Paediatrics: Multi-modal characterisation of the neonatal pain response during retinopathy of prematurity screening and treatment

Retinopathy of prematurity (ROP) is a condition of the retinal vascular system in premature infants, which can cause childhood blindness. The disease is treatable if detected at a sufficiently early stage; hence a programme of frequent screening exists to facilitate timely diagnosis. Unfortunately, ROP screening is considered to be painful; infants are extremely unsettled both during and after the procedure, with high pain scores, and have an increased likelihood of apnoeic episodes shortly after screening. Local anaesthetic eye drops and interventions such as swaddling and sucrose have previously been shown to have limited success in relieving the pain associated with the procedure.

Pain in infants is a serious clinical issue. High numbers of painful procedures in the preterm period can lead to long-term deficits in cognitive ability as well as short-term changes in physiological stability. It is therefore of critical importance to better treating pain in infants. However, as infants cannot describe their experiences identifying pain in infants is a complex problem. Behavioural and physiological measures of pain have been characterised, and more recently noxious-evoked brain activity has been identified in response to acute procedures in infants. As pain is a perception that manifests in the brain, combining brain activity measures with behavioural and physiological responses likely provides a more accurate composite measure which will help us understand the infant pain experience.

Key goals:

1. Fully characterise the physiological response to ROP screening in infants, using a multi-modal approach measuring brain activity, reflex withdrawal, facial expression, heart rate, and oxygen saturation.

2. Investigate pain perception using brain-derived approaches during ROP treatments and establish how generalizable these measures are to other prolonged clinical procedures.

3. Optimise techniques used during ROP screening, by comparing two currently used techniques, and evaluating the impact on short and long-term central nervous system function and pain perception.