The pain response to mydriatic eyedrops in preterm infants
A M Cohen, N Cook, M C Harris, G-S Ying, G Binenbaum, A M Cohen, N Cook, M C Harris, G-S Ying, G Binenbaum
Abstract
Objective: Evaluate physiological and behavioral pain responses of premature infants following instillation of mydriatic eyedrops for retinopathy of prematurity (ROP) examinations. While burning and stinging occurs in older patients, the infant pain response is not well characterized.
Study design: Vital sign and video monitor recorded infant responses before, during and after mydriatic (tropicamide 1%, phenylephrine 2.5%) administration upon first ROP exam. Two masked observers graded Premature Infant Pain Profile (PIPP) scores immediately before and following eyedrop administration. Scores <7 indicate no/minimal pain, 7 to 12 slight/moderate, >12 severe.
Result: Twenty infants had mean premydriatic PIPP score 3.6 (s.d. 1.6), mean postmydriatic score 5.7 (s.d. 3.4), mean change 2.1 (s.d. 3.4) (P=0.01). One (5%) had premydriatic PIPP score ≥7, seven (35%) post scores ≥7 (P=0.07) with one >12.
Conclusion: Mydriatic drops cause a clinically significant pain response in one-third of infants. Non-pharmacological supportive measures are recommended for all infants until predictive factors are defined.
Conflict of interest statement
CONFLICTS OF INTEREST
The authors declare no conflict of interest.
Figures
References
- Laws DE, Morton C, Weindling M, Clark D. Systemic effects of screening for retinopathy of prematurity. Br J Ophthalmol. 1996 May;80(5):425–428.
- Belda S, Pallas CR, De la Cruz J, Tejada P. Screening for retinopathy of prematurity: is it painful? Biol Neonate. 2004;86(3):195–200.
- Kirchner L, Jeitler V, Pollak A, et al. Must screening examinations for retinopathy of prematurity necessarily be painful? Retina. 2009 May;29(5):586–591.
- American Academy of Pediatrics Committee on Fetus and Newborn, American Academy of Pediatrics Section on Surgery, Canadian Paediatric Society Fetus and Newborn Committee. Batton DG, Barrington KJ, Wallman C. Prevention and management of pain in the neonate: an update. Pediatrics. 2006 Nov;118(5):2231–2241.
- Gal P, Kissling GE, Young WO, et al. Efficacy of sucrose to reduce pain in premature infants during eye examinations for retinopathy of prematurity. Ann Pharmacother. 2005 Jun;39(6):1029–1033.
- Marsh VA, Young WO, Dunaway KK, et al. Efficacy of topical anesthetics to reduce pain in premature infants during eye examinations for retinopathy of prematurity. Ann Pharmacother. 2005 May;39(5):829–833.
- Mitchell A, Stevens B, Mungan N, Johnson W, Lobert S, Boss B. Analgesic effects of oral sucrose and pacifier during eye examinations for retinopathy of prematurity. Pain Manag Nurs. 2004 Dec;5(4):160–168.
- Samra HA, McGrath JM. Pain management during retinopathy of prematurity eye examinations: a systematic review. Adv Neonatal Care. 2009 Jun;9(3):99–110.
- Sun X, Lemyre B, Barrowman N, O’Connor M. Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic review. Acta Paediatr. 2010 Mar;99(3):329–334.
- Hassler-Hurst J, Wadham C, Rayman G. A double-blind study comparing 0.5% and 1% tropicamide for annual retinal screening in diabetic adolescents. Diabet Med. 2004 May;21(5):434–439.
- Rush R, Rush S, Nicolau J, Chapman K, Naqvi M. Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity. Retina. 2004 Apr;24(2):242–245.
- Ballantyne M, Stevens B, McAllister M, Dionne K, Jack A. Validation of the premature infant pain profile in the clinical setting. Clin J Pain. 1999 Dec;15(4):297–303.
- Pasero C. Pain assessment in infants and young children: Premature Infant Pain Profile. Am J Nurs. 2002 Sep;102(9):105–106.
- Stevens B, Johnston C, Petryshen P, Taddio A. Premature Infant Pain Profile: development and initial validation. Clin J Pain. 1996 Mar;12(1):13–22.
Source: PubMed