Pain assessment during eye examination for retinopathy of prematurity screening: Skin conductance versus PIPP‐R

Abstract

Aim To assess changes in skin conductance during retinopathy of prematurity screening and to study the correlation between the skin conductance and a validated pain scale. Methods Prospective observational study. Fifty‐three eye examinations were performed in 32 preterm infant candidates for retinopathy of prematurity screening. Outcome measures were changes in Premature Infant Pain Profile‐Revised (PIPP‐R) scale and number of skin conductance fluctuations. Results There was a significant increase from baseline in the number of skin conductance fluctuations and PIPP‐R during the procedure. The maximum value of number of skin conductance fluctuations was 0.64 ± 0.44 peaks/sec, and the maximum value of PIPP‐R was 10.8 ± 3.3. A correlation between the skin conductance and PIPP‐R was not found at any time during the eye examination. Repeated measures correlation analyses showed only a moderate positive correlation between PIPP‐R and number of skin conductance fluctuation values. Conclusion There were significant changes in both PIPP‐R and number of skin conductance fluctuations during retinopathy of prematurity screening, reaffirming that this procedure is painful and stressful. The number of skin conductance fluctuations and PIPP‐R are not significantly correlated, which likely reflects that these parameters evaluate different but complementary aspects of neonatal pain responses.

Skin Conductance Measurement as a Selective and Continuous Pain Assessment Method During Eye Examinations for Retinopathy of Prematurity

“…22 Avila-Alvarez et al recently studied SCM during ROP examination and noted a significant increase in both SCM and PIPP-R scores during the procedure, but without a correlation between PIPP-R scores and skin conduction. 15 PIPP-R scores and SCM were both highest during scleral indentation in the study by Avila-Alvarez et al, 15 which is in concordance with our study where N-PASS scores and SCM were highest mainly during WFDRI during which scleral indentation was used. Avila-Alvarez et al also state that the main advantages of SCM is its objectivity and the possibility of continuous monitoring.…”

“…Although results from SCM vary in the current literature 15,22,24 it still seems that the method is capable of evaluating pain during short term interventions. In our previous study on SCM during heel lancing, we found that SCM at baseline took a longer time to stabilize and was higher in infants with a GA of < 28 weeks than in infants with a GA of ≥ 28 + 0 weeks.…”

“…13 ROP screening starts at a postnatal age of 6 weeks, but the first examination is postponed to postmenstrual age (PMA) 31 weeks in infants born < 26 weeks' (25+6) GA. 13 Eye examinations for ROP screening are sometimes painful and stressful, and is dependent on the ophthalmologist's investigative level of skill. [14][15][16] The methods currently applied for pain relief during ROP screening, such as topical anesthetic eye drops, oral sucrose and non-nutritive sucking, seem to be inadequate. [16][17][18] Pain management in preterm infants is important to prevent both short-and long-term adverse effects of pain.…”

The skin conductance-based non-invasive pain assessment instrument for infants

“…Researchers have carried out experiments, and even a scoping review that describes the validity of SC based on past research 4 and so, in this article, we find an overview of SC and its comparison with another pain scale. Recent studies have reported a significant relationship between SCM and Neonatal Infant Pain Scale (NIPS) 19,22,30 , Neonatal Facial Coding System (NFCS) 22,26 , Premature Infant Pain Profile-Revised (PIPP-R) 28 , Bernese Pain Scale for Neonates (BPSN) 17 , Comfort-b 15 , Prechtl Scale 17 , Newborn Individualized Developmental Care and Assessment Program (NIDCAP) 20,29 , Acute Pain in Newborn (APN) score 5 and crying time. However, there are variations of previous studies report related similarity of SCM with other physiological and behavioural pain tools.…”

Analysis of the infant’s acute pain assessment using developed conductance skin electric instrument compared to the behavioural and faces pain scale in painful injected vaccine

“…Schubach used the Varioprot B SC apparatus, Zimmerman used the Q Sensor SC, and Petterson used the Sensormedic SC apparatus. 7,[9][10][11][12][13][14] In this study, the PaIncare-UI SC apparatus was used. The first reason is because this tool hasn't been comparing with other measuring instruments yet.…”