Pain and stress assessment after retinopathy of prematurity screening examination: Indirect ophthalmoscopy versus digital retinal imaging

BMC Pediatrics

Carmen R Pallás-Alonso²  David Lora-Pablos¹  Pilar Tejada-Palacios²  Javier De-La-Cruz-Bértolo¹  Sonia Caserío-Carbonero²  M Teresa Moral-Pumarega² 

[1]IMAS12, “12 de Octubre, University Hospital Avenida de Córdoba s/n, 28041, Madrid, Spain

[2]Department of Neonatology (IMAS12-SAMID), “12 de Octubre”, University Hospital (SERMAS), Madrid, Spain

关键词: Telemedicine;    Retinopathy of prematurity;    Pain measurement;    Diagnostic techniques;   

Others  :  1170682
DOI  :  10.1186/1471-2431-12-132

 received in 2012-03-02, accepted in 2012-08-21,  发布年份 2012

【 摘 要 】

Background

Increasingly, neonatal clinics seek to minimize painful experiences and stress for premature infants. Fundoscopy performed with a binocular indirect ophthalmoscope is the reference examination technique for screening of retinopathy of prematurity (ROP), and it is associated with pain and stress. Wide-field digital retinal imaging is a recent technique that should be evaluated for minimizing infant pain and stress.

Methods

The purpose of the study was to assess and compare the impact of using a binocular indirect ophthalmoscope (BIO), or wide-field digital retinal imaging (WFDRI) on pain and stress in infants undergoing ROP screening examination. This was a comparative evaluation study of two screening procedures. Ophthalmologic examinations (N = 70) were performed on 24 infants with both BIO and WFDRI. Pain assessments were performed with two specific neonatal scales (Crying, requires oxygen, increased vital signs, expression and sleeplessness, CRIES and, Premature infant pain profile, PIPP) just prior to the examination, and 30 seconds, 1 hour, and 24 hours later after ending the examination.

Results

Changes over time were significantly different between BIO and WFDRI with both scales (PIPP score, p = .007, and CRIES score, p = .001). Median PIPP score (interquartile interval) at baseline was 4 (3–5). At 30 seconds the score was 8 (6–9) for BIO and 6 (5–7) for WFDRI, respectively. The increase in PIPP score between baseline and 30 seconds was significantly lower with WFDRI (p = .006). The median increase in CRIES score from baseline to 30 seconds was 1 point lower for WFDRI than for BIO (p < .001). No significant difference in response remained at 1 hour or 24 hour assessments.

Conclusions

A transient short-term pain and stress response occurs with both BIO and WFDRI. Infants examined for screening of ROP with digital retinal imaging present less pain and stress at 30 seconds following completion of the exam when compared with binocular indirect ophthalmoscopy.

【 授权许可】

   
2012 Moral-Pumarega et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Gilbert CE, Foster A: Childhood blindness in the context of VISION 2020-the Right to Sight. Bull World Health Organ 2001, 79:227-232.
• [2]American Academy of Pediatrics American Academy of Ophthalmology American Association for Pediatric Ophthalmology and Strabismus: Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2006, 117:572-576.
• [3]Joint Working Party of The Royal College of Ophthalmologists The British Association of Perinatal Medicine: Retinopathy of prematurity: guidelines for screening and treatment: the report. Early Hum Dev 1996, 46:239-258.
• [4]Cryotherapy for Retinopathy of Prematurity Cooperative Group: Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results. Arch Ophthalmol 1988, 106:471-479.
• [5]Photographic Screening for Retinopathy of Prematurity Cooperative Group: The Photographic Screening for Retinopathy of Prematurity study (PHOTO-ROP): Primary Outcomes. Retina 2008, 28(suppl):47-54.
• [6]Sun X, Lemyre B, Barrowman N, et al.: Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic review. Acta Paediatr 2010, 99:329-334.
• [7]Rush R, Rush S, Nicolau J, et al.: Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity. Retina 2004, 24:242-245.
• [8]Anand KJ, Sippell WG, Aynsley-Green A: Randomized trial of fentanyl anaesthesia in preterm neonates undergoing surgery: Effects on the stress response. Lancet 1987, 1:62-66.
• [9]Bouwmeester NJ, Anand KJ, van Dijk M, et al.: Hormonal and metabolic stress responses after major surgery in children aged 0–3 years: a double blind, randomized trial comparing the effects of continuous versus intermittent morphine. Br J Anaesth 2001, 87:390-399.
• [10]Taddio A, Shah V, Gilbert-MacLeod C, et al.: Conditioning and Hyperalgesia in Newborns Exposed to Repeated Heel Lance. JAMA 2002, 288:857-861.
• [11]Bhutta AT, Anand KJ: Vulnerability of the developing brain. Neuronal mechanisms. Clin Perinatol 2002, 29:357-372.
• [12]Grunau R: Early pain in preterm infants. A model of long-term effects. Clin Perinatol 2002, 29:373-394.
• [13]Als H, Duffy F, McAnulty G, et al.: Early experience alters brain function and structure. Pediatrics 2004, 113:846-857.
• [14]Peters KL, Rosychuk RJ, Hendson L, et al.: Improvement of short- and long-term outcomes for very low birth weight infants: Edmonton NIDCAP trial. Pediatrics 2009, 124:1009-1020.
• [15]Kleberg A, Warren I, Norman E, et al.: Lower stress responses after newborn individualized developmental care and assessment program care during eye screening examinations for retinopathy of prematurity: A randomized study. Pediatrics 2008, 121:267-278.
• [16]Schwartz SD, Harrison SA, Ferrone PJ, et al.: Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera. Ophthalmology 2000, 107:25-28.
• [17]Al E, Holmes JM, Astle WF, et al.: Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study. Ophthalmology 2003, 110:2113-2117.
• [18]Mukherjee AN, Watts P, Al-Madfai H, et al.: Impact of retinopathy of prematurity screening examination on cardiorespiratory indices. A comparison of Indirect Ophthalmoscopy and Retcam imaging. Ophthalmology 2006, 113:1547-1552.
• [19]Dhaliwal CA, Wright E, McIntosh N, et al.: Pain in neonates during screening for retinopathy of prematurity using binocular indirect ophthalmoscopy and wide-field digital retinal imaging: a randomised comparison. Arch Dis Child Fetal Neonatal Ed 2010, 95:F146-F148.
• [20]Mehta M, Adams G, Bunce C, et al.: Pilot study of systemic effects of three different screening methods used for retinopathy of prematurity. Early Hum Dev 2005, 81:355-360.
• [21]Pallás Alonso CR, De la Cruz Bértolo J, Tejada Palacios P: Impacto de los nuevos criterios de cribado para la retinopatía de la prematuridad. Un año de experiencia. An Esp Pediatr 2001, 55:53-57.
• [22]Krechel SW, Bildner J: CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth 1995, 5:53-61.
• [23]Ballantyne M, Stevens B, McAllister M, et al.: Validation of the premature infant pain profile in the clinical setting. Clin J Pain 1999, 15:297-303.
• [24]Laws DE, Morton C, Weindling M, Clark D: Systemic effects of screening for retinopathy of prematurity. Br J Ophthalmol 1996, 80:425-428.
• [25]Belda S, Pallás CR, de la Cruz J, Tejada P: Screening for retinopathy of prematurity: is it painful? Biol Neonate 2004, 86:195-200.