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Updated: Sep 19, 2025
Electrophysiological Measurements and Analysis of Nociception in Human Infants
Published on: December 20, 2011
Detection of Nociceptive Stimuli Using the Newborn Infant Parasympathetic Evaluation Index in Children Aged From 3 to
Frantisek Kolek1,2,3, Jakub Jonas1, Tomas Vymazal1
1Department of Anaesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Insights
The Newborn Infant Parasympathetic Evaluation (NIPE) Index effectively monitors stress in children over 3 years old. This method is more sensitive than hemodynamic monitoring for detecting the stress response to endotracheal suctioning.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Autonomic Nervous System Function
Background:
- Objective monitoring of patient stress response is crucial.
- Parasympathetic nervous system tone can be measured using respiratory arrhythmia analysis.
- The Newborn Infant Parasympathetic Evaluation (NIPE) Index is validated for children under 2 years.
Purpose of the Study:
- To assess the applicability of the NIPE Index in older children (3-18 years).
- To determine if NIPE can detect stress responses in this age group.
- To compare NIPE's sensitivity to hemodynamic parameters during stressful procedures.
Main Methods:
- NIPE monitoring was performed on pediatric patients (3-18 years) with intubated airways.
- NIPE values were recorded before, during, and after endotracheal suctioning.
- Statistical analysis (ANOVA, Scheffé test) compared NIPE values and hemodynamic parameters.
Main Results:
- The NIPE Index significantly decreased during endotracheal suctioning (average reduction of 13.4 points).
- NIPE values returned to baseline 5 minutes post-suctioning.
- No significant changes in heart rate or blood pressure were observed, irrespective of catecholamine support.
Conclusions:
- The NIPE Index is a sensitive indicator of stress response to endotracheal suctioning in children over 3 years old.
- NIPE is more sensitive than hemodynamic parameters for detecting this stress response.
- The NIPE Index's effectiveness is independent of catecholamine therapy.
Background:
One option to objectively monitor patient stress response is to measure parasympathetic nervous system tone using respiratory arrhythmia analysis. The Newborn Infant Parasympathetic Evaluation (NIPE) Index has been developed for children younger than 2 years of age, and reliability has been confirmed by several studies.
Aims:
The aim of this study is to determine whether this method is also applicable to older children.
Methods:
Patients aged 3-18 years, admitted to the Department of Anaesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, were included in this study. NIPE monitoring was provided on patients with airways secured by endotracheal intubation or tracheostomy. NIPE values were recorded before endotracheal suctioning, 1 min after the start, and 5 min after the end of suctioning. Subsequently, the averages of the values were analyzed using ANOVA and the Scheffé test. Along with the NIPE value, changes in hemodynamic parameters were monitored during the suction, and the results of both methods were compared.
Results:
The NIPE value during endotracheal suctioning was significantly lower, with an average reduction of 13.4 points on a 100-point scale, and returned to baseline 5 min after suctioning ended. No significant changes in hemodynamic parameters (heart rate and blood pressure) were observed, either in the whole group of patients or in the group not receiving catecholamine support.
Conclusions:
The NIPE index detects the stress response to endotracheal suctioning in children older than 3 years and is more sensitive than hemodynamic parameters, regardless of catecholamine therapy.
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