Scientific Letter
Skin conductance to assess pain and stress during retinopathy of prematurity screening
La conductancia de la piel para evaluar el dolor y el estrés durante el cribado de la retinopatía de la prematuridad
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class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Skin conductance to assess pain and stress during retinopathy of prematurity screening" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "365" "paginaFinal" => "366" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alejandro Avila-Alvarez, Lorena Vazquez Gomez, Andrea Sucasas Alonso, Henar Romero Rey, Montserrat Cabana Vazquez" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Alejandro" "apellidos" => "Avila-Alvarez" "email" => array:1 [ 0 => "Alejandro.avila.neonatologia@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Lorena" "apellidos" => "Vazquez Gomez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Andrea" "apellidos" => "Sucasas Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Henar" "apellidos" => "Romero Rey" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Montserrat" "apellidos" => "Cabana Vazquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Neonatología, Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, A Coruña, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, A Coruña, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La conductancia de la piel para evaluar el dolor y el estrés durante el cribado de la retinopatía de la prematuridad" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1107 "Ancho" => 1617 "Tamanyo" => 51325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Boxplot diagram showing the differences in the number of skin conductance fluctuations (NSCF) in patients with and without desaturation episodes during eye examination.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Preterm infants at high risk for retinopathy of prematurity (ROP) should undergo regular retinal examinations,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> which may be painful.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> Assessing pain accurately in newborns continues to be a challenge, and there is a need for more objective and reliable tools.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of our study was to evaluate the changes in skin conductance (SC) during eye examinations conducted for ROP screening and to study their association with changes in heart rate and oxygen saturation.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We carried out a prospective observational study from January to May 2017. We included infants born at 32 or fewer weeks’ gestation that were candidates for retinal screening according to national guidelines.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> We used both pharmacological and nonpharmacological pain relief measures, including swaddling, facilitated tucking, a quiet environment, oral paracetamol, sucrose, non-nutritive sucking and topical anaesthetic drops. We measured skin conductance with a Med-Storm® monitor (Med-storm Innovation; Oslo, Norway) and a 3-electrode system applied to the sole of the foot. We recorded the number of SC fluctuations per second (NSCF) in peaks/sec. More extensive descriptions of the SC monitor and the NSCF have been published previously.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> We recorded the maximum NSCF at 4 predefined time points: baseline, at placement of the lid speculum, at scleral indentation and at the end of the procedure. We also recorded all episodes of tachycardia (>180<span class="elsevierStyleHsp" style=""></span>bpm), bradycardia (<100<span class="elsevierStyleHsp" style=""></span>bpm) and oxygen desaturation (saturation<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>85% for >10<span class="elsevierStyleHsp" style=""></span>s). The analysis included a maximum of 3 examinations per patient. We obtained the written consent of the parents, and the study protocol was approved by the local research ethics committee.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The sample included 30 eye examinations performed in 19 patients (8 girls, 11 boys) born at a mean gestational age of 30.1 weeks (standard deviation [SD], ±1.1) and a mean birth weight of 1226.3<span class="elsevierStyleHsp" style=""></span>g (SD, ±259.6). None of the patients required mechanical ventilation, while 3 (15.7%) required supplementary oxygen.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The infants experienced episodes of tachycardia in 19 out of the 30 examinations (63.3%), bradycardia in 6 (20%) and desaturation in 15 (50%). There was a significant increase in the NSCF from baseline to both lid speculum insertion and to scleral indentation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The mean maximum NSCF during the examination was 0.64<span class="elsevierStyleHsp" style=""></span>peaks/s (SD, ±0.4), most frequently at the time of scleral indentation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We found no statistically significant differences in the mean maximum NSCF between patients with and without tachycardia (0.74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.52 vs 0.58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.31; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.3) or between patients with and without bradycardia (0.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.62 vs 0.59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.32; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.17). Episodes of desaturation were associated with a higher NSCF (0.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.46 vs 0.44<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.19; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.009), as can be seen in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Skin conductance methods are based on stress-induced sweating and reflect increases in sympathetic nervous system activity. This sweating is a reaction to any of various emotional stimuli, such as nervousness, anxiety, fear, stress, or pain. When palmar and plantar sweat glands fill as a result of sympathetic nerve firing, skin resistance decreases; and when the sweat is reabsorbed, skin resistance increases. This outcome gives rise to the peaks in SC that are used to evaluate pain and stress (the NSCF).