Jonas Center Spotlight

Jonas Scholar Shares Vision Research

In honor of Healthy Vision Month this May, we spoke to current Jonas Scholar Christine Catts MSN, RN, NNP-BC. Catts is DNP Scholar at Thomas Jefferson University in Philadelphia, PA. Below she shares information on her research of Retinopathy of Prematurity.

Retinopathy of Prematurity (ROP) is a disorder of the developing retina in premature infants that may lead to blindness. In premature infants, the retina and retinal vasculature is not fully developed, dependent on the degree of prematurity. Interruption of normal retinal development due to premature birth and subsequent exposure to life saving interventions in the neonatal intensive care unit (NICU) compounds the potential of ROP developing. The American Academy of Pediatrics (AAP) recommends screening infants with birth weights <1500 grams or gestational age ≤ 30 weeks. Serial examinations and treatment per the AAP recommendations has decreased the likelihood of blindness in the premature infant population. (American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, 2013) But, the examination itself, with the insertion of the speculum and scleral indentation, is known to cause pain and adverse reactions such as apnea, bradycardia, and increased oxygen requirements at the time of the exam and for a period following. Often, the infants most vulnerable to ROP are still fragile at the time of first examination, with some requiring mechanical ventilation and oxygen. Studies of non-pharmacological support with sucrose, nonnutritive sucking and swaddling have been utilized alone or in conjunction with topical anesthetics. (Francis, 2016, Samra & McGrath, 2009) Results have been mixed in the success in any one intervention, with no one strategy shown to be superior. (Francis, 2016) Recommendations for further research have been in the use of a consistent approach to limit infant pain. (Samra & McGrath, 2009, Hered & Gyland, 2010, Francis, 2016)

The aim of my project is a standardized nursing approach to the ROP examination that will reduce infant pain and other adverse events utilizing non-pharmacologic interventions. Recommendations for this study and local practice revolve around swaddling and administration of oral sucrose during the examination to decrease pain and minimize adverse reactions, while optimizing examination results. Measurement of neonatal pain, agitation, and sedation scale (NPASS) scores will be monitored to gauge the effects of the non-pharmacologic interventions. Secondary aims address the standardization of education and scripting to parents to ensure their understanding of ROP and the importance of the examination and treatment on long term outcomes for their infant. Work on this project is in collaboration with Jefferson College of Nursing, frontline neonatal intensive care unit nursing staff at Virtua Health in southern New Jersey and with Virtua-affiliated ophthalmology colleagues.

References

American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus. (2013, January). Screening examination of premature infants for retinopathy of prematurity. Pediatrics, 131, 189-195.

Francis, K. (2016). What is best practice for providing pain relief during retinopathy of prematurity eye examinations? Advances in Neonatal Care, 16, 220-228.

Hered, R. W., & Gyland, E. A. (2010). The Retinopathy of prematurity screening examination: Ensuring a safe and efficient examination while minimizing infant discomfort. Neonatal Network, 29(3), 143-151.

Samra, H. A., & McGrath, J. M. (2009). Pain management during retinopathy of prematurity eye examinations. Advances in Neonatal Care, 9, 99-110.

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