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Analgesia for retinopathy of prematurity screening: A systematic review
Arun J Thirunavukarasu1,2, Refaat Hassan1,3, Shalom V Savant1,4
1School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Insights
Oral paracetamol effectively reduces pain during retinopathy of prematurity (ROP) screening in premature infants. While intranasal fentanyl also helps, its routine use is not advised due to side effects. Further research is needed for optimal pain management.
Area of Science:
- Neonatal ophthalmology
- Pain management in neonates
- Pharmacology
Background:
- Premature neonates require regular eye exams for retinopathy of prematurity (ROP).
- Current pain management (topical anesthetics, sugar solution) is insufficient.
- This review evaluates alternative pharmacological analgesics for ROP screening pain.
Purpose of the Study:
- To systematically review pharmacological interventions for pain during ROP screening in neonates.
- To assess the efficacy of various analgesics in reducing pain scores.
Main Methods:
- Systematic review following PRISMA guidelines (PROSPERO CRD42022302459).
- Searched electronic databases for studies on pharmacological pain interventions for ROP screening.
- Analyzed pain scores using validated tools, categorizing interventions into topical anesthesia and alternative treatments.
Main Results:
- Eleven studies met inclusion criteria.
- Topical analgesia, oral paracetamol, and intranasal fentanyl effectively reduced pain during eye exams.
- Oral morphine and inhaled nitrous oxide showed no significant effect on pain scores.
Conclusions:
- Oral paracetamol is recommended as a premedication for ROP screening.
- Routine fentanyl use is discouraged due to potential side effects.
- Non-pharmacological methods should be used; further research is needed for optimal analgesic strategies.
Background And Aims:
Premature neonates require regular ophthalmological examination, generally indirect ophthalmoscopy, to screen for retinopathy of prematurity (ROP). Conventional analgesia is provided with topical anesthetic eyedrops and oral sugar solution, but neonates still experience significant pain. Here, the literature base was examined to evaluate the usefulness of other pharmacological analgesics.
Materials And Methods:
A systematic review was undertaken, adhering to a PROSPERO preregistered protocol in accordance with PRISMA guidelines (identifier CRD42022302459). Electronic databases were searched for primary research articles on pharmacological pain interventions used for ROP screening in neonates. The primary outcome measure was pain scores recorded using validated pain scoring tools, with and without pharmacological interventions in neonates during eye examination. For analysis, studies were separated into two categories: topical anesthesia and alternative pharmacological treatments.
Results:
Eleven studies met the inclusion criteria. Topical analgesia, oral paracetamol, and intranasal fentanyl were found to be effective in reducing the pain of eye examination. Oral morphine and inhaled nitrous oxide had no significant effect on premature infant pain profile (PIPP) scores during indirect ophthalmoscopy.
Discussion:
In addition to topical anesthesia, premedication with oral paracetamol is recommended during screening examination for ROP. The routine use of fentanyl is not recommended due to the risk of potential side effects. Non-pharmacological measures, such as sweet oral solutions and comfort techniques should also be employed. Further research is required to determine whether the use of nitrous oxide has a role, and to develop a safe and effective analgesic strategy to fully ameliorate the pain of ROP screening.
