Comparison of the Pain-relieving Effects of Human Milk, Sucrose, and Distilled Water during Examinations for Retinopathy of Prematurity: A Randomized Controlled Trial원문보기
Jang, Eun Kyung
(Department of Neonatology, Neonatal Intensive Care Unit, Severance Hospital)
,
Lee, Hyejung
(College of Nursing.Mo-Im Kim Nursing Research Institute, Yonsei University)
,
Jo, Keum Sik
(Department of Neonatology, Neonatal Intensive Care Unit, Severance Hospital)
,
Lee, Sung Mi
(Department of Neonatology, Neonatal Intensive Care Unit, Severance Hospital)
,
Seo, Hyun Jin
(Department of Neonatology, Neonatal Intensive Care Unit, Severance Hospital)
,
Huh, Eun Joo
(Department of Neonatology, Neonatal Intensive Care Unit, Severance Hospital)
Purpose: This study compared the pain-relieving effects of human milk, sucrose, and distilled water during examinations for retinopathy of prematurity. Methods: Forty-five preterm infants were randomly assigned to receive a pacifier dipped in one of three solutions: human milk (n=14), 24% sucrose (n...
Purpose: This study compared the pain-relieving effects of human milk, sucrose, and distilled water during examinations for retinopathy of prematurity. Methods: Forty-five preterm infants were randomly assigned to receive a pacifier dipped in one of three solutions: human milk (n=14), 24% sucrose (n=15), or distilled water (n=16), 2 minutes before an eye examination. Their pain score, pulse rate, and oxygen saturation were measured at three time points: 5 minutes before the examination, 30 seconds after speculum introduction, and 2 minutes after the examination. Results: The infants' mean gestational age and weight at birth were $33.1{\pm}2.1$ weeks and $1,842{\pm}470g$, respectively. There were no between-group differences in pain relief during the eye examination. The pain score significantly increased both during (p<.001) and after the examinations (p=.003). Oxygen saturation decreased during the examinations (p<.001); however, the infants in the 24% sucrose group showed higher oxygen saturation (p=.047) during the examinations than the infants in the other groups. Conclusion: Sucking on a pacifier dipped in human milk or 24% sucrose did not reduce the pain associated with eye examinations in preterm infants. Pacifiers dipped in sucrose can be used to maintain better oxygen saturation during these examinations.
Purpose: This study compared the pain-relieving effects of human milk, sucrose, and distilled water during examinations for retinopathy of prematurity. Methods: Forty-five preterm infants were randomly assigned to receive a pacifier dipped in one of three solutions: human milk (n=14), 24% sucrose (n=15), or distilled water (n=16), 2 minutes before an eye examination. Their pain score, pulse rate, and oxygen saturation were measured at three time points: 5 minutes before the examination, 30 seconds after speculum introduction, and 2 minutes after the examination. Results: The infants' mean gestational age and weight at birth were $33.1{\pm}2.1$ weeks and $1,842{\pm}470g$, respectively. There were no between-group differences in pain relief during the eye examination. The pain score significantly increased both during (p<.001) and after the examinations (p=.003). Oxygen saturation decreased during the examinations (p<.001); however, the infants in the 24% sucrose group showed higher oxygen saturation (p=.047) during the examinations than the infants in the other groups. Conclusion: Sucking on a pacifier dipped in human milk or 24% sucrose did not reduce the pain associated with eye examinations in preterm infants. Pacifiers dipped in sucrose can be used to maintain better oxygen saturation during these examinations.
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문제 정의
The total scores range from 0 (no pain) to 21 (severe pain); higher scores indicate more pain and discomfort. A nurse educator in the NICU, who had experience in using the PIPP, trained nurse observers, who were experienced neonatal care nurses, to assess the pain of preterm infants during ROP examinations in this study. The two nurse observers independently assessed the infants’ PIPP scores in real time by sitting next to the infants’ beds.
제안 방법
All infants who participated in the study were administered mydriatic eye drops (0.5% tropicamide and 2.5% phenylephrine) 1 hour prior to the examination, and topical anesthetic eye drops (proxymetacaine 0.5%, Alcaine® 30 seconds prior to the introduction of the eye speculum.
Using a generalized estimating equation (GEE) analysis, the effects of solution type on PIPP scores, PR, and oxygen saturation were analyzed at each time point. Potential covariatesgestational age at birth, post-conceptional age, and Apgar scores-were adjusted for each outcome measure.
Both swaddling and the provision of a pacifier to infants are commonly practiced during ROP examinations in the NICU, and multiple non-pharmacological management strategies have been recommended in practice [17]. The purpose of this study was to compare the pain-relieving effects of human milk, 24% sucrose, and distilled water by providing a pacifier dipped in one of these solutions to preterm infants during ROP examinations.
The primary reason for non-enrollment was failure to obtain consent (n=3), and the other reasons for exclusion were the absence of available human milk (n=2) or not being dilated (n=1) (Figure 1). The research nurse randomly allocated the 45 eligible preterm infants to one of three groups: human milk (n=14), 24% sucrose (n=15), or distilled water (control group) (n=16). The group assignment was carried out using a random digit table and kept in sealed envelopes when parental consent was obtained.
The three study groups were homogeneous in terms of sex, gestational age at birth, birth weight, weight at examination, post-conceptional age, Apgar scores at 1 and 5 minutes, and examination duration (Table 1). The mean gestational age at birth of all preterm infants was 33.
The two nurse observers independently assessed the infants’ PIPP scores in real time by sitting next to the infants’ beds.
대상 데이터
A total of 51 preterm infants met the eligibility criteria during the study period. Of those, 45 preterm infants were included in this study.
A total of 51 preterm infants met the eligibility criteria during the study period. Of those, 45 preterm infants were included in this study. The primary reason for non-enrollment was failure to obtain consent (n=3), and the other reasons for exclusion were the absence of available human milk (n=2) or not being dilated (n=1) (Figure 1).
This study was carried out in a 46-bed, level III NICU at an academic medical center in Seoul, Korea. The inclusion criteria were preterm infants (<35 weeks of gestational age at birth) whose first eye examination was scheduled.
이론/모형
The primary outcome measure of this study was the composite pain score assessed by the PIPP [18]. The PIPP is a validated scale for the assessment of procedural pain in preterm and full-term infants based on seven indicators: gestational age, behavioral status, highest measured heart rate, lowest measured oxygen saturation, wrinkling of the forehead, squinting, and expansion of the alae nasi.
The sample size calculation was based on a previously published study of pain in infants during ROP examinations using the pain composite scale [16]. That study showed a standard deviation (SD) of 2.
성능/효과
047). The PIPP score was more likely to be elevated in infants with younger gestational age at birth, higher post-conceptional age, or a lower Apgar score at 5 minutes (p=.007, p=.004, and p= .037, respectively) (Table 3).
후속연구
Furthermore, this study included a small sample size, which may have limited the power of the experiment. Further research is needed to compare the pain-relieving effects of sucrose and human milk using a larger sample size.
However, a pacifier dipped in a 24% sucrose solution may improve the oxygen saturation level of preterm infants during ROP examinations. Further research is needed to investigate the pain-relieving effects of multiple applications of a pacifier soaked in either human milk or 24% sucrose during ROP examinations.
1 mL each, during ROP examinations in order to ensure that the effects would last for 6 minutes. Further research is needed to test the pain-relieving effects of multiple doses of either human milk or sucrose.
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