Effectiveness of Reverse Kangaroo Mother Care  Position in Decreasing Adverse Physiological Events  and Pain during Screening of Premature Infants  for Retinopathy of Prematurity

Background. Retinopathy of prematurity (ROP) screening is uncomfortable and even painful in preterm infants. Objective. To determine the effectiveness of the Reverse-Kangaroo Mother Care (R-KMC) position compared with the conventional position in decreasing adverse physiological events and pain during ROP screening. Methods. This was a parallel randomized controlled trial with two arms- R-KMC position and conventional position (control). The primary outcomes included increased oxygen saturation, decreased heart and respiratory rates, and decreased pain intensity measured by Prematurity Infant Pain Profile (PIPP). Results. There were 100 preterm infants recruited. There were no differences in baseline characteristics, mean ROP screening duration, mean physiological parameters after the mydriatic application and during ROP screening between the two. Only the mean respiratory rates were significantly lower among the R-KMC group during the application of mydriatric agent. (50.26 ± 6.18 vs. 51.6 ± 8.35; p=0.0191). Relative risk (RR) in the control group is 37 to 84 versus 40 to 68 in the R-KMC group. The R-KMC group had a significantly lower mean PIPP score (6.5±2.06 vs. 8.8±2.80; p<0.0001) after mydriatic application and during ROP screening (7.6±2.05 vs. 9.8±2.90; p<0.0001) compared with control. No apnea was observed after mydriatic application, but one apneic episode was in control during ROP screening. 26% of the ROP screeners recommended the R-KMC position during ROP screening, while a majority (70%) was neutral. Conclusion. R-KMC position, a low-cost intervention, significantly reduces pain during ROP screening. It is recommended as a position of choice during ROP screening.

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Effectiveness of Gentle Human Touch for Pain Control During Examination for Retinopathy of Pre-maturity: A Randomized Controlled Trial

Frontiers in Pediatrics ◽

10.3389/fped.2020.608378 ◽

2020 ◽

Vol 8 ◽

Author(s):

Yongping Sun ◽

Jinghan Zhang ◽

Xu Chen ◽

Yang Yang ◽

Jie Qiu ◽

...

Keyword(s):

Heart Rate ◽

Controlled Trial ◽

Control Group ◽

Term Infants ◽

Randomized Controlled ◽

Profile Score ◽

Infant Pain ◽

Human Touch ◽

Experimental Group ◽

Rop Screening

Background: Retinopathy of pre-maturity (ROP) is a disorder of the retinal blood vessels in pre-term infants with low birth weight. It is a leading cause of blindness in children. During ROP screening, the use of mydriatic drops and eyelid openers causes pain and discomfort. Pain management strategies include medications and behavioral interventions. The objectives of this study was to investigate the effects of Gentle Human Touch on pain in pre-term infants undergoing screening for ROP.Methods: In this randomized controlled trial, 82 infants in the neonatal intensive care unit at Children's Hospital of Nanjing Medical University who met the ROP screening criteria were randomly assigned to experimental and control groups using the random number table. The infants in the experimental group continuously received Gentle Human Touch during screening, while those in the control group were screened according to the routine procedure. All neonates were administered local eye anesthesia before the screening. The degree of pain was assessed using the Pre-mature Infant Pain Profile score. A double-channel near-infrared spectroscopy device was used to monitor regional cerebral oxygen saturation (rScO2), while oxygen saturation (SaO2) and heart rate were measured using pulse oximetry. The Pre-mature Infant Pain Profile score was the primary outcome, while heart rate, SaO2, and rScO2 were the secondary outcomes.Results: The gestational age, corrected gestational age, birth weight, and Apgar score at examination and the basal heart rate, SaO2, and rScO2 showed no significant intergroup differences (P > 0.05 for all). Both groups demonstrated significant decreases in SaO2 and rScO2 in response to the examination (P < 0.05 for all). During the examination, the Pre-mature Infant Pain Profile score (14.82 ± 3.22 vs. 9.29 ± 2.89, respectively; P < 0.05) was significantly higher in the control group than in the experimental group, while rScO2 (57.61 ± 3.51 vs. 54.76 ± 4.54%, respectively; P < 0.05) and SaO2 (91.89 ± 6.43 vs. 85.68 ± 8.31%; P < 0.05) were significantly higher in the experimental group than in the control group. There was no significant difference in heart rate changes between the two groups before and after the examination (182.60 ± 3.50 vs. 170.80 ± 3.50 time/min; P > 0.05).Conclusions: The findings of this study suggest that Gentle Human Touch can effectively alleviate pain during ROP screening in pre-mature infants.Clinical Trial Registration: ISRCTN10976481, Registered 06 March 2020, Retrospectively registered.

