Clinical trial NCT05967572: The Effect of Different Music Listened During Retinopathy Examination to Premature Infants
Official title: The Effect of Different Music Listened During Retinopathy Examination to Premature Infants on Their Pain and Comfort Level: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Retinopathy of Prematurity
Newborn
Keywords: Pain
Nursing
Comfort
Music
Prematurity
Lead sponsor: Necmettin Erbakan University
Sponsor class: OTHER
First posted: 2023-08-01
Enrollment: 84
Sex: ALL
Minimum age (years): 28
Maximum age (years): 36
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: The research is a stratified randomized controlled experimental type study.
Primary purpose: SUPPORTIVE_CARE

Brief summary: Retinopathy of Prematurity (ROP); It is a disease of premature and low birth weight infants, characterized by incomplete vascularization of the retina, etiology and pathogenesis of which is unknown, and causes vision loss. There is an increase in the incidence and severity of ROP development in direct proportion to the decrease in birth week and birth weight. While ROP is a problem below 32 weeks of gestation in developed countries, it is reported to develop severely up to 34 weeks of gestation in developing countries. In a multicenter study conducted by the Turkish Neonatology Society in our country, the frequency of ROP in very low birth weight preterm infants was found to be 42%, and the frequency of advanced ROP was 11%. The incidence of ROP in babies with a gestational age of 33-35 weeks was 6.1%, and advanced ROP was 6 per thousand. The frequency of ROP was found to be 10.3% in babies with a birth weight of 1500-2000 grams, and severe ROP was reported in 19 of these babies. ROP examination is a procedure that causes pain, deterioration in comfort and physiological changes in preterm newborns. After this examination, an increase in blood pressure and heart rate and a decrease in oxygen saturation are observed. Pharmacological and non-pharmacological (non-pharmacological) methods are used to reduce the pain and increase the comfort level of the premature newborn. As a pharmacological method, there is no other routine method used to reduce pain other than the administration of local anesthetic drops before the examination. Because of this situation, nurses apply various non-pharmacological methods to alleviate pain. These methods are; breast milk, sucrose use, oral dextrose use, non-nutritive sucking, positioning, listening to music and mother's voice. In the literature, no specific study was found in which music was used to reduce pain and increase the comfort level during the ROP examination. Therefore, this research will be carried out to determine the effect of different music played on the pain and comfort level of premature babies during the retinopathy examination.

Detailed description: Retinopathy of Prematurity (ROP); It is a disease characterized by incomplete vascularization of the retina seen in premature and low birth weight infants, the etiology and pathogenesis of which are unknown, causing vision loss. There is an increase in the incidence and severity of ROP development in direct proportion to the decrease in the week of birth and birth weight. While ROP is a problem below 32 weeks of gestation in developed countries, it is reported to develop severely up to 34 weeks of gestation in developing countries. In a multicenter study conducted by the Turkish Neonatology Society in our country, the frequency of ROP in very low birth weight preterm infants was found to be 42%, and the frequency of advanced ROP was 11%. The incidence of ROP in babies with a gestational age of 33-35 weeks was 6.1%, and advanced ROP was 6 per thousand. The frequency of ROP was found to be 10.3% in babies with a birth weight of 1500-2000 grams, and severe ROP was reported in 19 of these babies. Thanks to the increasing frequency of preterm birth in recent years and scientific and technological advances in neonatology, life expectancy is extended up to the 23rd week of gestation. However, this increased the incidence of retinopathy. Therefore, it is of great importance for neotologists, pediatricians and nurses who care for preterms to know the pathophysiology, staging, risk factors and principles of appropriate care for them in reducing the incidence, possible complications and mortality rates of ROP. ROP examination is a procedure that causes pain, deterioration in comfort and physiological changes in preterm newborns. After this examination, an increase in blood pressure and heart rate and a decrease in oxygen saturation are observed. These physiological changes observed after the examination continue for 24 hours. Pharmacological and non-pharmacological (non-pharmacological) methods are used to reduce the pain and increase the comfort level of the premature newborn. As a pharmacological method, there is no other routine method used to reduce pain other than the administration of local anesthetic drops before the examination. Because of this situation, nurses apply various non-pharmacological methods to alleviate pain. These methods are; breast milk, sucrose use, oral dextrose use, non-nutritive sucking, positioning, listening to music and mother's voice. In the literature review; In a study evaluating the effectiveness of sucrose combination with non-nutritive sucking, they reported that pain was moderately reduced and more studies are needed. In another study (2015), it was concluded that topical anesthesia and oral dextrose were not effective in reducing pain in both groups. In a study comparing the effectiveness of breast milk and sucrose, it is recommended to use breast milk because of the rapid recovery of the baby after the ROP examination. In the comparison of the position, which is another non-pharmacological method, with the routine practice in the study conducted in 2019; It has been concluded that the frock position is more effective in relieving pain. In another study, it was stated that the mother's voice as music therapy also showed an analgesic effect and accelerated the recovery after the ROP examination. In the light of this information, when we look at the literature, no specific study was found in which a rain stick and The Happiest Baby music were used to reduce pain and increase the comfort level during the ROP examination. Therefore, this research will be carried out to determine the effect of different music played on the pain and comfort level of premature babies during the retinopathy examination.

Eligibility criteria: Inclusion Criteria:

* • Gestational age ≤34 weeks

  * Birth Weight ≤2000 grams
  * Preterm newborns with a corrected/postnatal age of 28-36 weeks at the time of examination
  * Having the baby's first ROP examination
  * Not giving sedative, opioid and anticonvulsant drugs before/during the examination
  * Parents do not have diagnosed mental or mental problems and agree to participate in the research.

Exclusion Criteria:

* Presence of a condition that prevents pain assessment (intracranial hemorrhage, neuromotor developmental retardation, etc.)

