Exploring Clinical Facts of Pain and Stress for Preterm Infants Receiving Retinopathy of Prematurity Examination

Abstract

Background: Retinopathy of prematurity (ROP) is a common complication affecting premature infants Except for the local anesthetic eye drops proved by empirical studies there is no consensus among the pain/stress managements from initial of mydriasis until after the examination and discussing associated factors rarely It is essential to explore the clinical fact thoroughly to understand the pain/stress performances under ROP exams and to investigate the associated factors Method: A natural observation method was used Period from twenty minutes before administration of mydriatic eye drops until one hour after ROP exam was digital videotaped and described qualitatively A semi-structured coding instruction was developed and the content validity index was 0 97 and the intra-rater and inter-rater reliability was 88% and 85% respectively The potential associated items contained characteristics of participants and context smoothness level of the administration developmental care quantified by Evaluation of Intervention (EVIN) and other possible factors Meanwhile except for crying and bradycardia pain and stress performances were measured by Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Evaluation (BE) respectively Convenient sampling was used in a neonatal intensive care unit in a tertiary hospital in southern Taiwan Each participant was observed four times maximally Each recording of exam was sampled at 12 event/time points Results: Between August 2014 to April 2015 23 preterm infants were enrolled and 43 ROP exams were recorded In average the participants were 27 6 weeks gestational age (GA) with body weight (BW) 1025 gm at birth and 33 7 weeks postmenstrual age (PMA) with 1612 gm when they received the exam Approximately the mean period of each administration of mydriatic eye drops was 36 seconds while the ROP exam was 3 minutes The trends of pain/stress performances are similar Scores at event/time points were statistically significantly higher than baseline from the initial of administration of mydriatic eye drops until ten minutes after the exam The top pain/stress scores were measured at scleral indention insertion of eye lid speculum and first dosage of mydratic eye drops (p

Date of Award	2015 Aug 4
Original language	English
Supervisor	Mei-Chih Huang (Supervisor)