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Oral Sucrose Improves Analgesia During Retinopathy of Prematurity Screening

10.21203/rs.3.rs-642733/v1 ◽

2021 ◽

Author(s):

Ryan R Ramoutar ◽

Anil J Singh ◽

Charikleia Papandreou

Keyword(s):

Retinopathy Of Prematurity ◽

Screening Methods ◽

Infant Pain ◽

The Mean ◽

Oral Sucrose ◽

Group 2 ◽

Pipp Score ◽

Topical Analgesia ◽

Rop Screening ◽

Group 1

Abstract Purpose To determine whether sucrose provides significant analgesia during Retinopathy of Prematurity (ROP) screening Methods This was a prospective, randomized, sinlge masked audit. The examinations were performed by a single examiner. Forty-five (45) neonates were separated into two groups; Group 1 received oral sucrose while Group 2 received oral sucrose and non-nutritive suckling (NNS) at the discretion of the attending nurse. Pain was assessed using the Premature Infant Pain Profile (PIPP) score and recorded at baseline, immediately following lid speculum, at 3 minutes and 6 minutes following lid speculum insertion. Results The mean baseline PIPP score was 0.5. Fifteen (15) neonates (33%) received NNS. The mean PIPP scores at speculum insertion in both groups (Group 1: 7.24, Group 2: 5.50) were observed to be higher than at baseline and lower in Group 2 than in Group 1. In both groups, the scores at 3 minutes (Group 1: 4.70, Group 2: 4.20) and 6 minutes (Group 1 4.50, Group 2: 4.70) were observed to be higher than at baseline, lower than at speculum insertion, but not significantly different to each other. Conclusions Lid speculum insertion during ROP screening appears to be a significantly painful event. ROP examinations should be conducted with a combination of topical analgesia and sucrose and NNS for greatest pain-relieving effect.

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Effects of Kangaroo Mother Care on Repeated Procedural Pain and Cerebral Oxygenation in Preterm Infants

American Journal of Perinatology ◽

10.1055/s-0041-1731650 ◽

2021 ◽

Author(s):

Yu Wang ◽

Linping Zhang ◽

Wenbin Dong ◽

Rong Zhang

Keyword(s):

Oxygen Saturation ◽

Preterm Infants ◽

Cerebral Oxygenation ◽

Intervention Group ◽

Recovery Phase ◽

Kangaroo Mother Care ◽

Procedural Pain ◽

Control Group ◽

Blood Collection ◽

Infant Pain

Objective The study aimed to investigate the effects of kangaroo mother care (KMC) on repeated procedural pain and cerebral oxygenation in preterm infants. Study Design Preterm infants of 31 to 33 weeks of gestational age were randomly divided into an intervention group (n = 36) and a control group (n = 37). Premature infant pain profile (PIPP) scores, heart rate, oxygen saturation, regional cerebral tissue oxygenation saturation (rcSO2), and cerebral fractional tissue oxygen extraction (cFTOE) were evaluated during repeated heel stick procedures. Each heel stick procedure included three phases: baseline, blood collection, and recovery. KMC was given to the intervention group 30 minutes before baseline until the end of the recovery phase. Results Compared with the control group, the intervention group showed lower PIPP scores and heart rates, higher oxygen saturation, and rcSO2 from the blood collection to recovery phases during repeated heel sticks. Moreover, there were significant changes in cFTOE for the control group, but not the intervention group associated with repeated heel stick procedures. Conclusion The analgesic effect of KMC is sustained over repeated painful procedures in preterm infants, and it is conducive to stabilizing cerebral oxygenation, which may protect the development of brain function. Key Points

