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Pain relief for premature infants during ophthalmology assessment
Yogavijayan Kandasamy1, Roger Smith, Ian M R Wright
1Department of Neonatology, Townsville Hospital, Queensland, Australia. Yoga_Kandasamy@health.qld.gov.au
Insights
Pain relief for premature infants during eye exams is crucial. Topical anesthetics offer slight pain reduction, while non-pharmacological methods like pacifiers and nesting are beneficial for managing infant distress during retinopathy of prematurity screening.
Area of Science:
- Neonatal care
- Ophthalmology
- Pain management
Background:
- Ophthalmological examinations for retinopathy of prematurity (ROP) in premature infants can cause significant pain and distress.
- Previous research explored topical anesthesia, oral sucrose, and non-pharmacological interventions for pain relief during these procedures.
Purpose of the Study:
- To review current evidence on the effectiveness of different pain relief methods for premature infants undergoing ROP examinations.
Main Methods:
- A comprehensive literature search was conducted using MEDLINE and the Cochrane Central Register of Controlled Trials.
- The search covered studies published between January 1980 and January 2011, focusing on pain relief for ROP screening.
Main Results:
- Topical proparacaine showed marginal pain reduction without adverse effects.
- Oral sucrose and withholding feeding did not significantly reduce pain scores.
- Pacifiers and nesting were associated with lower pain scores and reduced distress.
- Lid speculum insertion was identified as a particularly uncomfortable aspect of the examination.
Conclusions:
- Topical anesthetics provide a small benefit in reducing pain during infant eye exams.
- Feeding before the examination may improve infant comfort, contrary to some standard practices.
- Non-pharmacological interventions like pacifier use and nesting demonstrate potential benefits for pain and distress management.
Background:
The ophthalmological examination of premature infants, which is essential for the detection of retinopathy of prematurity (ROP), can be painful and distressing for the infant. Various researchers have investigated the benefits of topical anesthesia, oral sucrose, and non pharmacological intervention for pain relief. The purpose of this study is to review the current state of knowledge on the effectiveness of these approaches.
Methods:
A literature search was performed with MEDLINE (January 1980 to January 2011) and the Cochrane Central Register of Controlled Trials, Issue 1 of 4 (January 2011), to determine the currently available evidence on methods of pain relief for premature infants undergoing ROP examination.
Results:
Most studies supported the use of topical proparacaine, which marginally decreased pain without any side effects. Oral sucrose did not significantly reduce pain scores during ROP examinations, and withholding feeding before the examination was not beneficial. Infants given pacifiers had lower pain scores than those without pacifiers, and infants who were nested experienced less distress during and after the procedure. Conflicting data existed on the benefits of different examination techniques, but the insertion of a lid speculum appeared to be the most uncomfortable aspect of the screening examination.
Conclusions:
Topical anesthetics marginally reduce pain during eye examination in premature infants. Contrary to standard practice, it appears that patients are more comfortable if they are fed before the examination, and there is no benefit of oral sucrose. Nonpharmacological interventions, including sucking on a pacifier and nesting, may also be beneficial.
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