Acta Pædiatrica ISSN 0803-5253
READERS’ FORUM
Comment on ‘Oral sucrose and non-nutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations’ Dear Sir, We read the article Oral sucrose and nonnutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations by Dilli et al (1) with great interest. This re-emphasises the fact that these premature infants do feel pain, which we cannot ignore. For example, table 2 showed that there was moderate to severe pain in both the study and control groups, according to the Premature Infant Pain Profile (PIPP) scores (2). So, in addition to pacifiers and sucrose, we should use all possible measures to reduce pain and stress by carrying out an extremely gentle and brief examination. The 95% confidence interval PIPP scores for Group One, who received sucrose, and Group Two, who received sterile water, were 13.7 14.43 and 15.78 17.02, respectively. The difference in PIPP scores ranged from 1.35 to 3.32 and, at the lower range, they could be well below two. The mean intraclass correlation coefficient value of 0.87 (0.80–0.92) was determined for intra-observer reliability. The difference in the two groups in the lower range can be attributed to just intra-observer variability. Also, the authors did not mention how clinically significant they felt the 2.7 point mean reduction in PIPP score was. In addition, it would have been better to observe the infants in both groups after the eye examination was completed to see which group recovered from the stress faster. There was no information about whether the groups were similar in terms of severity of retinopathy. For example, an infant with severe retinopathy is likely to receive a prolonged examination with more stress and a higher score. We find that oral sweeteners and pacifiers are more useful as pain relieving measures during laser photocoagulation under topical anaesthesia, than during screening. We use a gauze piece, with one end dipped in a dextrose
solution and the other one within the mouth. This stays in place throughout the laser procedure and acts in two ways, supplying the sucrose and a stimulus for sucking.
CONFLICT OF INTEREST The authors have no conflict of interests to disclose.
FUNDING SOURCE The authors have no funding source to disclose.
References
_ 1. Dilli D, Ilarslan NEC ß , Kabatasß EU, Zenciroglu A, Sß imsßek Y, Okumusß N. Oral sucrose and non-nutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations. Acta Paediatr 2014; 103: e76–9. 2. Stevens B, Johnston C, Petryshen P, Taddio A. Premature infant pain profile: development and initial validation. Clin J Pain 1996; 12: 13–22. DOI:10.1111/apa.12793
Danish Alam, Tapas R. Padhi ([email protected]; [email protected]), Rohit R. Modi L V Prasad eye institute, Bhubaneswar, India Correspondence: Tapas Ranjan Padhi, MS, Retinavitreous service, L V Prasad Eye Institute, Bhubaneswar 751024, India. Tel: 91-9438361078 | Fax: 91-674-3987130 | Emails: [email protected]; [email protected]
ratio may lead to such a difference (2).We have a few queries in the manuscript. The authors have used nonparametric test of independent samples to compare various devices. However, these values are paired observations. Hence, appropriate tests would be Friedmans two-way analysis of variance for more than two groups, Wilcoxons signed rank test for two groups or paired t-test for normally distributed data. We also suggest authors to use test of agreement and provide intraclass correlation coefficients, if it is possible with the data. The correlation can also be performed to look for positive or negative relations between different devices if there is no agreement. Multiple pairwise analyses of different devices would increase the a-error and might result in spurious significant values (3). The authors had taken each measurement of NIRS for duration of 2 h. It is not clear from the paper that how was the data of 2 h handled and compared between various devices. Did the author averaged or took scheduled values? Nevertheless, we agree with the message given by the authors and hope that uniform and verifiable standards are available for NIRS in near future.
CONFLICT OF INTEREST The authors have no conflict of interest.
SOURCE OF FUNDING None.
Cerebral oxygenation measurement in preterm neonates by various devices Sir, We thank Schneider and colleagues (1) for an interesting paper. The authors have shown significant differences in cerebral tissue oxygenation levels among four commercially available NIRS devices. Different measurement intervals, light wavelengths used, trends or absolute value measurements, light pathway distance (depends on probe size and manufacturer) and algorithm of venous to arterial blood
ª2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e513–e514
References
1. Schneider A, Minnich B, Hofst€atter E, Weisser C, Hattinger-J€ urgenssen E, Wald M. Comparison of four near-infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants. Acta Paediatr 2014; 103: 934–8. 2. Elser HE, Holditch-Davis D, Brandon DH. Cerebral Oxygenation Monitoring: a Strategy to Detect IVH and PVL. Newborn Infant Nurs Rev 2011; 11: 153–9. 3. Aickin M, Gensler H. Adjusting for multiple testing when reporting research results: the Bonferroni vs Holm methods. Am J Public Health 1996; 86: 726–8. DOI:10.1111/apa.12808
e513
Readers’ Forum
Readers’ Forum
Readers’ Forum
Readers’ Forum 1
Shiv Sajan Saini ([email protected]) , Vidushi Mahajan2
2.Department of Paediatrics, Government Medical College and Hospital, Chandigarh, India
1.Neonatal Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Correspondence: Dr Shiv Sajan Saini, DM, MD, Assistant Professor, Neonatal Unit, Department of Paediatrics, Post Graduate Institute of Medical
e514
Education and Research, Chandigarh- 160 012, India. Tel.: 91-172-2756264 | Fax: 91-172-2744401 | Email: [email protected]
ª2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e513–e514