  * Oxygen requirement (nasal cannula, hood or incubator)
  * Having any congenital defect (eye, neurological) that may adversely affect the examination
  * Having a diagnosed hearing loss
  * Performing a different painful procedure at least one hour before the ROP
  * Being connected to a mechanical ventilator
  * Congenital hearing problems in family members

Primary outcomes:
measure: Baby Information Form:
timeFrame: It will be applied when babies first arrive.
Secondary outcomes:
measure: Premature Infant Pain Profile (PIPP)
timeFrame: Approximately 2 minutes of video will be recorded and measurement will be taken approximately in the first minute of the video and 2 minutes after the video.
Other outcomes:
measure: Premature Baby Comfort Scale
timeFrame: Approximately 2 minutes of video will be recorded and measurement will be taken approximately in the first minute of the video and 2 minutes after the video.
Locations:
city: Konya
country: Turkey
facility: Necmettin Erbakan University
state: Meram
Study officials:
affiliation: Necmettin Erbakan University
name: Semra KÖSE
role: STUDY_DIRECTOR
References:
citation: Bilgeç, G. H., & Erol N. (2018). Epidemiology, Prevalence and Incidence in Retinopathy of Prematurity (Vol. 2, Issue 1). Chen, H. L., Chen, C. H., Wu, C. C., Huang, H. J., Wang, T. M., & Hsu, C. C. (2009). The Influence of Neonatal Intensive Care Unit Design on Sound Level. Pediatrics and Neonatology, 50(6), 270-274. https://doi.org/10.1016/S1875-9572(09)60076-0 Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Routledge. Corrigan, M. J., Keeler, J. R., Miller, H. D., ben Khallouq, B. A., & Fowler, S. B. (2020). Music therapy and retinopathy of prematurity screening: using recorded maternal singing and heartbeat for post exam recovery. Journal of Perinatology, 40(12), 1780-1788. https://doi.org/10.1038/S41372-020-0719-9 Derebent, E. (2007). The Effect of Kangaroo Care on Reducing Pain During Invasive Procedures for Premature Babies. Dilli, D., Ilarslan, N. E. Ç., Kabataş, E. U., Zenciroǧlu, A., Şimşek, Y., & Okumuş, N. (2014). Oral sucrose and non-nutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations. Acta Paediatrica (Oslo, Norway: 1992), 103(2). https://doi.org/10.1111/APA.12454 Dolgun, G. (2019). The Use of Pulse Oximetry in Defining Critical Congenital Heart Diseases and the Role of Midwife-Nurse. Journal of Education and Research in Nursing. https://doi.org/10.5222/head.2019.134 Gibbins, S., Stevens, B. J., Yamada, J., Dionne, K., Campbell-Yeo, M., Lee, G., Caddell, K., Johnston, C., & Taddio, A. (2014). Validation of the Premature Infant Pain Profile-Revised (PIPP-R). Early Human Development, 90(4), 189-193. https://doi.org/10.1016/J.EARLHUMDEV.2014.01.005 Koç, E., Yağmur, A., Prof, B., Özdek, S., & Ovali, F. (2021). Turkish Neonatology Society Turkish Ophthalmology Society Turkey Retinopathy of Prematurity Guideline 2021 Update. Küçük Alemdar, D., & Güdücü Tüfekci, F. (2015). The Reliability and Validity of the Premature Infant Comfort Scale's Turkish. Journal of Education and Research in Nursing. https://doi.org/10.5222/head.2015.142 Metres, O. (2014). Retinopathy of Prematurity from a Nursing Perspective. https://cms.galenos.com.tr/Uploads/Article_25271/European%20Archives%20of%20Medical%20Research-30-63-En.pdf Metreş, Ö., & Yıldız, S. (2019). Pain Management with ROP Position in Turkish Preterm Infants During Eye Examinations: A Randomized Controlled Trial. Journal of Pediatric Nursing, 49, e81-e89. https://doi.org/10.1016/J.PEDN.2019.08.013 Nesargi, S. v, Nithyanandam, S., Rao, S., Nimbalkar, S., & Bhat, S. (2015). Topical Anesthesia or Oral Dextrose for the Relief of Pain in Screening for Retinopathy of Prematurity: a Randomized Controlled Double-blinded Trial. https://doi.org/10.1093/tropej/fmu058 Parra, J., de Suremain, A., Berne Audeoud, F., Ego, A., & Debillon, T. (2017). Sound levels in a neonatal intensive care unit significantly exceeded recommendations, especially inside incubators. Acta Paediatrica, International Journal of Paediatrics, 106(12), 1909-1914. https://doi.org/10.1111/apa.13906 Sancak, S., Topçuoğlu, S., Çelik, G., Günay, M., & Karatekin, G. (2019). Frequency of Retinopathy of Prematurity and Evaluation of Risk Factors. Zeynep Kamil Medical Bulletin. https://doi.org/10.16948/zktipb.474762 Sun, X., Lemyre, B., Barrowman, N., & O'Connor, M. (2010). Pain management during eye examinations for retinopathy of prematurity in preterm infants: A systematic review. In Acta Paediatrica, International Journal of Paediatrics (Vol. 99, Issue 3, pp. 329-334). https://doi.org/10.1111/j.1651-2227.2009.01612.x Şener Taplak, A., & Erdem, E. (2017). A Comparison of Breast Milk and Sucrose in Reducing Neonatal Pain During Eye Exam for Retinopathy of Prematurity. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 12(5), 305-310. https://doi.org/10.1089/BFM.2016.0122 Taplak, A. S., & Erdem, E. (2018). Pain Management in Examination for Retinopathy of Prematurity. In Journal of Health Sciences) (Vol. 27, Issue 2).