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

Timothy Disher¹, Chris Cameron², Souvik Mitra^3,4

¹Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia.

|June 3, 2018

Insights

Sweet taste interventions, with or without adjuncts, are likely optimal for reducing pain during retinopathy of prematurity eye exams in infants. However, no intervention provided complete pain relief.

Area of Science:

Neonatal care
Ophthalmology
Pain management

Background:

Eye examinations are necessary for preterm infants to detect retinopathy of prematurity (ROP).
These examinations can cause significant pain and distress to neonates.
Effective pain management strategies are crucial for improving infant well-being during ROP screening.

Purpose of the Study:

To systematically review and combine evidence from randomized trials on pain-relieving interventions for ROP examinations.
To identify the most effective interventions for reducing pain during these procedures using network meta-analysis.

Main Methods:

A systematic review and network meta-analysis of multiple databases (Medline, Embase, Cochrane, Web of Science, WHO ICTRP) was conducted.
Twenty-nine studies involving 1487 infants were included after rigorous screening and data extraction.
Random effect models were used to pool data, with pain during examination as the primary outcome.

Main Results:

Topical anesthetic (TA) combined with sweet taste and an adjunct intervention (e.g., nonnutritive sucking) showed the highest probability of being optimal.
This combination demonstrated a significant reduction in pain compared to TA alone (mean difference: -3.67).
Secondary outcomes, though sparsely reported, also supported sweet-tasting solutions with or without adjuncts as optimal.

Conclusions:

Multisensory interventions, particularly those involving sweet taste, are likely the most effective approach for minimizing pain during ROP eye examinations.
While interventions can reduce pain, none were found to be effective in completely eliminating it.
Further research may be needed to address limitations such as heterogeneity in pain assessment.

Read full analysis

Abstract

Context:

Retinopathy of prematurity eye examinations conducted in the neonatal intensive care.

Objective:

To combine randomized trials of pain-relieving interventions for retinopathy of prematurity examinations using network meta-analysis.

Data Sources:

Systematic review and network meta-analysis of Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and the World Health Organization International Clinical Trials Registry Platform. All databases were searched from inception to February 2017.

Study Selection:

Abstract and title screen and full-text screening were conducted independently by 2 reviewers.

Data Extraction:

Data were extracted by 2 reviewers and pooled with random effect models if the number of trials within a comparison was sufficient. The primary outcome was pain during the examination period; secondary outcomes were pain after the examination, physiologic response, and adverse events.

Results:

Twenty-nine studies (N = 1487) were included. Topical anesthetic (TA) combined with sweet taste and an adjunct intervention (eg, nonnutritive sucking) had the highest probability of being the optimal treatment (mean difference [95% credible interval] versus TA alone = -3.67 [-5.86 to -1.47]; surface under the cumulative ranking curve = 0.86). Secondary outcomes were sparsely reported (2-4 studies, N = 90-248) but supported sweet-tasting solutions with or without adjunct interventions as optimal.

Limitations:

Limitations included moderate heterogeneity in pain assessment reactivity phase and severe heterogeneity in the regulation phase.

Conclusions:

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.

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