Ozkan Zarif Nurten, Arayici Sema, Celik Kiymet, Kihtir Zeynep, Ongun Hakan
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Türkiye.
Front Pediatr. 2024 Aug 2;12:1441324. doi: 10.3389/fped.2024.1441324. eCollection 2024.
This study aimed to investigate the effectiveness of intranasal dexmedetomidine in reducing pain scores during retinopathy of prematurity (ROP) screening examinations in preterm infants.
Infants born at ≤32 weeks of gestational age, undergoing routine ROP examinations in the neonatal intensive care unit, were included in the study and divided into two groups: the standard protocol group ( = 43) and the dexmedetomidine group ( = 56), over a 1-year period. Both groups received standard procedural preparation including swaddling, oral dextrose, and topical anesthesia with proparacaine. The dexmedetomidine group additionally received intranasal dexmedetomidine at a dose of 1 mcg/kg before the procedure. Pain scores (PIPP score), heart rate, respiratory rate, blood pressure, and oxygen saturation were compared at baseline, 1-min, and 5-min during the procedure.
There were no significant differences between the groups regarding descriptive and pre-procedure characteristics. In the dexmedetomidine group, the median (25-75p) PIPP score, heart rate, systolic blood pressure and mean (±SD) respiratory rate measured at the 1st minute of the procedure were significantly lower than those in the standard group [PIPP score 10 (8-13) vs. 14 (10-16), < 0.001; heart rate 165 (153-176) beats/min vs. 182 (17-190) beats/min, < 0.001; respiratory rate 60 (±7) breaths/min vs. 65(±9) breaths/min, = 0.002; systolic blood pressure 78 (70-92) mmHg vs. 87 (78-96) mmHg, = 0.024; respectively] whereas the saturation value was significantly higher (88% (81-95) vs. 84% (70-92), = 0.036; respectively). By the 5th minute of the procedure, the median (25-75p) PIPP score [4 (2-6) vs. 6 (4-10), < 0.001], heart rate [148 (143-166) beats/min vs. 162 (152-180) beats/min, = 0.001] and respiratory rate [56 (54-58) breaths/min vs. 58 (54-62) breaths/min, = 0.034] were significantly lower, and the saturation level was significantly higher [96% (94-97) vs. 93% (91-96), = 0.003] in the dexmedetomidine group. Additionally, the frequency of adverse effects was significantly lower in the dexmedetomidine group compared to the standard protocol group (11% vs. 47%, = 0.001).
Administering intranasal dexmedetomidine before ROP screening examinations was associated with a decrease in pain scores among preterm infants. This suggests its potential as an effective and well-tolerated method for pain management during ROP screenings.
本研究旨在探讨鼻内给予右美托咪定对降低早产儿视网膜病变（ROP）筛查检查期间疼痛评分的有效性。
纳入在新生儿重症监护病房接受常规ROP检查、胎龄≤32周的婴儿，在1年的时间里将其分为两组：标准方案组（n = 43）和右美托咪定组（n = 56）。两组均接受标准的程序准备，包括包裹、口服葡萄糖和用丙美卡因进行局部麻醉。右美托咪定组在检查前额外经鼻给予剂量为1μg/kg的右美托咪定。在检查期间的基线、1分钟和5分钟时比较疼痛评分（PIPP评分）、心率、呼吸频率、血压和血氧饱和度。
两组在描述性和检查前特征方面无显著差异。在右美托咪定组中，检查第1分钟时测得的PIPP评分中位数（25 - 75百分位数）、心率、收缩压和平均（±标准差）呼吸频率显著低于标准组[PIPP评分10（8 - 13）对14（10 - 16），P < 0.001；心率165（153 - 176）次/分钟对182（171 - 190）次/分钟，P < 0.001；呼吸频率60（±7）次/分钟对65（±9）次/分钟，P = 0.002；收缩压78（70 - 92）mmHg对87（78 - 96）mmHg，P = 0.024；分别]，而血氧饱和度值显著更高（88%（81 - 95）对84%（70 - 92），P = 0.036；分别）。到检查第5分钟时，右美托咪定组的PIPP评分中位数[4（2 - 6）对6（4 - 10），P < 0.001]、心率[148（143 - 166）次/分钟对162（152 - 180）次/分钟，P = 0.001]和呼吸频率[56（54 - 58）次/分钟对58（54 - 62）次/分钟，P = 0.034]显著更低，血氧饱和度水平显著更高[96%（94 - 97）对93%（91 - 96），P = 0.003]。此外，右美托咪定组的不良反应发生率显著低于标准方案组（11%对47%，P = 0.001）。
在ROP筛查检查前给予鼻内右美托咪定与降低早产儿疼痛评分相关。这表明其作为ROP筛查期间有效且耐受性良好的疼痛管理方法的潜力。