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Efficacy of 25% Glucose in Pain Alleviation During Retinopathy of Prematurity (ROP) Screening: A Randomized Controlled Trial

ACTA MEDICA IRANICA ◽

10.18502/acta.v58i12.5153 ◽

2021 ◽

Author(s):

Setareh Sagheb ◽

Ziba Mosayebi ◽

Nooshin Karimi ◽

Zahra Nikseresht ◽

Mohammad Mehdi Ani

Keyword(s):

Local Anesthetic ◽

Retinopathy Of Prematurity ◽

Controlled Trial ◽

The Other ◽

Control Group ◽

Oral Glucose ◽

Eye Drops ◽

Analgesic Effects ◽

Positive Effects ◽

Rop Screening

Retinopathy of prematurity (ROP) remains a painful examination, despite the common application of local anesthetic eye drops. This study aimed at examining the analgesic effects of 25% glucose in a premature infant pain profile (PIPP) in the first eye examination of infants with ROP. This three-group, randomized clinical trial was conducted from March to February 2017. One oral dose of 25% glucose solution (1 cc/kg) was administered one minute before the first examination of ROP. Mydriatic and anesthetic eye drops were locally instilled in the eyes before the examination for each group. Then, comparisons were made with the control group, which did not receive oral glucose (B), as well as the group which received 1 ml/kg of distilled water (C). The main investigator, who was blinded to the groups, evaluated pain using PIPP at one minute before, during, and one and five minutes after the procedure (ethics code: IR.TUMS.MEDICINE.REC.1396.3130). The baseline characteristics were comparable between the groups. During the procedure, the group receiving oral 20% glucose showed significantly lower PIPP scores (13.8±1.39) compared to the other groups (group B: 15.95±1.27 and group C: 15.10±1.19) (P=0.001). The positive effects persisted for five minutes in this group after the procedure (7.6±1.26), compared to the other groups (P=0.034). During and after ROP screening, oral 25% glucose in combination with local anesthetic eye drops can cause a significant reduction in pain.

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The Effect of Individualized Developmental Care Practices in Preterm Infants

Complementary Medicine Research ◽

10.1159/000504357 ◽

2019 ◽

Vol 27 (2) ◽

pp. 97-104

Author(s):

Dilek Küçük Alemdar ◽

Sevil İnal

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Oral Feeding ◽

Control Group ◽

Developmental Care ◽

Significant Difference ◽

Care Practices ◽

Maternal Voice

Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.

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Non-contact smartphone-based fundus imaging compared to conventional fundus imaging: a low-cost alternative for retinopathy of prematurity screening and documentation

Scientific Reports ◽

10.1038/s41598-019-56155-x ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Maximilian W. M. Wintergerst ◽

Michael Petrak ◽

Jeany Q. Li ◽

Petra P. Larsen ◽

Moritz Berger ◽

...

Keyword(s):

Retinopathy Of Prematurity ◽

Low Cost ◽

Cost Effective ◽

Field Of View ◽

Fundus Examination ◽

Fundus Imaging ◽

Examination Time ◽

Sensitivity Specificity ◽

Rop Screening ◽

Good Agreement

AbstractRetinopathy of prematurity (ROP) is a frequent cause of treatable childhood blindness. The current dependency of telemedicine-based ROP screening on cost-intensive equipment does not meet the needs in economically disadvantaged regions. Smartphone-based fundus imaging (SBFI) allows for affordable and mobile fundus examination and, therefore, could facilitate cost-effective telemedicine-based ROP screening in low-resources settings. We compared non-contact SBFI and conventional contact fundus imaging (CFI) in terms of feasibility for ROP screening and documentation. Twenty-six eyes were imaged with both SBFI and CFI. Field-of-view was smaller (ratio of diameters, 1:2.5), level of detail was equal, and examination time was longer for SBFI as compared to CFI (109.0 ± 57.8 vs. 75.9 ± 36.3 seconds, p < 0.01). Good agreement with clinical evaluation by indirect funduscopy was achieved for assessment of plus disease and ROP stage for both SBFI (squared Cohen’s kappa, 0.88 and 0.81, respectively) and CFI (0.86 and 0.93). Likewise, sensitivity/specificity for detection of plus disease and ROP was high for both SBFI (90%/100% and 88%/93%, respectively) and CFI (80%/100% and 100%/96%). SBFI is a non-contact and low-cost alternative to CFI for ROP screening and documentation that has the potential to considerably improve ROP care in middle- and low-resources settings.

