Use of the NIPE monitor to continuously assess the nociception-comfort balance in mechanically ventilated, sedated, preterm infants: An observational study.

To establish whether the Newborn Infant Parasympathetic Evaluation (NIPE) score provides information on the nociception-comfort balance during the routine care of mechanically ventilated, sedated, premature infants. A single-center, prospective, observational study in a tertiary neonatal intensive care unit. Premature infants born before 33 weeks of gestational age and who were mechanically ventilated and received continuous sedation or analgesics within the first 7 days post-partum. Continuous NIPE monitoring and repeated assessments of the Premature Infant Pain Profile-Revised (PIPP-R) score during routine care involving multiple potentially painful procedures. The NIPE score was recorded continuously from 10 min before the care procedure until 10 min after the end of the care procedure. The PIPP-R score was rated before, during, and after care by trained nurses blinded to the NIPE score. Fifty infants were included. The PIPP-R score increased significantly during care and decreased afterwards; conversely, the NIPE score decreased during care and increased afterwards (both p < 0.0001). Higher PIPP-R scores were significantly associated with lower NIPE scores in a linear mixed-effects model accounting for repeated measurements (p < 0.001). Discriminant performance varied according to the PIPP-R threshold considered, with an AUROC of 0.67 [95% confidence interval: 0.58-0.76] for the lower PIPP-R threshold and 0.79 [95% confidence interval: 0.70-0.88] for the higher threshold.

conclusionIn mechanically ventilated, sedated, premature infants, the NIPE score provides continuous autonomic information during routine care and may complement multidimensional clinical pain assessments in critically ill newborns. WHAT IS KNOWN: • Mechanically ventilated, sedated preterm infants frequently undergo painful procedures in NICU, while their behavioral responses may be attenuated by sedation, making pain assessment challenging. • The NIPE monitor continuously provides assessment of autonomic activity, reflecting the balance between nociception and pain. WHAT IS NEW: • In mechanically ventilated, sedated preterm infants, NIPE scores decreased during routine care and increased afterward. • NIPE showed dynamic changes during prolonged care episodes and provided continuous autonomic information that complemented behavioral scales.