Dempsey Eugene, McCreery Kathryn
Neonatology, Cork University Maternity Hospital, Cork, Ireland.
Cochrane Database Syst Rev. 2011 Sep 7;2011(9):CD007645. doi: 10.1002/14651858.CD007645.pub2.
Screening examinations for retinopathy of prematurity (ROP) are performed routinely in the neonatal intensive care unit and are a recognised cause of pain in the newborn.
To determine the effect of instillation of topical anaesthetic eye drops compared with placebo or no treatment on pain in infants undergoing ROP screening.
We used the standard search strategy of the Cochrane Neonatal Review Group. This included a search of the Cochrane Neonatal Group register and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 10, 2010). We identified relevant studies by searching the following: (1) computerised bibliographic databases: MEDLINE (1966 to October 2010), EMBASE (1988 to October 2010) and Web of Science (1975 to March 2010; (2) the Oxford Database of Perinatal Trials. We searched electronically abstracts from PAS from 2000 to 2010 and handsearched abstracts from ESPR from 2000 to 2009.
All randomised, or quasi-randomised controlled trials, or randomised cross-over trials.
We used the standard methods of the Cochrane Neonatal Review Group.
We identified two studies for inclusion. Both studies were randomised cross-over trials performed in single centres. Both studies used the Premature Infant Pain Profile (PIPP) score as a measure of pain response. Different methods of evaluating PIPP scores are presented including the absolute PIPP score, a PIPP score > 10 or > 12 and an increase in PIPP ≥ 4 from the baseline value. There is a nonsignificant reduction in pain scores at one minute and a nonsignificant increase at five minutes post insertion of the speculum. PIPP score > 12 at one minute resulted in a statistically significant reduction in the number of patients who experienced pain (typical risk ratio (RR) 0.56, 95% CI 0.36 to 0.89; typical risk difference (RD) -0.23, 95% CI -0.39 to -0.86; number needed to treat to benefit (NNTB) 4). When pain was defined as an increase in PIPP > 4 there was a statistically significant reduction in the absolute number of patients who experienced pain at one minute (typical RR 0.70, 95% CI 0.52 to 0.94; typical RD -0.19, 95% CI -0.34 to -0.04; NNTB 5.3).
AUTHORS' CONCLUSIONS: The administration of topical proparacaine 30 seconds prior to the ophthalmological evaluation was associated with a reduction in pain scores especially at the time of speculum insertion. However, despite treatment, screening remains a painful procedure and the role of nonpharmacological and pharmacological intervention including different local anaesthetic agents should be ascertained in future randomised trials.
早产儿视网膜病变（ROP）筛查在新生儿重症监护病房中常规进行，是新生儿疼痛的一个公认原因。
确定与安慰剂或不治疗相比，局部麻醉眼药水滴眼对接受ROP筛查的婴儿疼痛的影响。
我们采用了Cochrane新生儿综述小组的标准检索策略。这包括检索Cochrane新生儿小组登记册和Cochrane对照试验中央登记册（CENTRAL，Cochrane图书馆，2010年第10期）。我们通过检索以下内容来识别相关研究：（1）计算机化书目数据库：MEDLINE（1966年至2010年10月）、EMBASE（1988年至2010年10月）和科学引文索引（1975年至2010年3月）；（2）牛津围产期试验数据库。我们检索了2000年至2010年PAS的电子摘要，并手工检索了2000年至2009年ESPR的摘要。
所有随机、半随机对照试验或随机交叉试验。
我们采用了Cochrane新生儿综述小组的标准方法。
我们确定了两项纳入研究。两项研究均为在单一中心进行的随机交叉试验。两项研究均使用早产儿疼痛量表（PIPP）评分作为疼痛反应的衡量指标。介绍了评估PIPP评分的不同方法，包括绝对PIPP评分、PIPP评分>10或>12以及PIPP较基线值增加≥4。在插入窥镜后1分钟时疼痛评分有非显著降低，5分钟时有非显著增加。1分钟时PIPP评分>12导致经历疼痛的患者数量有统计学显著减少（典型风险比（RR）0.56，95%置信区间0.36至0.89；典型风险差（RD）-0.23，95%置信区间-0.39至-0.86；受益所需治疗人数（NNTB）4）。当将疼痛定义为PIPP增加>4时，1分钟时经历疼痛的患者绝对数量有统计学显著减少（典型RR 0.70，95%置信区间0.52至0.94；典型RD -0.19，95%置信区间-0.34至-0.04；NNTB 5.3）。
在眼科评估前30秒给予丙美卡因局部麻醉与疼痛评分降低有关，尤其是在插入窥镜时。然而，尽管进行了治疗，筛查仍然是一个痛苦的过程，未来的随机试验应确定非药物和药物干预（包括不同的局部麻醉剂）的作用。
