title: The pain response to mydriatic eyedrops in preterm infants.
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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Divisions of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Cohen
authors.forename: N
authors.initials: N
authors.lastname: Cook
authors.forename: M C
authors.initials: MC
authors.lastname: Harris
authors.forename: G-S
authors.initials: GS
authors.lastname: Ying
authors.forename: G
authors.initials: G
authors.lastname: Binenbaum
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009184:Mydriatics / Q000009:adverse effects*; D009883:Ophthalmic Solutions; D010147:Pain Measurement / Q000379:methods*; D010656:Phenylephrine / Q000008:administration & dosage* / Q000009:adverse effects*; D015143:Philadelphia; D011446:Prospective Studies; D012178:Retinopathy of Prematurity / Q000175:diagnosis* / Q000503:physiopathology; D014331:Tropicamide / Q000009:adverse effects*
chemical_list: D009184:Mydriatics; D009883:Ophthalmic Solutions; D010656:Phenylephrine; D014331:Tropicamide