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Oropharyngeal Administration of Colostrum for Preventing Necrotizing Enterocolitis and Late-onset Sepsis in Preterm Infants with Gestational Age ≤ 32 Weeks: A Single-center Randomized Controlled Trial

10.21203/rs.3.rs-145820/v1 ◽

2021 ◽

Author(s):

xia ouyang ◽

changyi yang ◽

wenlong xiu ◽

yanhua hu ◽

susu mei ◽

...

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Enteral Feeding ◽

Gestational Age ◽

Late Onset ◽

Controlled Trial ◽

Control Group ◽

Clinical Trial Registry ◽

Late Onset Sepsis ◽

Full Enteral Feeding

Abstract BackgroundOropharyngeal administration of colostrum (OAC) may provide immunoprotective and anti-inflammatory effects that potentially reduce the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) and improve short-term outcomes.ObjectiveTo evaluate the role of OAC in the early prevention of NEC and LOS in preterm infants with gestational age (GA) ≤ 32 weeks.MethodsA randomized, placebo-controlled trial was conducted in a 40-bed tertiary neonatal intensive care unit (NICU) in China. Preterm infants with GA ≤ 32 weeks were divided randomly into an OAC group, which received 0.4 ml maternal colostrum smearing via the oropharyngeal route every 3 hours for 10 days beginning within the first 48 hours after birth, and a control group, which received normal saline instead. Data from the two groups were collected and compared.ResultsA total of 127 patients in the OAC group and 125 patients in the control group were finally enrolled. The incidence of NEC (Bell stage 2 or 3) and LOS was lower in the OAC group [2.4% vs. 10.4%, χ2 = 6.845, ༰=0.009; 4.7% vs. 13.6%, χ2 = 5.983, ༰=0.014]. In addition, the incidence of intraventricular hemorrhage (IVH) (stage 3 or 4) was lower [1.6% vs. 7.2%,χ2 = 4.775, ༰=0.029], and the time of achieving full enteral feeding was shorter [ 22.0 days vs. 25.0 days༌Z = 6༌424.500༌P = 0.009)] in the OAC group. No cases of adverse reactions were observed in either group.ConclusionsOAC is a safe and simple NICU procedure that yields a potential advantage in decreasing the incidence of NEC, LOS, and severe IVH and shortening the time to achieve full enteral feeding in preterm infants with GA ≤ 32 weeks.Trial registrationChinese Clinical Trial Registry, ChiCTR1900023697, Registered 8 June 2019, Retrospectively registered, http://www.chictr.org.cn/edit.aspx? pid = 39398

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Use of expressed breast milk for pain relief during venepuncture in neonates

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183516 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1832

Author(s):

Abinaya S. ◽

Vinoth S. ◽

Ramesh S.

Keyword(s):

