Efficacy of sucrose to reduce pain in premature infants during eye examinations for retinopathy of prematurity.
BACKGROUND
Eye examinations for retinopathy of prematurity (ROP) are painful to the neonate. The use of topical anesthetic for eye examinations to evaluate ROP is routine in our neonatal intensive care unit (NICU), but does not completely suppress painful responses. Sweet solutions have been shown to reduce procedural pain in newborns.


OBJECTIVE
To examine whether the addition of sucrose 24% to topical anesthetic improves procedural pain control during the ROP eye examination.


METHODS
Neonates born at < or = 30 weeks' gestation were included in this placebo-controlled, double-blind, crossover study. Patients were randomly assigned to receive treatment with either proparacaine HCl ophthalmic solution 0.5% plus 2 mL of sucrose 24% or proparacaine HCl ophthalmic solution 0.5% plus 2 mL of sterile water (placebo) prior to an eye examination. In a subsequent eye examination, each patient received the alternate treatment. Oral sucrose and sterile water were prepared in the pharmacy in identical syringes, and physicians, nurses, and pharmacists in the NICU were blinded to the treatment given. Pain was measured using the Premature Infant Pain Profile (PIPP) scoring system, which measures both physical and physiologic measures of pain, and the scores were simultaneously assessed by 2 study nurses. PIPP scores were recorded 1 and 5 minutes before and after the eye examination and during initial placement of the eye speculum. The same ophthalmologist performed all eye examinations. Several different definitions of a pain response were investigated.


RESULTS
Twenty-three infants were studied, with 12 receiving sucrose and 11 receiving placebo as the first treatment. For 3 of the 5 definitions of pain response, patients experienced significantly less pain at speculum insertion with sucrose than with placebo. After the ROP examination, pain responses were similar with either sucrose or placebo.


CONCLUSIONS
Oral sucrose may reduce the immediate pain response in premature infants undergoing eye examination for ROP.
Gal
Peter
P
Pharmacy Division, Greensboro Area Health Education Center, Greensboro, NC 27401-1020, USA. peter.gal@mosescone.com
Kissling
Grace E
GE
Young
William O
WO
Dunaway
Kimberly K
KK
Marsh
Virginia A
VA
Jones
Susan M
SM
Shockley
Dawn H
DH
Weaver
Nicole L
NL
Carlos
Rita Q
RQ
Ransom
J Laurence
JL
D000284:Administration, Oral; D000779:Anesthetics, Local / Q000627:therapeutic use; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D011430:Propoxycaine / Q000008:administration & dosage / Q000627:therapeutic use; D012178:Retinopathy of Prematurity / Q000150:complications / Q000175:diagnosis*; D013395:Sucrose / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D015351:Vision Screening / Q000379:methods*
D000779:Anesthetics, Local; D009883:Ophthalmic Solutions; D013395:Sucrose; C005717:proxymetacaine; D011430:Propoxycaine