My good friend Gene Dempsey (a neonatologist and clinical researcher in Cork) reminded me of their trial published in 2010, and suggested that the title of my previous post may be misleading. I guess I really don’t want readers to think that nothing works and therefore we should stop analgesic maneuvers before RoP screening exams. What I meant to imply is that no particular intervention abolishes pain responses. Using several interventions together does give some pain relief and should be standard. Even the local anesthetic eye drops while not very effective do show an effect when the data are analyzed in systematic review. Dr Dempsey gave me permission to copy his comments into a post:
I think the title of this section may be a little misleading. As you point out in the last pargraph, the combination of swaddling, oral sucrose and topical anaesthetic was associated with relatively low scores and I believe should be the standard for ROP screening. Whilst the review you highlight is good, I think the following review is as good
Sun X, Lemyre B, Barrowman N, O’Connor M. Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic review.. Acta Paediatr. 2010 Mar;99(3):329-34. http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2009.01612.x/abstract.Also our own rct of sucrose use (O’Sullivan A, O’Connor M, Brosnahan D, McCreery K, Dempsey EM. Sweeten, soother and swaddle for retinopathy of prematurity screening: a randomised placebo controlled trial.. Arch Dis Child Fetal Neonatal Ed. 2010 Nov;95(6):F419-22 http://fn.bmj.com/content/95/6/F419.abstract) showed a reduction in pain scores during speculum insertion and indentation, was not included in Kandasamy review.
The Cochrane review of local anesthetic eye drops is in fact authored by Dr Dempsey. Dempsey E, McCreery K: Local anaesthetic eye drops for prevention of pain in preterm infants undergoing screening for retinopathy of prematurity. Cochrane Database Syst Rev 2011, 9(9):CD007645. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007645.pub2/abstract