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

早产儿视网膜病变（ROP）是早产儿视网膜血管系统的一种疾病，可导致儿童失明。如果在足够早的阶段发现，这种疾病是可以治疗的;因此，有一个经常检查的方案，以促进及时诊断。不幸的是，ROP筛查被认为是痛苦的;婴儿在手术期间和手术后都非常不安，疼痛评分很高，并且在筛查后不久呼吸暂停发作的可能性增加。局部麻醉滴眼液和干预措施，如襁褓和蔗糖，以前已被证明在缓解与手术相关的疼痛方面取得了有限的成功。婴儿疼痛是一个严重的临床问题。在早产期进行大量痛苦的手术会导致认知能力的长期缺陷以及生理稳定性的短期变化。因此，更好地治疗婴儿疼痛至关重要。然而，由于婴儿不能描述他们的经验，识别婴儿的疼痛是一个复杂的问题。疼痛的行为和生理措施已被表征，最近，在婴儿急性手术中已确定了毒性诱发的脑活动。由于疼痛是一种表现在大脑中的感知，将大脑活动测量与行为和生理反应相结合可能会提供更准确的综合测量，这将有助于我们了解婴儿的疼痛体验。关键目标：1.充分验证婴儿ROP筛查的生理反应，使用多模态方法测量大脑活动、反射退缩、面部表情、心率和血氧饱和度。在ROP治疗期间使用脑源性方法调查疼痛感知，并确定这些措施对其他长期临床程序的可推广性。通过比较两种目前使用的技术，并评估对短期和长期中枢神经系统功能和疼痛感知的影响，优化ROP筛查期间使用的技术。

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.