Pain-Relieving Interventions for Retinopathy of Prematurity: A Meta-analysis

Disher, Timothy; Cameron, Chris; Mitra, Souvik; Cathcart, Kelcey; Campbell-Yeo, Marsha

doi:10.1542/peds.2018-0401

Cited by 38 publications

(76 citation statements)

References 43 publications

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“…However, these examinations are performed through pharmacologically dilated pupils and usually involve the application of intense illumination, physical restraints and manipulation of the eye, all of which can be sources of pain. For this reason, a combination of non‐pharmacological and pharmacological analgesic measures are currently used, although we know that these methods provide only partial pain relief . This phenomenon was observed in our sample, where in spite of different pain relief measures used, both PIPP‐R scores and SC remained above the ‘severe pain level’, this is a PIPP‐R > 12 or a NSCF > 0.44 peaks/sec.…”

Section: Discussionmentioning

confidence: 59%

“…Eye examinations can cause distress and pain, as far as they are associated with a number of behavioural and physiological effects: changes in facial expression and heart rate, apnoea, feed intolerance, increased oxygen requirements, etc In fact, the recent 2018 American Academy of Paediatrics (AAP) statement on ROP screening recommends that efforts should be made to minimise the discomfort and systemic effect of the examination, and it is imperative to investigate novel approaches to reduce pain in this setting . However, there is still no gold standard for the evaluation and treatment of pain during ROP screening …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…The Norwegian guidelines recommend retinal screening for all infants born before a gestational age (GA) of 32 weeks regardless of birthweight, and for high‐risk infants an eye examination is performed weekly . This procedure is recognised as stressful and painful for the infant and may lead to an elevated pain score, heart rate, respiratory rate and decreased oxygen saturation, .…”

Section: Introductionmentioning

confidence: 99%

“…Oral sucrose has been found to be safe and partly beneficial during ROP screening and sucrose in combination with other pain relieving strategies is recommended to achieve synergy effects . A recent meta‐analysis reported that topical anaesthetics, a sweet taste and non‐nutritive sucking in combination had a better pain relieving effect than topical anaesthetics alone or in combination with only non‐nutritive sucking or a sweet taste . Despite multi‐modal approaches, most studies found elevated pain response, indicating insufficient pain relief .…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta‐analysis reported that topical anaesthetics, a sweet taste and non‐nutritive sucking in combination had a better pain relieving effect than topical anaesthetics alone or in combination with only non‐nutritive sucking or a sweet taste . Despite multi‐modal approaches, most studies found elevated pain response, indicating insufficient pain relief .…”

Section: Introductionmentioning

confidence: 99%

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Skin‐to‐skin contact during eye examination did not reduce pain compared to standard care with parental support in preterm infants

et al. 2019

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Aim: We compared the pain relieving effect of skin-to-skin contact versus standard care in the incubator during screening for retinopathy of prematurity.Methods: This randomised crossover study included 35 preterm infants of less than 32 weeks of gestational age admitted to St Olavs University Hospital, Trondheim, Norway, between January 2014 and June 2016. Randomisation was for skin-to-skin with one of the parents or standard care with supportive positioning by parents for the first of two consecutive eye examinations. The pain score was measured twice using the Premature Infant Pain Profile (PIPP) during and after the eye examination. The infants' movement activity was video recorded after the examination.Results: There was no difference in mean pain scores with skin-to-skin contact versus standard care during (10.2 vs. 10.3, p = 0.91) or after (7.0 vs. 6.8, p = 0.76) the procedure. Independent of the randomisation group, PIPP scores were lower than previous comparable studies have found. Bouts of movement activity were also the same whether the examination was conducted in skin-to-skin position or in the incubator (p = 0.91).Conclusion: Skin-to-skin contact during the eye examination did not provide additional pain relief compared to standard care where the parents were already a part of the multidimensional approach.

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Preterm Infant Stress During Handheld Optical Coherence Tomography vs Binocular Indirect Ophthalmoscopy Examination for Retinopathy of Prematurity

et al. 2021

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urvival and neurodevelopmental outcomes in preterm infants, including periviable infants (22-25 weeks' gestational age), have improved over the past 20 years. However, despite these achievements, long-term neurodevelopmental outcomes for these infants remain a concern. [1][2][3] Prolonged exposure to early-life stress while in the intensive care nursery (ICN) causes alterations in the neural connectome leading to cognitive deficits later in life. [4][5][6] Stressors in the ICN include physiological stressors such as sepsis, environmental stressors such as excessive light, and experiential stressors such as blood draws. 4,7,8 Retinopathy of prematurity (ROP) examination by a trained ophthalmologist usually entails placement of an eyelid speculum, mydriatic drops, retinal illumination by the bright light of a binocular indirect ophthalmoscope, and pressure on the outer surface of the eye. 9 Binocular indirect ophthalmoscopy (BIO) is a repeated experiential stressor/ painful procedure for infants [10][11][12][13] and can produce changes in heart rate, both tachycardia and bradycardia, and apnea during and after examination. 11,14-16 Use of oral sucrose and intranasal fentanyl have been reported to reduce pain associated with retinal examination without increasing the risk of respiratory depression; however, their safety and efficacy need to be verified. 17,18 Approximately 70 000 infants per year in the United States receive 1 or more BIO examinations for ROP screening. 19IMPORTANCE Binocular indirect ophthalmoscopy (BIO) examination for retinopathy of prematurity (ROP) is a well-known cause of repeated preterm infant stress. OBJECTIVE To compare stress during investigational optical coherence tomography (OCT) imaging to that during BIO for ROP. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study examined infants at the bedside in the intensive care nursery. Consecutive preterm infants enrolled in Study of Eye Imaging in Preterm Infants (BabySTEPS) who had any research OCT imaging as part of the study. Patients were recruited from June to November 2019, and analysis began April 2020. MAIN OUTCOMES AND MEASURES Infant stress was measured using modified components of a neonatal pain assessment tool before (baseline) and during OCT imaging and BIO examination of each eye. RESULTS For 71 eye examinations of 16 infants (mean [SD] gestational age, 27 [3] weeks; birth weight, 869 [277] g), change from baseline to each eye examination was lower during OCT imaging than during BIO and the difference between OCT imaging and BIO at each eye examination was significant for the following: infant cry score (first eye examination: mean [SD], 0.03 [0.

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Pain-Relieving Interventions for Retinopathy of Prematurity: A Meta-analysis

Abstract: Multisensory interventions including sweet taste is likely the optimal treatment for reducing pain resulting from eye examinations in preterm infants. No interventions were effective in absolute terms.

Cited by 38 publications

References 43 publications

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

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

Skin‐to‐skin contact during eye examination did not reduce pain compared to standard care with parental support in preterm infants

Preterm Infant Stress During Handheld Optical Coherence Tomography vs Binocular Indirect Ophthalmoscopy Examination for Retinopathy of Prematurity

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