McCarty Dana B, Clary-Williams Erika, LeBLond Kristen D, Liu Tianyi, Zbornik-Thompson Tika, Ulrich J Niklas, Go Michelle S
Division of Physical Therapy, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Pediatric Rehabilitation Services, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States.
Front Psychol. 2024 May 6;15:1354033. doi: 10.3389/fpsyg.2024.1354033. eCollection 2024.
Infants born <31 weeks gestational age with birth weight ≤ 1,500 grams receive routine eye examinations to screen for Retinopathy of Prematurity (ROP) while in the Neonatal Intensive Care Unit (NICU) to help prevent vision threatening complications; however, preterm infants' sensory systems are underdeveloped, and repeated exposure to painful stimuli is associated with worse developmental outcomes.
An interdisciplinary NICU team designed a collaborative eye exam model (CEEM) incorporating best practice recommendations for infant pain control during exams. Pain scores and vital signs were recorded before, during, and after exams. Two sets of mixed-effects regression models with a random intercept on infants were established to investigate relationships between the intervention, birth gestational age (BGA), postmenstrual age (PMA), and outcomes associated with painful stimuli. Survey feedback was elicited from NICU stakeholders about the CEEM.
Thirty standard of care (SC) and 35 CEEM exams of 37 infants were included in final analysis. In infants of the same BGA, the number of desaturation events was significantly reduced in the CEEM group ( = 0.003) and became 1.53 times smaller with each additional week of BGA ( = 0.009). Probability of heart rate recovery within 15 min lowered significantly in the CEEM group ( = 0.04). In SC or CEEM or between infants of the same PMA, no differences were observed for bradycardia, heart rate range, chance of heart rate recovery, or pain scores. Increases in tachycardia ( < 0.001) events and desaturations = 0.006 were discovered in the CEEM group. When considering interaction effects, the CEEM appeared to reduce the number of desaturations to a greater degree for infants at earliest BGAs with attenuation of this effect with greater BGA. Regarding PMA, bradycardia and tachycardia events were reduced for infants across PMAs in the CEEM, but the effect for tachycardia improves with age, while the effect for bradycardia diminishes with age. Stakeholders agreed that the infant's eye exam experience and the staff experience was "very much" improved by the CEEM.
Despite variable findings in selected outcome measures, the CEEM was positively viewed by staff. Infants may benefit from the CEEM differently based on BGA and PMA.
孕周小于31周且出生体重≤1500克的婴儿在新生儿重症监护病房（NICU）期间需接受常规眼部检查，以筛查早产儿视网膜病变（ROP），帮助预防威胁视力的并发症；然而，早产儿的感觉系统发育不完善，反复暴露于疼痛刺激与更差的发育结局相关。
一个跨学科的NICU团队设计了一种协作眼部检查模型（CEEM），纳入了检查期间婴儿疼痛控制的最佳实践建议。在检查前、检查期间和检查后记录疼痛评分和生命体征。建立了两组对婴儿具有随机截距的混合效应回归模型，以研究干预措施、出生孕周（BGA）、月经后年龄（PMA）以及与疼痛刺激相关的结局之间的关系。征求了NICU利益相关者对CEEM的调查反馈。
最终分析纳入了37名婴儿的30次标准护理（SC）检查和35次CEEM检查。在相同BGA的婴儿中，CEEM组的血氧饱和度下降事件数量显著减少（ = 0.003），并且随着BGA每增加一周，该数量减少至原来的1.53倍（ = 0.009）。CEEM组15分钟内心率恢复的概率显著降低（ = 0.04）。在SC组或CEEM组中，或在相同PMA的婴儿之间，心动过缓、心率范围、心率恢复的几率或疼痛评分均未观察到差异。在CEEM组中发现心动过速（ < 0.001）事件和血氧饱和度下降（ = 0.006）有所增加。在考虑交互作用时，对于最早BGA的婴儿，CEEM似乎在更大程度上减少了血氧饱和度下降的数量，且随着BGA增加这种效果减弱。关于PMA，CEEM中各PMA的婴儿心动过缓和心动过速事件均减少，但心动过速的效果随年龄改善，而心动过缓的效果随年龄减弱。利益相关者一致认为，CEEM“极大地”改善了婴儿的眼部检查体验和工作人员的体验。
尽管在选定的结局指标上有不同的发现，但工作人员对CEEM的评价是积极的。根据BGA和PMA的不同，婴儿可能从CEEM中获得不同的益处。
