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What Is Best Practice for Providing Pain Relief During Retinopathy of Prematurity Eye Examinations?
1Massachusetts General Hospital, Boston.
Insights
Painful retinopathy of prematurity (ROP) screenings require effective pain reduction strategies. Nonpharmacological methods, topical anesthetics, and examination techniques show potential for improving comfort in premature infants during eye exams.
Area of Science:
- Neonatal ophthalmology
- Pain management in infants
- Preterm infant care
Background:
- Retinopathy of prematurity (ROP) screenings are essential for preterm infants but are recognized as painful procedures.
- Infants requiring ROP screenings include those 30 weeks gestation or less, weighing 1500g or less, or those between 1500-2000g or over 30 weeks gestation with unstable courses.
Purpose of the Study:
- To systematically review literature and identify effective pain reduction interventions for premature infants undergoing retinal eye examinations.
Main Methods:
- A systematic literature search was conducted on CINAHL Plus and MEDLINE.
- Keywords used included "retinopathy of prematurity" and "pain".
- The search was limited to experimental or quasi-experimental studies published within the last 10 years.
Main Results:
- Fourteen studies were identified, evaluating interventions for pain reduction during ROP examinations.
- Three main categories of interventions were found: nonpharmacological (9 studies), topical anesthetics (3 studies), and examination techniques (2 studies).
- These strategies yielded varied results but demonstrated potential benefits when implemented consistently.
Conclusions:
- Consistent pain management policies are crucial for ROP examinations.
- Clinicians should consider combining strategies to maximize infant comfort and pain relief.
- Further research is needed to explore novel pain-mitigating techniques and the feasibility of speculum-free examinations.
Background:
Retinopathy of prematurity screenings is considered a painful procedure. Yet, preterm infants 30 weeks of gestation or less or weighing 1500 g or less or between 1500 and 2000 g or greater than 30 weeks of gestation with an unstable course are required to have these examinations until their eyes reach maturity.
Purpose:
A systematic search of the literature was conducted to answer the question "For premature infants undergoing retinal eye examinations, what interventions are the most effective for pain reduction?"
Methods/Search Strategy:
CINAHL Plus and MEDLINE were searched using the key words: retinopathy of prematurity and pain. The search was limited to the last 10 years and experimental or quasi-experimental studies attempting to reduce pain during eye examinations.
Findings/Results:
The search criteria yielded 14 studies that addressed interventions to decrease pain during examinations. Three strategies were noted for pain relief including nonpharmacological interventions (n = 9), topical anesthetics (n = 3), and examination techniques (n = 2). The findings indicate that these 3 strategies provided varying results for pain relief but could be beneficial if provided in a consistent protocol.
Implications For Practice:
Consequently, policies for pain management during retinopathy of prematurity examinations need to be used consistently. It is important for clinicians to consider using a combination of strategies that maximize comfort and provide pain relief.
Implications For Research:
There remains a need to continue to examine pain-relieving techniques for retinopathy of prematurity examinations. Further investigation is needed to evaluate effective strategies that mitigate pain and the pathways causing pain. In addition, investigating the clinical feasibility of examinations without speculum use may be worthwhile.
