Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Quality Improvement Article
  • Published:

Reducing discomfort of eye drops prior to retinal examination in the neonatal intensive care unit

Journal of Perinatology volume 40, pages 1857–1862 (2020)Cite this article

Subjects

Abstract

Objective

To evaluate the effectiveness in reducing pain by giving oral sucrose and non-pharmacological comfort measures prior to topical administration of mydriatic eye drops on premature infants undergoing retinopathy of prematurity (ROP) screening eye exams in a neonatal intensive care unit (NICU).

Study design

A prospective quality improvement study was conducted in the NICU where infants were given oral sucrose prior to administration of mydriatic eye drops while a second person performed facilitated tucking and containment. Premature Infant Pain Profile (PIPP) scores were recorded during eye drop administration and compared to a group that did not receive any comfort measures.

Result

Sixty-eight infants were enrolled. Mean PIPP scores increased an average of 1.5 (SD = 1.5) during administration of mydriatic drops without comfort measures compared to 0.6 (SD = 0.8) when comfort measures were used. This difference was statistically significant (p < 0.001).

Conclusions

Oral sucrose and simple comfort measures can be effective in reducing pain associated with mydriatic eye drops.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: “Comfort group” protocol for ROP screening examination.
Fig. 2: Timeline of administration of 24% oral sucrose.
Fig. 3: PIPP scores before, during and after administration of cyclomydril eye drops in the Baseline vs. Comfort Measures group.

Similar content being viewed by others

References

  1. Good WV, Hardy RJ, Dobson V, Palmer EA, Phelps DL, Quintos M, et al. The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics. 2005;116:15–23.

    PubMed  Google Scholar 

  2. Belda S, Pallás CR, de la Cruz J, Tejada P. Screening for retinopathy of prematurity: is it painful? Neonatology. 2004;86:195–200.

    Google Scholar 

  3. Kirchner L, Jeitler V, Pollak A, Mullner-Eidenbock A, Weinzettel R, Kraschl R, et al. Must screening examinations for retinopathy of prematurity necessarily be painful? Retina. 2009;29:586–91.

    PubMed  Google Scholar 

  4. Mitchell AJ, Green A, Jeffs DA, Roberson PK. Physiologic effects of retinopathy of prematurity screening examinations. Adv Neonatal Care. 2011;11:291–7.

    PubMed  PubMed Central  Google Scholar 

  5. Cohen AM, Cook N, Harris MC, Ying G-s, Binenbaum G. The pain response to mydriatic eye drops in preterm infants. J Perinatol. 2013;33:462–5.

    CAS  PubMed  Google Scholar 

  6. Hassler-Hurst J, Wadham C, Rayman G. A double-blind study comparing 0.5% and 1% tropicamide for annual retinal screening in diabetic adolescents. Diabet Med. 2004;21:434–9.

    CAS  PubMed  Google Scholar 

  7. Lim DL, Batilando M, Rajadurai VS. Transient paralytic ileus following the use of cyclopentolate-phenylephrine eye drops during screening for retinopathy of prematurity. J Paediatr Child Health. 2003;39:318–20.

    CAS  PubMed  Google Scholar 

  8. Mitchell A, Hall RW, Erickson SW, Yates C, Hendrickson H. Systemic absorption of cyclopentolate and adverse events after retinopathy of prematurity exams. Curr Eye Res. 2016;41:1601–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Lee JM, Kodsi SR, Gaffar MA, Rubin SE. Cardiopulmonary arrest following administration of Cyclomydril eyedrops for outpatient retinopathy of prematurity screening. J AAPOS. 2014;18:183–4.

    PubMed  Google Scholar 

  10. Lees BJ, Cabal LA. Increased blood pressure following pupillary dilation with 2.5% phenylephrine hydrochloride in preterm infants. Pediatrics. 1981;68:231–4.

    CAS  PubMed  Google Scholar 

  11. Stevens B, Johnston C, Franck L, Petryshen P, Jack A, Foster G. The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates. Nurs Res. 1999;48:35–43.

    CAS  PubMed  Google Scholar 

  12. Young TE. Pharmacology review. NeoReviews. 2003;4:e163.

    Google Scholar 

  13. Taddio A, Shah V, Shah P, Katz J. Beta-endorphin concentration after administration of sucrose in preterm infants. Arch Pediatr Adolesc Med. 2003;157:1071–4.

