{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:18:54Z","timestamp":1792797534226,"version":"4.5.0"},"reference-count":20,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T00:00:00Z","timestamp":1728345600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Assessing pain in infants and neonates is challenging due to their inability to communicate verbally. While validated subjective tools exist, they rely on interpreting the child\u2019s behavior, leading to potential inconsistencies and underestimation of pain. Based on heart rate variability, the newborn infant parasympathetic evaluation (NIPE) index offers a more objective approach to pain assessment in children under 2 years. Although promising, research on its effectiveness during surgery under general anesthesia remains limited and inconclusive.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>This study compared the effectiveness of NIPE-guided fentanyl administration to traditional vital signs (heart rate and mean arterial pressure) in managing pain during surgery in children under 2 years.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Seventy children undergoing head, neck, or upper extremity surgery were randomized into group N (NIPE) or group C (Control) with 35 participants in each group. Both groups received standardized anesthesia and monitoring, including NIPE. Group N received fentanyl when NIPE scores fell below 50, while group C received fentanyl upon a 20% increase in heart rate or mean arterial pressure (MAP). Postoperative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scores, alongside fentanyl consumption, sedation levels, and potential side effects.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Both groups exhibited similar outcomes in terms of postoperative pain scores, fentanyl consumption, sedation levels, and absence of side effects (postoperative respiratory depression or nausea and vomiting). Additionally, intraoperative NIPE scores, heart rate, and MAP were comparable between the groups. There are strong correlations between both groups in terms of NIPE scores (<jats:italic>r<\/jats:italic> = 0.735, <jats:italic>p<\/jats:italic> &lt; 0.0001), heart rate (<jats:italic>r<\/jats:italic> = 0.630, <jats:italic>p<\/jats:italic> &lt; 0.0001), and MAP (<jats:italic>r<\/jats:italic> = 0.846, <jats:italic>p<\/jats:italic> &lt; 0.0001). In both group C and group N, the NIPE scores reveal strong negative correlations with heart rate (<jats:italic>r<\/jats:italic> = \u22120.610, <jats:italic>p<\/jats:italic> &lt; 0.0001, and <jats:italic>r<\/jats:italic> = \u22120.674, <jats:italic>p<\/jats:italic> &lt; 0.0001) and MAP (<jats:italic>r<\/jats:italic> = \u22120.860, <jats:italic>p<\/jats:italic> &lt; 0.0001, and <jats:italic>r<\/jats:italic> = \u22120.756, <jats:italic>p<\/jats:italic> &lt; 0.0001).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>NIPE-guided intraoperative fentanyl administration was not superior to heart rate\/MAP-guided administration, as both achieved similar pain management outcomes in this study. However, NIPE may offer a more practical and precise approach, as it is an objective tool with a defined threshold. These findings suggest NIPE\u2019s promise as a valuable tool for managing pain in children under 2 years undergoing surgery. However, confirmation of its widespread effectiveness requires further research with larger, multicenter studies encompassing procedures with a broader spectrum of pain severity.<\/jats:p>\n<\/jats:sec>","DOI":"10.7717\/peerj.18267","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T07:08:11Z","timestamp":1728371291000},"page":"e18267","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of newborn infant parasympathetic evaluation (NIPE) index for guiding intraoperative fentanyl administration in children under 2 years: a randomized controlled 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Systematic review and meta-analysis","volume":"67","author":"Oliveira","year":"2017","journal-title":"Brazilian Journal of Anesthesiology"},{"issue":"5","key":"10.7717\/peerj.18267\/ref-12","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1007\/s10877-021-00670-8","article-title":"The newborn infant parasympathetic evaluation in pediatric and neonatology: a literature review","volume":"35","author":"Recher","year":"2021","journal-title":"Journal of Clinical Monitoring and Computing"},{"issue":"12","key":"10.7717\/peerj.18267\/ref-13","doi-asserted-by":"publisher","first-page":"e1052-e60","DOI":"10.1097\/PCC.0000000000002454","article-title":"Assessment of Procedural distress in sedated\/intubated children under 3 years old using the newborn infant parasympathetic evaluation: a diagnostic accuracy pilot study","volume":"21","author":"Recher","year":"2020","journal-title":"Pediatric Critical Care Medicine"},{"issue":"4","key":"10.7717\/peerj.18267\/ref-14","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1016\/j.jpedsurg.2023.12.008","article-title":"Newborn and Infant Parasympathetic Evaluation (NIPE) monitor for assessing pain during surgery and interventional procedures: a systematic review","volume":"59","author":"Sakthivel","year":"2024","journal-title":"Journal of Pediatric Surgery"},{"key":"10.7717\/peerj.18267\/ref-15","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s12871-021-01272-2","article-title":"Comparative study of analgesia nociception index (ANI) vs. standard pharmacokinetic pattern for guiding intraoperative fentanyl administration among mastectomy patients","volume":"21","author":"Tribuddharat","year":"2021","journal-title":"BMC Anesthesiology"},{"issue":"4","key":"10.7717\/peerj.18267\/ref-16","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/j.bjan.2017.03.004","article-title":"Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery","volume":"67","author":"Turan","year":"2017","journal-title":"Revista Brasileira De Anestesiologia"},{"issue":"1","key":"10.7717\/peerj.18267\/ref-17","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1213\/ANE.0000000000001984","article-title":"Intraoperative \u201cAnalgesia nociception index\u201d-guided fentanyl administration during sevoflurane anesthesia in lumbar discectomy and laminectomy: a randomized clinical trial","volume":"125","author":"Upton","year":"2017","journal-title":"Anesthesia & Analgesia"},{"issue":"7","key":"10.7717\/peerj.18267\/ref-18","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1111\/pan.14188","article-title":"The performance of the heart rate variability-derived Newborn Infant Parasympathetic Evaluation Index as a measure of early postoperative pain and discomfort in infants-a prospective observational study","volume":"31","author":"Verweij","year":"2021","journal-title":"Pediatric Anesthesia"},{"issue":"4","key":"10.7717\/peerj.18267\/ref-19","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1111\/pan.13613","article-title":"The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia-A prospective observational pilot study","volume":"29","author":"Weber","year":"2019","journal-title":"Pediatric Anesthesia"},{"key":"10.7717\/peerj.18267\/ref-20","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12871-019-0774-y","article-title":"Newborn infant parasympathetic evaluation (NIPE) as a predictor of hemodynamic response in children younger than 2 years under general anesthesia: an observational pilot study","volume":"19","author":"Zhang","year":"2019","journal-title":"BMC Anesthesiology"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/18267.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/18267.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/18267.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/18267.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T07:08:19Z","timestamp":1728371299000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/18267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,8]]},"references-count":20,"alternative-id":["10.7717\/peerj.18267"],"URL":"https:\/\/doi.org\/10.7717\/peerj.18267","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,8]]},"article-number":"e18267"}}