Paper
Monday, November 14, 2005
Eye Examinations for Retinopathy of Prematurity: The Need for Effective Pain Relief
Anita J. Mitchell, RN, PhD1, Bonnie Stevens, RN, PhD2, Nils Mungan, MD, FRCS3, Sharon Lobert, RN, PhD4, Barbara J. Boss, PhD, FNP4, and William Johnson, PhD5. (1) School of Nursing, University of Louisiana at Monroe, Monroe, LA, USA, (2) Faculty of Nursing, The University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada, (3) Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA, (4) School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA, (5) Preventive Medicine, University of Mississippi, Jackson, MS, USA
| Learning Objective #1: Describe a randomized controlled trial that examined pain relief for preterm infants during eye examinations |
| Learning Objective #2: Explain the need for research on effective pain relief for infants during eye examinations for Retinopathy of Prematurity |
Diagnostic and therapeutic procedures performed on preterm infants in the NICU may be painful in nature. One procedure performed routinely is the eye examination for retinopathy of prematurity (ROP), but few studies have measured the pain experienced by preterm infants during these examinations, or examined the effectiveness of interventions to relieve this pain. 24% oral sucrose given with a pacifier has been shown to be effective in reducing pain during heel sticks and venipunctures in neonates, The purpose of this study was to examine the analgesic effects of 24% oral sucrose and a pacifier during eye examinations for retinopathy of prematurity (ROP). A randomized controlled trial tested the hypothesis that there would be a difference in the analgesic effects of a pacifier with 24% sucrose versus a pacifier with sterile water. 30 preterm infants were randomly assigned to one of two treatments and received either (1) three doses of sterile water with a pacifier, or (2) three doses of 24% sucrose with a pacifier. Each group of infants also received local anesthetic eye drops and swaddling. Pain levels were measured with the Premature Infant Pain Profile (PIPP) (Stevens et al., 1996). The mean PIPP score was 8.8 for the sucrose group, and 11.4 for the water group (t 2.87, p= 0.0077 two-tailed). In comparison to PIPP scores during sucrose studies involving heel sticks, PIPP scores during eye examinations were generally higher, indicating a possibly more painful procedure. The study findings suggest that sucrose with a pacifier, accompanied by local anesthetic eye drops and swaddling, may be beneficial for minimizing pain during eye examinations in preterm infants. However, continued research is needed in order to monitor possible adverse effects on infants following eye examinations, and to examine the effectiveness of additional behavioral and pharmacological interventions for pain relief.