Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1267-e1278 (doi:10.1542/peds.2006-2510)
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ARTICLE

Lower Stress Responses After Newborn Individualized Developmental Care and Assessment Program Care During Eye Screening Examinations for Retinopathy of Prematurity: A Randomized Study

Agneta Kleberg, RN, PhDa,b, Inga Warren, OT, MScc, Elisabeth Norman, MDb, Evalotte Mörelius, RN, PhDd, Ann-Cathrine Berg, RN, BSNb, Ezam Mat-Ali, MDe, Kristina Holm, MDf, Alistair Fielder, MD, PhDg, Nina Nelson, MD, PhDd and Lena Hellström-Westas, MD, PhDb

a Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden
b Departments of Paediatrics
f Ophtalmology, Lund University, Lund, Sweden
c Winnicott Baby Unit, St Mary's National Health Service Trust, London, United Kingdom
d Department of Paediatrics, Linköping University, Linköping, Sweden
e Northwick Park Hospital, London, United Kingdom
g Department of Optometry and Visual Science, City University, London, United Kingdom

OBJECTIVE. Screening examination for retinopathy of prematurity is distressing and painful. The aim of the present study was to investigate whether a Newborn Individualized Developmental Care and Assessment Program intervention during a retinopathy of prematurity examination results in less adverse behavioral, pain, and stress responses as compared with standard care.

METHODS. The first 2 eye examinations in 36 preterm infants were evaluated. The infants were randomly assigned at the first eye examination to receive either Newborn Individualized Developmental Care and Assessment Program care or standard care. At the second examination, crossover of subject assignment was performed. The assessments included behavioral responses; recordings of heart rate, respiration, and oxygenation; pain scores (premature infant pain profile); and salivary cortisol at defined time points up to 4 hours after the eye examination. The nursing support given during the eye examinations (intervention score) were scored using predefined criteria.

RESULTS. Altogether, 68 examinations were evaluated. Newborn Individualized Developmental Care and Assessment Program care was associated with better behavioral scores during the examination but there was no difference in heart rate, respiratory rate, oxygenation, or premature infant pain profile score between the 2 care strategies before or after the eye examination. Salivary cortisol increased from baseline to 30 minutes after the eye examination independent of care strategy and decreased significantly between 30 and 60 minutes when infants were subjected to Newborn Individualized Developmental Care and Assessment Program care but not after standard care. During the study period the intervention score for standard care increased and approached the score for Newborn Individualized Developmental Care and Assessment Program care at the later eye examinations.

CONCLUSION. A Newborn Individualized Developmental Care and Assessment Program-based intervention during eye examination does not decrease pain responses but results in faster recovery, as measured by lower salivary cortisol 60 minutes after the examination. The differences were seen despite the influence from the Newborn Individualized Developmental Care and Assessment Program intervention on the standard care treatment that occurred during the study period.

Key Words: developmental care • eye examination • NIDCAP • pain • preterm infant • retinopathy of prematurity • stress

Abbreviations: ROP—retinopathy of prematurity • NIDCAP—Newborn Individualized Developmental Care and Assessment Program • PMA—postmenstrual age • PIPP—premature infant pain profile

Accepted Oct 18, 2007.