# Detection of Nociceptive Stimuli Using the Newborn Infant Parasympathetic Evaluation Index in Children Aged From 3 to 18 Years

## TL;DR

This study shows that a method called NIPE can detect stress in children aged 3-18 during medical procedures, even better than traditional heart and blood pressure measures.

## Contribution

The study extends the use of the NIPE index to older children and demonstrates its sensitivity in detecting stress responses.

## Key findings

- NIPE values dropped significantly during suctioning and returned to normal 5 minutes later.
- Hemodynamic parameters like heart rate and blood pressure did not show significant changes.
- NIPE was more sensitive than hemodynamic measures in detecting stress, even in children on catecholamine therapy.

## Abstract

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.

The aim of this study is to determine whether this method is also applicable to older children.

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.

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.

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.