</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our study, we recorded marked changes in SC during an examination already known to be painful, illustrating that SC may be a good marker of acute pain. To our knowledge, no prior studies on SC have been performed in this setting. We ought to mention that the NSFC values that we observed during the eye examination were higher compared to those reported in association with other painful procedures (such as heel prick and venepuncture),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> which suggests that the level/intensity of pain is higher during a ROP evaluation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Our study involves several limitations. First, we cannot exclude that uncontrolled confounders have influenced SC responses. Second, our study was designed as a pilot study aiming to evaluate feasibility and changes in the NSCF; as such, we did not use any clinical scales to assess pain responses. An observational study is currently underway to investigate the correlation between clinical scales and SC.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Our results show a marked increase in the NSFC during eye examinations for ROP screening coupled with frequent changes in heart rate and desaturation episodes. We conclude that these changes in NSFC during ROP screening could be related at least partially to pain, but further research should investigate whether SC values are correlated to validated pain scores and determine whether SC can be a helpful tool for the detection of pain during ROP screening. Our data could serve as a reference in such future studies.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Avila-Alvarez A, Vazquez Gomez L, Sucasas Alonso A, Romero Rey H, Cabana Vazquez M. La conductancia de la piel para evaluar el dolor y el estrés durante el cribado de la retinopatía de la prematuridad. An Pediatr (Barc). 2020;92:365–366.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1252 "Ancho" => 2172 "Tamanyo" => 88175 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Changes in the number of skin conductance fluctuations (NSCF) during eye examinations.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1107 "Ancho" => 1617 "Tamanyo" => 51325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Boxplot diagram showing the differences in the number of skin conductance fluctuations (NSCF) in patients with and without desaturation episodes during eye examination.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus American Association of Certified Orthoptists: Screening Examination of Premature Infants for Retinopathy of Prematurity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.M. Fierson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatrics" "fecha" => "2013" "volumen" => "131" "paginaInicial" => "189" "paginaFinal" => "195" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What is best practice for providing pain relief during retinopathy of prematurity eye examinations?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Francis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ANC.0000000000000267" "Revista" => array:6 [ "tituloSerie" => "Adv Neonatal Care" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "220" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27195471" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pain management during retinopathy of prematurity eye examinations: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.A. Samra" 1 => "J.M. McGrath" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ANC.0b013e3181a68b48" "Revista" => array:6 [ "tituloSerie" => "Adv Neonatal Care" "fecha" => "2009" "volumen" => "9" "paginaInicial" => "99" "paginaFinal" => "110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19542771" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of pain in the neonate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.G. Maxwell" 1 => "C.P. Malavolta" 2 => "M.V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 9 | 20 |
| 2024 October | 44 | 40 | 84 |
| 2024 September | 44 | 35 | 79 |
| 2024 August | 57 | 54 | 111 |
| 2024 July | 32 | 24 | 56 |
| 2024 June | 39 | 26 | 65 |
| 2024 May | 37 | 44 | 81 |
| 2024 April | 36 | 26 | 62 |
| 2024 March | 35 | 21 | 56 |
| 2024 February | 31 | 27 | 58 |
| 2024 January | 24 | 24 | 48 |
| 2023 December | 24 | 21 | 45 |
| 2023 November | 30 | 37 | 67 |
| 2023 October | 31 | 31 | 62 |
| 2023 September | 32 | 16 | 48 |
| 2023 August | 22 | 19 | 41 |
| 2023 July | 27 | 25 | 52 |
| 2023 June | 28 | 28 | 56 |
| 2023 May | 28 | 21 | 49 |
| 2023 April | 29 | 17 | 46 |
| 2023 March | 62 | 21 | 83 |
| 2023 February | 42 | 14 | 56 |
| 2023 January | 33 | 25 | 58 |
| 2022 December | 68 | 27 | 95 |
| 2022 November | 64 | 37 | 101 |
| 2022 October | 66 | 38 | 104 |
| 2022 September | 44 | 24 | 68 |
| 2022 August | 56 | 51 | 107 |
| 2022 July | 52 | 45 | 97 |
| 2022 June | 45 | 40 | 85 |
| 2022 May | 44 | 33 | 77 |
| 2022 April | 29 | 29 | 58 |
| 2022 March | 41 | 44 | 85 |
| 2022 February | 34 | 33 | 67 |
| 2022 January | 52 | 20 | 72 |
| 2021 December | 50 | 39 | 89 |
| 2021 November | 70 | 54 | 124 |
| 2021 October | 102 | 78 | 180 |
| 2021 September | 44 | 42 | 86 |
| 2021 August | 40 | 63 | 103 |
| 2021 July | 56 | 30 | 86 |
| 2021 June | 56 | 47 | 103 |
| 2021 May | 43 | 68 | 111 |
| 2021 April | 117 | 60 | 177 |
| 2021 March | 55 | 33 | 88 |
| 2021 February | 32 | 20 | 52 |
| 2021 January | 55 | 32 | 87 |
| 2020 December | 42 | 18 | 60 |
| 2020 November | 42 | 13 | 55 |
| 2020 October | 38 | 14 | 52 |
| 2020 September | 48 | 37 | 85 |
| 2020 August | 52 | 26 | 78 |
| 2020 July | 87 | 41 | 128 |
| 2020 June | 89 | 7 | 96 |
| 2020 May | 40 | 15 | 55 |
| 2020 April | 38 | 10 | 48 |
| 2020 March | 28 | 10 | 38 |
| 2020 February | 27 | 12 | 39 |
| 2020 January | 29 | 10 | 39 |
| 2019 December | 36 | 13 | 49 |
| 2019 November | 18 | 4 | 22 |
| 2019 October | 31 | 11 | 42 |
| 2019 September | 27 | 10 | 37 |
| 2019 August | 14 | 18 | 32 |
| 2019 July | 21 | 20 | 41 |
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