Effect of breast milk and sucrose on pain and perfusion index during examination for retinopathy of prematurity

Turan, Özden; Akkoyun, İmren; Ince, Denız Anuk; Doğanay, Beyza; Tugcu, AU; Ecevit, Ayşe

doi:10.1080/14767058.2019.1628209

Cited by 9 publications

(18 citation statements)

References 18 publications

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“…15 Others find breast milk, sucrose and/or local anesthetic insufficient to curb the heart rate change (tachycardia) associated with lid speculum NICU eye exams. 16 We recognize that topical anesthetics can quickly numb the cornea which is not touched during our exams, but that the deep pressure of lid speculum and scleral depression are not blunted by a topical anesthetic drop just before the exam. We also have documented that topical anesthetic do not enhance recovery from strabismus surgery, but maybe actually worsen recovery in young patients.…”

Section: Discussionmentioning

confidence: 90%

<p>Oculocardiac Reflex During ROP Exams</p>

Schumacher¹,

Ball²,

Arnold³

et al. 2020

OPTH

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Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/XB2uu1ca7kQ Purpose: Reducing physiologic stress including bradycardia during staging eye exams for retinopathy of prematurity (ROP) is desirable. We observed heart rate change during routine retinopathy of prematurity eye examinations and compared the response with our ongoing study of oculocardiac reflex (OCR) elicited by uniform EOM tension during strabismus surgery. Patients and Methods: Electrocardiograph was prospectively monitored during ROP exams featuring indirect ophthalmoscopy with Alfonso lid speculum and see-through scleral depressor without topical anesthesia. Clinical data were retrieved from ROP-Check software. OCR was defined as maximally changed heart rate (HR) as a percent of baseline. Strabismus surgery patients under general anesthesia served as controls. Results: From 10/2017 to 9/2020, 281 infants had ROP exams, and the median OCR was 55.9% of baseline HR (IQR 41.4% to 72.6%), the kurtosis 0.93 and skewness 1.01 representing a drop from HR 169 ± 16 bpm to 102 ± 39 bpm. In comparison, 1493 adult and pediatric strabismus surgery patients had less OCR median bradycardia 87.8% (IQR 72-98%), kurtosis 1.60 and skewness −1.18. ROP %OCR correlated with birth gestational age (%OCR = 2.5 (GA)-11, r(279)=0.33, p<0.01) and with birthweight (%OCR = 0.02 (BW) + 38, r(279) =0.35, p<0.01). The duration of bradycardia induced by ROP exam averaged 92 ± 34 seconds (range 34-240 seconds). Conclusion: Bradycardia is common during eye exams in the smallest premature infants with greater degree, more rapid onset and longer duration than OCR during strabismus surgery.

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Section: Discussionmentioning

confidence: 90%

<p>Oculocardiac Reflex During ROP Exams</p>

Schumacher¹,

Ball²,

Arnold³

et al. 2020

OPTH

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“…Rationale: Nonnutritive sucking with oral sucrose and expressed breast milk have been well studied in the NICU population (83,86,(91)(92)(93)(94)(95)(96)(97)(98). The use of oral sucrose has had the biggest effect in some studies, but combinations of all nonnutritive suck techniques with swaddling have shown additive effects on pain reduction during heel stick procedures with no AEs reported among infants (99)(100)(101).…”

