Pain Monitor for Neonates and Infants

Pain Monitor forNeonates and Infants

A breakthrough in neonatal developmental care.

the first pain and comfortmonitoring system for neonatesand small infants

full-term babies 3. Parasympathetic tone correlatesto discomfort or wellbeing, giving an objectivemeasure of pain.

Numerous developmental care studies have shownthat premature infants are particularly sensitive tostress. Situations that cause pain or discomfort canimpact the neurodevelopment of the baby and canhave long-term health consequences 4.

Developmental CareMonitoring allows nursing staff to observe theimpact of environmental conditions such as noise,light, positioning, choice of face-mask, etc, andoptimise for the individual patient 5, 6. The positiveinfluences generated by developmental careactivities such as parental contact, cocooning,kangaroo care, etc. can be quantified 7, 8, reinforcingthe benefits and encouraging family centred care.

The NIPE index assists clinical staff in adapting post-operative and other analgesia protocols to the individualpatient 9, 10, 11. Similarly the treatment before and duringa potentially painful or stressful procedure in the NICUcan be adapted by monitoring the NIPE index, as cananalgesia at these times or during surgery.

Clinical ConsiderationsIt is estimated that a human being can feel painstarting from the 24th week of intrauterine life; thereis a correlation between the age of the newborn babyand their reaction to pain. The younger the infant, themore significant the reaction is in response to apainful stimulus. Similarly with repetition of painfulprocedures, the intensity of the response will beproportional to the number of stimulations. In generalfear, anxiety or depression can increase perception ofpain in adults; similarly these factors influence theneonate, who cannot understand what is happening.

Behavioural rating scales are not always easy to useand all can be time-consuming. Those used forprolonged pain assessment, such as the NeonatalPain Assessment Tool (PAT), have to be repeated,typically at hourly intervals. Even tools used only forchecks during procedures become significant withthe typical number of interventions each patientrequires in a single day 1. The demand on nursingtime to carry out pain assessments is thereforealmost impossible in today’s busy neonatal unit andpaediatric care environments.

Whichever of the numerous pain evaluation protocolsare used, the subjectivity of the assessment addspossible uncertainty 2. The clinician must be able toassess what they see and disregard subjectiveimpressions; pain scores can often vary for the samepatient, as individual nurses may perceive responsesdifferently. This inevitably makes it difficult to achieveconsistency and accuracy of assessment.

It is particularly important to evaluate the activity ofthe parasympathetic nervous system of pre-termbabies as it is now well documented that whateverthe degree of prematurity there is a large deficit inautonomic regulation capacity compared to that of

Objective Pain AssessmentThe NIPE monitor provides an index based on anelectrophysiological signal and it evaluatescontinuously, without the need for any extrasensors. This ensures a consistent and objectiverating of acute pain and/or patient comfort,available at all times and with minimal demand onnursing time.

The system allows both continuous andinstantaneous assessment of the parasympatheticcomponent of the autonomic nervous system inbabies and young infants. The NIPE technology hasproven efficacy in premature babies from around 26weeks’ gestation through to infants up to two yearsof age, using the ECG signal from the patientmonitor in use.

Correlation of acute or chronic painThe NIPE monitor displays a trend curve whichcorrelates to both chronic and acute pain levels. Theoverall trend shows the averaged (NIPEm) index and

gives an assessmentof long term pain orcomfort, whilst redspikes indicate acuteepisodes, typicallyfrom procedures orsurgical stimuli.

A highly visible digitaldisplay indicatescurrent NIPE index,with the user able to

toggle between averaged or instantaneous (NIPEi)value to quantify chronic and acute pain status.Substantial research has quantified the NIPE indexthresholds that correlate to significant pain, orconversely to a patient who is comfortable.

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NIPE Pain Monitor for Neonates and Infants

Features & BenefitsPatient Centred Care

• Enhances developmental care practice

• Treatments can be adapted for individual infant

• Pain management protocols can be adapted forthe infant

• Removes subjective interpretation of behavioralrating scales

• Effectively proven from 26 weeks’ gestation upto age of 2 years

Simple, Effective, Time-Saving

• Easy to use device

• Simple interpretation of readings

• No additional sensors required

• Continuous assessment of long term pain orcomfort

• Instantaneous assessment quantifying chronicand acute pain

References:1 Carbajal, R, Rousset, A, Danan, C, et al.

Epidemiology and treatment of painful proceduresin neonates in intensive care units. JAMA, 2008

2 Arias, M. & Guinsburg, A. Differences between uni-and multidimensional scales for assessing pain interm newborn infants at the bedside. Clinics, 2012

3 Patural, H, Pichot, V, Jaziri, V, et al. Autonomiccardiac control of very preterm newborns : aprolonged dysfunction. Early Human Development,2008

4 Silviera, P, Portella, A, et al. Developmental originsof health and disease (DOHaD). J. Pediatria, 2007

5 Kuissi et al. Effect of the positioning on the HRV inpremature newborns. JFRN, 2009

6 Rethore et al. Comfort of premature newborns.Comparison between 2 nasal CPAP systems. JFRN,2011

7 Alexandre et al. Impact of cocooning & maternalvoice on ANS in the premature newborn infant. ArchPediatr, 2013

8 Blouin et al. Impact du peau à peau sur le SNA dela mère et de l’enfant (NIPE). JFRN, 2014

9 Faye et al. Pain assessment in newborn infant withHRV. Clin J Pain, 2010

10 De Jonckheere et al. HRV analysis for newborninfants prolonged pain assessment. Conf Proc IEEEEng Med Biol Soc, 2011

11 Rakza et al. Evaluation de la douleur ou del’inconfort du nouveau-né après extractioninstrumentale. JFRN, 2011

Notes:

These specifications may change without notice due to continuous product improvement.This product is manufactured and marketed by Mdoloris Medical Systems.

Specifications:

Parameter Specification

Power Input (Adapter) 100 - 250Vac, 50Hz

Power Consumption 49W

Power Input (Monitor) 12Vdc ±5%, 40W

Display Colour LCD, with backlight

Size 27.0 x 24.7 x 14.5 cm (W x H x D)

Weight 1.85kg

Operating Temperature +5°C to +35°C

Storage Temperature -20°C to +60°C

Compliance EN 60601-1, EN 60601-1-2, MDD 93/42/EEC

E: [email protected]: +44 (0) 7778 133126

+44 (0) 7765 008634 © Delta Medical International Ltd, 2016

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