Placebo Group ◽

Breast Milk ◽

Controlled Trial ◽

Neurodevelopmental Outcome ◽

Neonatal Pain ◽

Expressed Breast Milk ◽

Infant Pain ◽

Repeated Pain ◽

Pipp Score ◽

Randomised Controlled

Background: It is now known that repeated pain in neonatal period influences neurodevelopmental outcome. It is necessary to assess and manage neonatal pain with appropriate interventions. The objective is to study whether expressed breast milk effectively reduces neonatal pain after venepuncture in comparison to placebo using sterile water.Methods: In this randomised controlled trial, neonates were randomised into two groups-expressed breast milk group and placebo group with 40 neonates in each group. Two minutes before venepuncture, 2 ml of test solution was administered. Mean Premature Infant Pain Profile (PIPP) score and mean cry time were recorded in neonates of both groups after venepuncture and compared.Results: At 0-30 second, 1-1 ½ minute, 3-3 ½ minute, 5-5 ½ minute after venepuncture, neonates in placebo group had mean PIPP score of 11.475, 10.125, 9.125, 7.575 respectively. At the same time intervals, mean PIPP score was 9.375, 7.825, 6.475, 5.05 in neonates of expressed breast milk group. Mean cry time after venepuncture was 105.65 seconds and 75.825 seconds in the placebo group and expressed breast milk group respectively.Conclusions: Compared to placebo, expressed breast milk significantly reduced mean PIPP score and cry time in neonates.

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Positive Mental Training in patients with Multiple Sclerosis experiencing psychological distress: A Preliminary Randomised Controlled Trial

10.1101/2021.07.15.21260604 ◽

2021 ◽

Author(s):

Katy Muray ◽

Giulia Melchiorre ◽

Alastair Dobbin ◽

Killian A Welch

Keyword(s):

Multiple Sclerosis ◽

Psychological Distress ◽

Randomised Controlled Trial ◽

Low Cost ◽

Controlled Trial ◽

Control Group ◽

Mental Training ◽

Current Form ◽

Self Rated Health ◽

Randomised Controlled

Introduction: Psychological distress is a major issue in multiple sclerosis (MS), having a significant impact on quality of life. Antidepressants are generally unhelpful for subsyndromal symptomatology, and psychological treatment approaches often not accessible or too cognitively demanding for some patients. There is an urgent need for low-cost interventions to improve wellbeing in MS. Methods: This was a pilot randomised controlled trial (RCT) of Positive Mental Training (PosMT), a low intensity intervention providing training in positivity, optimism and resilience previously shown to improve anxious and depressive symptomotology. 28 patients with MS were randomised to the intervention and 30 to the control group. Results: Follow-up data was obtained from 39 patents. The majority of participants receiving PosMT reported that they had used the intervention, with few reporting side effects. The intervention group reported a significant improvement in self-rated health as measured by the EuroQual visual analogue scale, F(4,34) = 3.204, p = 0.025, R2 = 0.274. Discussion: This preliminary RCT found that PosMT in its current form could be used by patients with MS with little difficulty. Despite the small size of the study, allocation to the intervention was found to be associated with a significant improvement in self-rated health. Given the low cost of PosMT and its easy availability (it can simply be downloaded from a website), this pilot RCT suggests it could be a useful tool for MS patients. We believe this intervention warrants further study, ideally in a large multi-centre RCT.

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Role of probiotics in preterm infants: a randomized controlled trial

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20170686 ◽

2017 ◽

Vol 4 (2) ◽

pp. 447 ◽

Cited By ~ 2

Author(s):

Sukanyaa S. ◽

Vinoth S. ◽

Ramesh S.

Keyword(s):

Weight Gain ◽

Preterm Infants ◽

Controlled Trial ◽

Health Benefit ◽

Control Group ◽

P Value ◽

Average Weight ◽

Preterm Babies ◽

Average Weight Gain

Background: Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Probiotics are proposed to aid in the quicker colonisation of the preterm gut by various mechanisms thereby providing innumerable health benefits to the preterm infants. Hence we conducted a study to analyse the role of probiotics in preterm babies. Our primary aim was to compare the weight gain pattern among preterm infants: those receiving probiotic and those who did not receive the probiotic.Methods: Preterm/VLBW babies were selected, randomized and placed into two groups. One group was given the chosen probiotic and the other was kept as control. The weight gain pattern and the duration of hospital stay among the two groups was compared at the end of one month of age.Results: The average weight gain in the probiotic group was higher than the control group which was statistically significant. (mean difference: 0.230 + 0.11 95% CI: -0.796 to -0.251 p value <0.000).Conclusions: Our study was yet another evidence proving the utility of probiotics in the field of neonatalogy.

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