Department of Neonatology (IMAS12-SAMID), 12 de Octubre, University Hospital (SERMAS), Madrid, Spain.
BMC Pediatr. 2012 Aug 28;12:132. doi: 10.1186/1471-2431-12-132.
Increasingly, neonatal clinics seek to minimize painful experiences and stress for premature infants. Fundoscopy performed with a binocular indirect ophthalmoscope is the reference examination technique for screening of retinopathy of prematurity (ROP), and it is associated with pain and stress. Wide-field digital retinal imaging is a recent technique that should be evaluated for minimizing infant pain and stress.
The purpose of the study was to assess and compare the impact of using a binocular indirect ophthalmoscope (BIO), or wide-field digital retinal imaging (WFDRI) on pain and stress in infants undergoing ROP screening examination. This was a comparative evaluation study of two screening procedures. Ophthalmologic examinations (N = 70) were performed on 24 infants with both BIO and WFDRI. Pain assessments were performed with two specific neonatal scales (Crying, requires oxygen, increased vital signs, expression and sleeplessness, CRIES and, Premature infant pain profile, PIPP) just prior to the examination, and 30 seconds, 1 hour, and 24 hours later after ending the examination.
Changes over time were significantly different between BIO and WFDRI with both scales (PIPP score, p = .007, and CRIES score, p = .001). Median PIPP score (interquartile interval) at baseline was 4 (3-5). At 30 seconds the score was 8 (6-9) for BIO and 6 (5-7) for WFDRI, respectively. The increase in PIPP score between baseline and 30 seconds was significantly lower with WFDRI (p = .006). The median increase in CRIES score from baseline to 30 seconds was 1 point lower for WFDRI than for BIO (p < .001). No significant difference in response remained at 1 hour or 24 hour assessments.
A transient short-term pain and stress response occurs with both BIO and WFDRI. Infants examined for screening of ROP with digital retinal imaging present less pain and stress at 30 seconds following completion of the exam when compared with binocular indirect ophthalmoscopy.
越来越多的新生儿诊所试图将早产儿的痛苦体验和压力降到最低。双目间接检眼镜下的眼底镜检查是早产儿视网膜病变（ROP）筛查的参考检查技术，它与疼痛和压力有关。广角数字视网膜成像技术是一种新技术，应评估其在减轻婴儿疼痛和压力方面的效果。
本研究旨在评估和比较使用双目间接检眼镜（BIO）或广角数字视网膜成像（WFDRI）对接受 ROP 筛查检查的婴儿疼痛和压力的影响。这是一项对两种筛查程序的比较评估研究。对 24 名婴儿同时进行 BIO 和 WFDRI 眼科检查（N=70）。在检查前、检查结束后 30 秒、1 小时和 24 小时，使用两种特定的新生儿评分（哭闹、需吸氧、生命体征增加、表情和失眠、CRIES 和早产儿疼痛量表、PIPP）进行疼痛评估。
两种评分（PIPP 评分，p=0.007，和 CRIES 评分，p=0.001）的时间变化在 BIO 和 WFDRI 之间有显著差异。基线时 PIPP 评分（四分位间距）中位数为 4（3-5）。BIO 为 8（6-9），WFDRI 为 6（5-7）。WFDRI 的 PIPP 评分在基线至 30 秒之间的增加明显较低（p=0.006）。与 BIO 相比，WFDRI 从基线到 30 秒时 CRIES 评分的中位数增加低 1 分（p<0.001）。在 1 小时或 24 小时评估时，无显著差异。
使用 BIO 和 WFDRI 均会引起短暂的短期疼痛和应激反应。与双目间接检眼镜相比，接受数字视网膜成像筛查的 ROP 婴儿在检查结束后 30 秒时疼痛和压力较小。