READERS’ FORUM
Comment on ‘Oral sucrose and non-nutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations’ Dear Sir, We read the article Oral sucrose and nonnutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations by Dilli et al (1) with great interest. This re-emphasises the fact that these premature infants do feel pain, which we cannot ignore. For example, table 2 showed that there was moderate to severe pain in both the study and control groups, according to the Premature Infant Pain Profile (PIPP) scores (2). So, in addition to pacifiers and sucrose, we should use all possible measures to reduce pain and stress by carrying out an extremely gentle and brief examination. The 95% confidence interval PIPP scores for Group One, who received sucrose, and Group Two, who received sterile water, were 13.7 14.43 and 15.78 17.02, respectively. The difference in PIPP scores ranged from 1.35 to 3.32 and, at the lower range, they could be well below two. The mean intraclass correlation coefficient value of 0.87 (0.80–0.92) was determined for intra-observer reliability. The difference in the two groups in the lower range can be attributed to just intra-observer variability. Also, the authors did not mention how clinically significant they felt the 2.7 point mean reduction in PIPP score was. In addition, it would have been better to observe the infants in both groups after the eye examination was completed to see which group recovered from the stress faster. There was no information about whether the groups were similar in terms of severity of retinopathy. For example, an infant with severe retinopathy is likely to receive a prolonged examination with more stress and a higher score. We find that oral sweeteners and pacifiers are more useful as pain relieving measures during laser photocoagulation under topical anaesthesia, than during screening. We use a gauze piece, with one end dipped in a dextrose
solution and the other one within the mouth. This stays in place throughout the laser procedure and acts in two ways, supplying the sucrose and a stimulus for sucking.
CONFLICT OF INTEREST The authors have no conflict of interests to disclose.
FUNDING SOURCE The authors have no funding source to disclose.
References
_ 1. Dilli D, Ilarslan NEC ß , Kabatasß EU, Zenciroglu A, Sß imsßek Y, Okumusß N. Oral sucrose and non-nutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations. Acta Paediatr 2014; 103: e76–9. 2. Stevens B, Johnston C, Petryshen P, Taddio A. Premature infant pain profile: development and initial validation. Clin J Pain 1996; 12: 13–22. DOI:10.1111/apa.12793
Danish Alam, Tapas R. Padhi ([email protected]; [email protected]), Rohit R. Modi L V Prasad eye institute, Bhubaneswar, India Correspondence: Tapas Ranjan Padhi, MS, Retinavitreous service, L V Prasad Eye Institute, Bhubaneswar 751024, India. Tel: 91-9438361078 | Fax: 91-674-3987130 | Emails: [email protected]; [email protected]
ratio may lead to such a difference (2).We have a few queries in the manuscript. The authors have used nonparametric test of independent samples to compare various devices. However, these values are paired observations. Hence, appropriate tests would be Friedmans two-way analysis of variance for more than two groups, Wilcoxons signed rank test for two groups or paired t-test for normally distributed data. We also suggest authors to use test of agreement and provide intraclass correlation coefficients, if it is possible with the data. The correlation can also be performed to look for positive or negative relations between different devices if there is no agreement. Multiple pairwise analyses of different devices would increase the a-error and might result in spurious significant values (3). The authors had taken each measurement of NIRS for duration of 2 h. It is not clear from the paper that how was the data of 2 h handled and compared between various devices. Did the author averaged or took scheduled values? Nevertheless, we agree with the message given by the authors and hope that uniform and verifiable standards are available for NIRS in near future.
CONFLICT OF INTEREST The authors have no conflict of interest.
SOURCE OF FUNDING None.
Cerebral oxygenation measurement in preterm neonates by various devices Sir, We thank Schneider and colleagues (1) for an interesting paper. The authors have shown significant differences in cerebral tissue oxygenation levels among four commercially available NIRS devices. Different measurement intervals, light wavelengths used, trends or absolute value measurements, light pathway distance (depends on probe size and manufacturer) and algorithm of venous to arterial blood
ª2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e513–e514
References
1. Schneider A, Minnich B, Hofst€atter E, Weisser C, Hattinger-J€ urgenssen E, Wald M. Comparison of four near-infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants. Acta Paediatr 2014; 103: 934–8. 2. Elser HE, Holditch-Davis D, Brandon DH. Cerebral Oxygenation Monitoring: a Strategy to Detect IVH and PVL. Newborn Infant Nurs Rev 2011; 11: 153–9. 3. Aickin M, Gensler H. Adjusting for multiple testing when reporting research results: the Bonferroni vs Holm methods. Am J Public Health 1996; 86: 726–8. DOI:10.1111/apa.12808
e513
Readers’ Forum
Readers’ Forum
Readers’ Forum
Readers’ Forum 1
Shiv Sajan Saini ([email protected]) , Vidushi Mahajan2
2.Department of Paediatrics, Government Medical College and Hospital, Chandigarh, India
1.Neonatal Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Correspondence: Dr Shiv Sajan Saini, DM, MD, Assistant Professor, Neonatal Unit, Department of Paediatrics, Post Graduate Institute of Medical
e514
Education and Research, Chandigarh- 160 012, India. Tel.: 91-172-2756264 | Fax: 91-172-2744401 | Email: [email protected]
ª2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e513–e514
