NIPE in NICU
8Pages

MEASURE ANS CONTROL NOCICEPTION IMPROVE OUTCOMES NIPE in the NICU Newborn Infant Parasympathetic Evaluation

Epigenetic programing in the first 1000 days: Stress caused by nociception is a major factor. Since conception, each new life starts to prepare itself to live. During Epigenetic programing in the first 1000 days, the autonomic nervous system (ANS) develops to allow new life to survive in its environment (1). Adverse events may lead to epigenetic changes, with implications for health and disease. The number of preterm infants is increasing; These babies are fragile as they are born with a weak parasympathetic system (2). Newborns in the NICU may undergo more than 12 painful procedures per...

POTENTIAL EFFECTORS Hormones, neurotransmitters, growth factors, nutrients Epigenetics (DNA methylation, histone modifications, microRNAs) Egg/sperm development/maturation POST NATAL Placental development/funciton Organ development Neuronal development Brain maturation/function Immune function Reproductive function Picture modified from Moore E et al. (8) OFFSPRING PHENOTYPE Brain morphology/function Physiological function Bahevior MATCHED ENVIRONMENT Promote health MISMATCHED ENVIRONMENT Predispose to pathology/disease Picture from Boersma JG. et al. (4)

The NIPE (Newborn Infant Parasympathetic Evaluation) monitor measures inter-beat distances of the R-R intervals Measuring the autonomic nervous system (ANS) derived from the ECG. These distances vary due to heart rate variability (HRV): the influence of respiration on the It is crucial to measure the well-being of these babies to vagus nerve. allow them to be as comfortable as possible. However pain assessment in neonates is extremely challenging, Analyzing the signal derived from HRV produces a metric pain scales are subject to inter-observer differences, (HFnu), indicating the relative of...

objectively the parasympathetic activity of the patient. A NIPE of 53 corresponds to a Comfort Behavioral Scale (CBS) score > 17 (10). Assessment of Procedural Distress in Sedated/Intubated Children Under 3 Years Old Using the Newborn Infant Parasympathetic Evaluation: A Diagnostic Accuracy Pilot Study Specificity Relationship of NIPE with CBS – Picture modified from Morgan R. et al. (10) 0 nb : the energy must be between 0 and 4 for an interpretable NIPE.

NIPE on skin to skin contact Impact of skin-to-skin contact on the autonomic nervous system in the preterm infant and his mother Dr. Walas validated the NIPE in an observational study, showing the NIPE value decreases more depending on the intensity of the stimulation (11). Faye PM et al. proved that Low NIPE values corresponded to high EDIN scores and vice-versa (12) NIPE detecting different pain intensities 1,6 Picture modified from Butruille L, et al. (14) NIPE detecting the effects of saccharose during heel stick Using NIPE will allow evaluation of the state of comfort/ discomfort of...

of using NIPE technology NIPE shows the sympathetic/parasympathetic balance allowing taking better decisions to control nociception improving outcomes (17). The Goldilocks principle, that means not too little, but not too much. NIPE and ANI help me optimize analgosedation in my patients. Dr. Wojciech Walas Evaluation of the newborn parasympathetic activity C. Garabedian. et al., PLoS One 2017 Jul 12(7):e0180653. Head of Anesthesiology and Intensive Therapy for Children and Neonates University Hospital in Opole, Poland A tool to measure parasympathetic tone, through heart rate variability,...

Agnes Linnér , Malin Almgren Epigenetic programming-The important first 1000 days. Acta Paediatr 2020 Mar;109(3): 443-452 doi: 10.1111/apa.15050. Epub 2019 Oct 24. Hugues P, et al. Autonomic cardiac control of very preterm newborns: A prolonged dysfunction. Early Human Development. Early Human Development 84(10):681-7. Epipain study : Carbajal R, et al Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA. 2008 Jul 2;300(1):60-70. Boersma GJ, et al. Long-term impact of early life events on physiology and behaviour. J Neuroendocrinol 2014 Sep;26(9):...