The heart rate variability derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in paediatric surgical patients from 0‐2 years under sevoflurane anaesthesia ‐ a prospective observational pilot study

Summary

Background

The heart rate variability derived Newborn Infant Parasympathetic Evaluation (NIPE^™) Index is a continuous non‐invasive tool to assess pain and discomfort in infants < 2 years. Initial studies focused on pain monitoring in the neonatal intensive care unit environment.

Aim

To investigate the performance of the NIPE in infants under sevoflurane anaesthesia. The primary objective of this study was to compare the NIPE and heart rate as tools to help recognise the need for additional opioid drugs. Secondary objectives were the course of the NIPE and heart rate around specific standardized noxious procedural mile‐stones.

Methods

NIPE and heart rate values recorded during a 120 sec. interval before the anaesthetist's decision to administer additional opioid due to perceived insufficient anti‐nociception and during a 120 sec. interval after drug administration were analysed by means of a repeated measures ANOVA. The same analyses were performed for datasets around per protocol administration of morphine for postoperative analgesia, performance of a caudal block and surgical incision.

Results

In patients with a NIPE value <50, additional opioid drug administration resulted in a rise of NIPE values, reaching a maximum increase of 5.1 (95% CI 0.22 to 9.99) units 120 sec. after drug administration (p= 0.041). There was no evidence of a change in heart rate during these two 120 sec. periods. Per protocol administration of morphine, caudal block and surgical incision did not result in changes of the NIPE, which was around 65 units on these occasions, and heart rate.

Conclusions

In infants anaesthetised with sevoflurane, NIPE values <50 might be indicative of insufficient anti‐nociception. The results of this observational pilot study might suggest that the NIPE could be a better measure of the nociception / anti‐nociception balance than heart rate.

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