Lille, Department of Neonatology, Jeanne de Flandre Hospital, 59000, Lille, France

    Mohamed Riadh Boukhris & Laurent Storme

  4. CHU Lille, CIC-IT 1403, Centre D’Innovation Technologique, 59000, Lille, France

    Mathieu Jeanne & Julien De jonckheere

  5. CHU Lille, Anesthesia and Critical Care, 59000, Lille, France

    Mathieu Jeanne

  6. ULR 7365 Groupe de Recherches Sur Les Formes Injectables Et Les Technologies Associées, University of Lille, 59000, Lille, France

    Mathieu Jeanne

  7. APHP, Hôpital Armand-Trousseau, Anesthesia Department, DMU Dream, 75012, Paris, France

    Nada Sabourdin

Authors
  1. Morgan Recher
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  2. Mohamed Riadh Boukhris
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  3. Mathieu Jeanne
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  7. Julien De jonckheere
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Contributions

Drs. Recher and De Jonckheere conceptualised the study, conducted the initial analyses, drafted the initial manuscript, reviewed, and revised the manuscript. Drs. Boukhris and Sabourdin drafted the initial manuscript and revised the manuscript. Dr Jeanne, Prs. Storme and Leteurtre reviewed the manuscript for important intellectual content and revised the manuscript. All authors have approved the final manuscript as submitted for publication and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Morgan Recher.

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Conflict of interest

Julien De jonckheere and Mathieu Jeanne are shareholders of and scientific consultants for Mdoloris Medical Systems (which commercializes the NIPE monitor). The other authors have no conflicts of interest relevant to this article to disclose.

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This is a literature review. No ethical approval is required.

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Recher, M., Boukhris, M.R., Jeanne, M. et al. The newborn infant parasympathetic evaluation in pediatric and neonatology: a literature review. J Clin Monit Comput 35, 959–966 (2021). https://doi.org/10.1007/s10877-021-00670-8

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  • DOI: https://doi.org/10.1007/s10877-021-00670-8

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