Sweeten, soother and swaddle for retinopathy of prematurity screening: a randomised placebo controlled trial

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 95; no. 6; pp. F419 - F422
• Main Authors: O'Sullivan, A, O'Connor, M, Brosnahan, D, McCreery, K, Dempsey, E M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.11.2010; BMJ Publishing Group LTD
• Subjects: Administration, Oral; Analgesia - methods; Analgesics - administration & dosage; Female; Humans; Infant Care - methods; Infant, Newborn; Infant, Premature; Infants; Intensive Care, Neonatal - methods; Male; Neonatal Screening - adverse effects; Neonatal Screening - methods; Pacifiers; Pain; Pain - etiology; Pain - prevention & control; Pain Measurement - methods; Physical Examination - adverse effects; Physical Examination - methods; Prospective Studies; Retinopathy of Prematurity - diagnosis; Sucrose - administration & dosage
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/adc.2009.180943

Objective To assess the efficacy of oral sucrose combined with swaddling and non-nutritive suck (NNS) as a method for reducing pain associated with retinopathy of prematurity (ROP) screening. Design Randomised placebo controlled study. Setting Tertiary level neonatal intensive care unit. Sample 40 infants undergoing primary eye examination for ROP screening. Intervention The control group were swaddled, and received 0.2 ml of sterile water given by mouth using a syringe and a soother. The intervention group were swaddled, and received 0.2 ml of sucrose 24% given by mouth using a syringe and a soother. Results 40 infants were included in the study. There was no difference in mean gestational age at birth, mean birth weight or corrected gestational age at first examination between both groups. The sucrose group had a significantly lower median Neonatal Pain, Agitation and Sedation Scale (N-PASS) score during ROP screening, initially following insertion of the speculum (6.5 vs 5, p=0.02) and subsequently during scleral indentation (9.5 vs 7.5, p=0.03). Fewer infants experienced episodes of desaturations or bradycardia in the intervention group (1 vs 4, p=0.18). Conclusion ROP screening is a necessary but recognised painful procedure. Sucrose combined with NNS and swaddling reduced the behavioural and physiological pain responses. However, pain scores remained consistently high and appropriate pain relief for ROP screening remains a challenge.