Reduction of preterm infant stress in screening for premature retinopathy

Prematurna retinopatija ili ROP glavni je uzrok gubitka vida kod nedonoščadi. Pravovremenim probirom na ROP i liječenjem možemo unaprijediti njihov vidni ishod. Stoga su nedonoščad gotovo redovito izložena, dokazano stresnim i bolnim postupcima probira. Nakon dugotrajnog vjerovanja da prijevremeno rođena djeca ne osjećaju bol i stres, saznanje o suprotnom pokrenulo je istraživanja o mogućim posljedicama stresa i boli na razvoj. Brojna istraživanja pokazuju da opetovana bol može imati izravne i dugoročne posljedice na neurološki i bihevioralni razvoj novorođenčadi. Strategije za smanjenje stresa i liječenje boli ključne su za promicanje rasta i razvoja, te minimaliziranje dugoročnih posljedica. Proceduralna analgezija bi trebala uključivati koncepte razvojne njege, nenutritivnog sisanja, farmakoloških i ostalih navedenih nefarmakoloških sredstava. Nažalost, literatura ne daje jasne dokaze da intervencije poput kapi za anesteziju, oralna saharoza ( ili glukoza, ili dekstroza), nenutritivno sisanje i pozicioniranje blagotvorno smanjuje stres (nelagodu) kod pregleda na ROP. Niti jedna od njih primijenjena samostalno nije pokazala značajniju promjenu u bodovima na skali za procjenu boli.Zbog mnogih nepoznanica u farmakokinetici i djelovanju, te nuspojavama primijenjenih lijekova za ublažavanje stresa, za nedonoščad je prije primjene nužno sagledati korist, odnosno štetu, koju uzrokuje primjena lijeka. Slijedom toga prilikom probira na ROP, često se primijeni samo lokalni anestetik i/ili saharoza koja se pokazala nedovoljnim sredstvom za ublažavanje stresa. Trenutne spoznaje nam pružaju nekoliko mogućih alata, farmakoloških i nefarmakoloških koje možemo primijeniti bez većeg rizika, a preporuka je da ih se koristi naizmjenično, u kombinacijama koje se u našem okruženju pokažu najefikasnijima. Brzi napredak u tehnologijama i proširivanje znanja o bolesti i genetici, zajedno s rastućom potrebom za učinkovitim i pravodobnim procjenama ROP-a, može u bliskoj budućnosti u potpunosti transformirati sadašnji dijagnostički pristup. Cilj nam je prvenstveno novim alatima suziti broj nedonoščadi koja trebaju biti pregledana, a onda i broj potrebnih pregleda, da se izbjegne nepotrebni stres i neugodnost za dijete, a kod djece koja moraju biti pregledavana smanjiti neugodnost i stres.Retinopathy of prematurity or ROP is the leading cause of vision loss in preterm infants. Timely screening and treatment of ROP can improve the visual outcome in infants. Hence, preterm infants are repeadetly exposed to proven stressful and painful screening procedures. After a long-held belief that premature infants do not feel pain and stress was proven contrary, researches about possible repercussions of stress and pain on infant development were initiated. Numerous studies reveal that recurrent pain can have direct and long-term consequences on the neurological and behavioral development of newborns. Strategies to reduce stress and treat pain are crucial in promotion of growth and development, as well as minimizationof longterm consequences. Procedural analgesia should include the concepts of developmental care, non-nutritive sucking, pharmacological and other listed nonpharmacological agents. Unfortunately, the literature does not provide clear evidence that interventions such as anesthetic drops, oral sucrose (or glucose, or dextrose), non-nutritive sucking, and positioning are beneficial in reduction of stress (discomfort) due to ophthalmic examination for ROP. None of the interventions by itselfdemonstrated a significant change in score points on the pain assessment scale. Due to many unknown factorsabout pharmacokinetics, action and side effects of drugs used to relieve stress, it is necessary to consider the benefits versus harms to premature infants. Consequently, when screening for ROP, only a local anesthetic and / or sucrose is often used, attested to be an insufficient stress reliever. Current knowledge provides us several possible methods, pharmacological and nonpharmacological, that can be used without significant risk. It is recommended to use those methods alternately, in combinations proven to be most effective in our environment. Rapid advances in technology and the expansion of knowledge about the disease and underlying genetics, together with the growing need for effective and timely ROP assessments, may completely transform the current diagnostic approach in the near future. Our goal is primarily to use new tools to reduce the number of premature infants that need to be examined and then the number of requisite examinations in order to avoid unnecessary stress and discomfort for the infant, children who need to be examined reduce discomfort and stress