Post-procedure pain in preterm neonates undergoing retinopathy of prematurity (ROP) screening: a prospective cohort study.

Objective: To evaluate the pain intensity in preterm infants during 48 h post retinopathy of prematurity (ROP) screening by binocular fundoscopy.

Design: Prospective cohort study.

Settings: Level-III-NICU in India.

Participants: 83 Neonates undergoing first ROP screening.

Main Outcome Measures: Pain assessment using the premature infant pain profile-revised (PIPP-R) score at baseline and 5 min, 30 min, 6 h, 24 h, and 48 h post-procedure.

Results: The mean gestation and birth weight was 29.8 (2.3) weeks and 1256 (344)g respectively. The median (IQR) PIPP-R score at baseline was 0 which significantly increased to 10.5 (8,12.5) 5 min (immediately) after the procedure. At 30 min and 6 h, scores were 7 (5,8) and 4.5 (3,5.5) respectively. After 24 h and 48 h, it decreased to 3 (0,5) and 0 (0,4.5) respectively. Nearly 59% (95%CI:40%-83%) of neonates had severe pain (PIPP-R score > 12) immediately after procedure.

Conclusion: A majority of neonates experience severe pain immediately after ROP screening, and mild-moderate pain continues for 6 h. Hence, an additional pharmacological agent should be considered for reducing neonatal pain.