Presented at the Neonatal Society 2005 Autumn Meeting.
Mat-Ali E, Warren I, Kleberg A, Westas L, Norman E, Nelson N, Morelius E, Berg AC, Holm C, Fielder A (introduced by K Ghaus)
St Mary’s Hospital, Paddington, London, UK
University Hospital of Lund, Sweden
Background: ROP examination is a necessary but stressful procedure in neonates. It has known adverse physiological effects. For example, significant changes in oxygen saturation and heart rate following examination of the eyes have been reported (1). NIDCAP is a highly skilled method of neonatal care. It may have some benefit in reducing response to stress.
Objective: To objectively look at the trend in physiological effects of ROP examinations, comparing two types of care; a NIDCAP-based approach and a conventional method. Also, to look at characteristics of neonates (such as those on CPAP and/or less than 1500g) who may potentially benefit from the intervention.
Methods: Infants eligible for ROP screenings were randomised from two centres (London and Lund) into the intervention (NIDCAP) group or control (conventional) group at the first examination. Subsequent ROP examinations were alternated with either NIDCAP-based care or conventional care. Physiological data on oxygen saturation, pulse rate and percentage of activity were continuously recorded using a NELLCOR pulse oxymetry monitor. The recordings were blindly evaluated using Malincrodt software before and during the examinations, including the periods of 1, 2, 3 and 4 hours following the procedures. Ethical approval was granted from both centres.
Results: Physiological recordings suitable for analysis were obtained from 68 examinations. (London: n=32, Lund: n=36; intervention: n=38, control: n=30). At the start of the study, there were no significant differences seen in all the physiological data between the control and intervention groups; p>0.05. In London, there was a significant reduction in the number of desaturations/min at 1 hour in the intervention group (-0.07) compared to control (0.03); p=0.008. Multivariate analysis showed that babies receiving CPAP in both centres had lower maximum pulse rate (MPR) in the intervention group than the control group following the examinations at 2 hours (173 vs 189; p=0.01), 3 hours (173 vs 188; p=0.04) and 4 hours (175 vs 188; p=0.01). Mean pulse rate was also significantly less (p<0.05) in the intervention group than the control at 1, 2, 3 and 4 hours following ROP screening. In both centres, babies in the intervention group had significantly less percentage of activity at 1 hour after the procedure (40% vs 51%; p=0.005). In London, babies <1500 g in the intervention group were also significantly less tachycardic at 3 and 4 hours (MPR: 170 vs 190; p=0.02, 174 vs 191; p<0.001).
Discussion: The study demonstrated that infants who received NIDCAP-based care had significantly less adverse physiological effects of ROP examinations. These effects were more evident in babies who were less than 1500g or requiring CPAP. The benefits may be more pronounced in London due to a greater difference in care between the two groups in the study, as NIDCAP is more widely practiced in Lund.
References
1. Laws, David et al. British J of Ophthalmology 1996 May; 80(5):425-428.