Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic review

Aim: To assess whether non-pharmacological and/or pharmacological measures lead to decreased pain during an eye examination in preterm infants. Methods: . Design: Systematic review. Subjects: Premature infants meeting the criteria for screening eye examination for retinopathy. Intervention: Databases were searched through the Ovid interface. Randomized and quasi-randomized controlled trials were included. Data were assessed independently by three reviewers. Main outcome measures: Pain assessed by Premature Infant Pain Profile (PIPP) or physiological changes. Results: Eight studies were included and grouped according to intervention: oral sucrose (group 1), anaesthetic eye drops (group 2) and non-pharmacological measures (group 3). For group 1, the mean PIPP score with sucrose was 1.38 (WMD) (95% CI: 0.41-2.35) lower than that of placebo (p = 0.005). For group 2, one study showed a reduction of two points on the PIPP score with topical proparacaine, whereas another showed no benefit. For group 3, developmental care improved developmental scores and salivary cortisol in one study. Conclusion: Sucrose reduced pain during the eye examination, whereas the efficacy of proparacaine was not consistent in the studies included. However, PIPP scores remained relatively high in all the studies; thus further research is required to delineate better pain reduction strategies.