    PubMed  Google Scholar 

  14. Eriksson M, Finnstrom O. Can daily repeated doses of orally administered glucose induce tolerance when given for neonatal pain relief? Acta Paediatr. 2004;93:246–9.

    PubMed  Google Scholar 

  15. Fierson WM, American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018;142(6):e20183061. Pediatrics. 2019;143:e20183810.

    Google Scholar 

  16. Grabska J, Walden P, Lerer T, Kelly C, Hussain N, Donovan T, et al. Can oral sucrose reduce the pain and distress associated with screening for retinopathy of prematurity? J Perinatol. 2005;25:33–35.

    PubMed  Google Scholar 

  17. O’Sullivan A, O’Connor M, Brosnahan D, McCreery K, Dempsey EM. Sweeten, soother and swaddle for retinopathy of prematurity screening: a randomised placebo controlled trial. Arch Dis Child Fetal Neonatal Ed. 2010;95:F419–422.

    PubMed  Google Scholar 

  18. Kandasamy Y, Smith R, Wright IMR, Hartley L. Pain relief for premature infants during ophthalmology assessment. J Am Assoc Pediatr Ophthalmol Strabismus. 2011;15:276–80.

    Google Scholar 

  19. Sun X, Lemyre B, Barrowman N, O’Connor M. Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic review. Acta Paediatr. 2010;99:329–34.

    CAS  PubMed  Google Scholar 

  20. Rush R, Rush S, Ighani F, Anderson B, Irwin M, Naqvi M. The effects of comfort care on the pain response in preterm infants undergoing screening for retinopathy of prematurity. Retina. 2005;25:59–62.

    PubMed  Google Scholar 

  21. Stevens B, Johnston C, Petryshen P, Taddio A. Premature infant pain profile: development and initial validation. Clin J Pain. 1996;12:13–22.

    CAS  PubMed  Google Scholar 

  22. Ballantyne M, Stevens B, McAllister M, Dionne K, Jack A. Validation of the premature infant pain profile in the clinical setting. Clin J Pain. 1999;15:297–303.

    CAS  PubMed  Google Scholar 

  23. Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2016;7:Cd001069.

    PubMed  Google Scholar 

  24. Blass EM, Shah A. Pain-reducing properties of sucrose in human newborns. Chem Senses. 1995;20:29–35.

    CAS  PubMed  Google Scholar 

  25. Johnston CC, Stremler R, Horton L, Friedman A. Effect of repeated doses of sucrose during heel stick procedure in preterm neonates. Biol Neonate. 1999;75:160–6.

    CAS  PubMed  Google Scholar 

  26. Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013;4:e0025.

    PubMed  PubMed Central  Google Scholar 

  27. Schwaller F, Fitzgerald M. The consequences of pain in early life: injury-induced plasticity in developing pain pathways. Eur J Neurosci. 2014;39:344–52.

    PubMed  PubMed Central  Google Scholar 

  28. Valeri BO, Holsti L, Linhares MB. Neonatal pain and developmental outcomes in children born preterm: a systematic review. Clin J Pain. 2015;31:355–62.

    PubMed  Google Scholar 

  29. Farkouh A, Frigo P, Czejka M. Systemic side effects of eye drops: a pharmacokinetic perspective. Clin Ophthalmol. 2016;10:2433–41.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank the nurses and staff at the Alberta Children’s Hospital (Calgary, AB).

Author information

Authors and Affiliations

  1. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Dan Ni Wang

  2. Section of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB, Canada

    Kyla Lavery, Vivian E. Hill & Stephanie A. Dotchin

  3. Department of Pediatrics, University of Calgary, Calgary, AB, Canada

    Stacey Dalgleish & Alexandra Howlett

Authors
  1. Dan Ni Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyla Lavery
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stacey Dalgleish
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexandra Howlett
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vivian E. Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephanie A. Dotchin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DNW designed the study, collected data, analyzed the data, and wrote the manuscript. KL designed the study, collected data, analyzed the data, created figures, and helped to write the manuscript. SD, AH, VH, and SAD designed the study, collected data, and helped write the manuscript.

Corresponding author

Correspondence to Dan Ni Wang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, D.N., Lavery, K., Dalgleish, S. et al. Reducing discomfort of eye drops prior to retinal examination in the neonatal intensive care unit. J Perinatol 40, 1857–1862 (2020). https://doi.org/10.1038/s41372-020-00852-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-00852-3

Search

Advanced search

Quick links