The Effect of White Noise and Swaddling on Pain, Heart Rate, and Oxygen Saturation in Term İnfants Undergoing Eye Examinations: A Randomised Controlled Trial

Early childhood is a critical period for identifying and treating eye diseases, as problems that develop during this time can lead to permanent vision loss. It is recommended that term infants be evaluated for congenital cataracts, congenital glaucoma, retinoblastoma, strabismus, amblyopia, and refractive errors. An estimated 20,000-40,000 babies are born with bilateral cataracts each year globally, leading to blindness in over 14 million children. Congenital glaucoma, a developmental disorder that can be unilateral or bilateral, often occurs at birth or within the first few months of life and can damage the optic nerve, leading to vision loss. The incidence of congenital glaucoma in developed countries is approximately 1 in 10,000-20,000 births. Infections such as rubella and cytomegalovirus (CMV) during pregnancy can also cause cataracts and glaucoma in infants. Detecting risk factors that could impede normal vision development through infant vision screening and providing early treatment helps prevent vision loss and blindness. In Turkey, the national vision screening program includes routine eye examinations and red reflex tests conducted by family physicians for infants aged 0-3 years. Additionally, term infants who do not require intensive care undergo detailed examinations for eye diseases like congenital cataracts and glaucoma at two reference hospitals designated by the Ministry of Health. These examinations use similar methods to those employed in retinopathy of prematurity (RP) screening.

Eye examinations for screening and early diagnosis can be painful and stressful for infants. Exposure to pain can lead to hypersensitivity to painful stimuli, a decreased pain threshold, and altered cortex development in the short term, as well as long-term behavioral problems and learning difficulties. Therefore, it is crucial to minimize pain and stress during these examinations. Systemic pharmacological analgesics used to reduce pain in infants can negatively impact their early brain development, nutrition, socialization, and memory in later years. Currently, non-pharmacologic methods to reduce pain in infants are gaining prominence. These methods are more cost-effective, easier to administer, and safer compared to pharmacologic approaches. They can also be used in combination with pharmacologic treatments. Various non-pharmacological methods frequently used for analgesia in newborns and infants include kangaroo care, swaddling, non-nutritive sucking, exposure to specific odors (such as from the mother, breast milk, or aromatic scents), sucrose, glucose, breast milk, music therapy, massage, white noise, and acupuncture. During eye examinations, blefastop is used to keep the baby's eyelids open, and a scleral depressor is employed to assess the bottom of the eye and move the eye sideways, causing discomfort. The white light source used by the ophthalmologist further unsettles the baby. Studies have explored different non-pharmacologic methods to reduce pain during eye examinations in premature infants, including touch, positioning, non-nutritive sucking, breast milk, glucose, sucrose, white noise, and music. However, these studies have yielded conflicting results, and the evidence remains insufficient. Upon reviewing the literature, no studies were encountered comparing the effects of non-pharmacologic methods on reducing pain during eye examinations in term infants. There is a need for further research to investigate the effectiveness of non-pharmacologic methods in alleviating pain during post-discharge eye examinations in term infants.

This study aimed to evaluate the effect of white noise and swaddling on interventional pain, heart rate, and oxygen saturation (SpO2) in term infants undergoing hospital eye examinations for post-discharge vision screening.

Hypotheses of the Study:

H01: Playing white noise to babies during eye examinations does not affect pain scores, heart rate, or oxygen saturation.