The pain response to mydriatic eyedrops in preterm infants

• Published in: Journal of perinatology Vol. 33; no. 6; pp. 462 - 465
• Main Authors: Cohen, A M, Cook, N, Harris, M C, Ying, G-S, Binenbaum, G
• Format: Journal Article
• Language: English
• Published: United States Nature Publishing Group 01.06.2013
• Subjects: Burning; Drug therapy; Eye diseases; Eye examinations; Female; Health aspects; Humans; Infant, Newborn; Infants; Infants (Premature); Intensive care; Intensive Care Units, Neonatal; Male; Medical examination; Mydriatics - adverse effects; Neonates; Newborn babies; Ophthalmic drugs; Ophthalmic Solutions; Ophthalmology; Pain; Pain Measurement - methods; Pediatrics; Phenylephrine; Phenylephrine - administration & dosage; Phenylephrine - adverse effects; Philadelphia; Physiological aspects; Physiology; Premature babies; Premature birth; Prospective Studies; Retinopathy; Retinopathy of Prematurity - diagnosis; Retinopathy of Prematurity - physiopathology; Risk factors; Tropicamide - adverse effects; Philadelphia; United States; United States > US; Pennsylvania
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2012.149

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. 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. 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. 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.