Section: Pharmacologic Management Of Painmentioning

confidence: 99%

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

Smith

Besunder

Betters

et al. 2022

Pediatric Critical Care Medicine

208

212

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RATIONALE:A guideline that both evaluates current practice and provides recommendations to address sedation, pain, and delirium management with regard for neuromuscular blockade and withdrawal is not currently available. OBJECTIVE:To develop comprehensive clinical practice guidelines for critically ill infants and children, with specific attention to seven domains of care including pain, sedation/agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment, and early mobility. DESIGN:The Society of Critical Care Medicine Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility Guideline Taskforce was comprised of 29 national experts who collaborated from 2009 to 2021 via teleconference and/or e-mail at least monthly for planning, literature review, and guideline development, revision, and approval. The full taskforce gathered annually in-person during the Society of Critical Care Medicine Congress for progress reports and further strategizing with the final face-to-face meeting occurring in February 2020. Throughout this process, the Society of Critical Care Medicine standard operating procedures Manual for Guidelines development was adhered to. METHODS:Taskforce content experts separated into subgroups addressing pain/ analgesia, sedation, tolerance/iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment (family presence and sleep hygiene), and early mobility. Subgroups created descriptive and actionable Population, Intervention, Comparison, and Outcome questions. An experienced medical information specialist developed search strategies to identify relevant literature between January 1990 and January 2020. Subgroups reviewed literature, determined quality of evidence, and formulated recommendations classified as "strong" with "we recommend" or "conditional" with "we suggest. " Good practice statements were used when indirect evidence supported benefit with no or minimal risk. Evidence gaps were noted. Initial recommendations were reviewed by each subgroup and revised as deemed necessary prior to being disseminated for voting by the full taskforce. Individuals who had an overt or potential conflict of interest abstained from relevant votes. Expert opinion alone was not used in substitution for a lack of evidence. RESULTS:The Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility taskforce issued 44 recommendations (14 strong and 30 conditional) and five good practice statements.

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“…ROP is characterized as an eye disease affecting premature infants, and it is one of the leading causes of preventable vision loss and blindness in childhood. [1][2][3] Moreover, ROP is one of the severe pediatric diseases, accounting for 6% to 18% cases of childhood blindness worldwide. 4 The frequency of ROP may vary according to the socioeconomic status of countries and the quality of newborn care.…”

mentioning

confidence: 99%

“…In addition to pharmacological applications, such as topical anesthetic drops, various nonpharmacological applications to reduce pain during retinopathy examination have garnered much research interest in modern medicine 9. Nonpharmacological methods used as alternatives to pharmacological methods for pain reduction during ROP examination in recent evidence-based studies include the use of sucrose; sucrose with enveloping and nonnutritive absorption; sucrose and nonnutritive suction; breast milk, sucrose, and distilled water; and the Neonatal Individualized Developmental Care and Assessment Program during breastfeeding and retinopathy eye examinations 1,2,12–14…”

mentioning

confidence: 99%

“…Retinopathy of prematurity (ROP) is a condition developing due to the abnormal proliferation of retinal vessels in premature infants born in the third trimester of pregnancy or before, and its pathogenesis is not completely understood. ROP is characterized as an eye disease affecting premature infants, and it is one of the leading causes of preventable vision loss and blindness in childhood 1–3. Moreover, ROP is one of the severe pediatric diseases, accounting for 6% to 18% cases of childhood blindness worldwide 4.…”

mentioning

confidence: 99%

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Nonpharmacological Applications During the Retinopathy of Prematurity Examination and Their Effects on Pain Control

Erçelik

Yılmaz

2022

Journal of Perinatal &Amp; Neonatal Nursing

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Examination for retinopathy of prematurity (ROP) is a very painful procedure. Therefore, pain management is essential given the possibility of sensory and behavioral problems in newborns, who are constantly exposed to painful stimuli. In this light, the use of nonpharmacological methods alone or in combination with pharmacological methods is recommended for pain control. This systematic review and meta-analysis was to evaluate the effects of nonpharmacological treatments on pain during ROP examination. Randomized controlled trials published in English between 2011 and 2021 and available in the electronic databases

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Effect of breast milk and sucrose on pain and perfusion index during examination for retinopathy of prematurity

Cited by 9 publications

References 18 publications

<p>Oculocardiac Reflex During ROP Exams</p>

<p>Oculocardiac Reflex During ROP Exams</p>

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

Nonpharmacological Applications During the Retinopathy of Prematurity Examination and Their Effects on Pain Control

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