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Pilot study of the systemic effects of three different screening methods used for retinopathy of prematurity
Manisha Mehta1, G G W Adams, Catey Bunce
1Strabismus and Paediatric Service, Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK.
Insights
Retinopathy of prematurity (ROP) screening using RetCam 120 or indirect ophthalmoscopy with a speculum caused more infant stress than indirect ophthalmoscopy alone. Consider these physiological and behavioral changes when selecting ROP screening methods.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- Timely ROP screening is crucial for early intervention and vision preservation.
- Various screening methods exist, each with potential impacts on infant well-being.
Purpose of the Study:
- To compare physiological and behavioral responses of premature infants to three ROP screening methods.
- To identify the least stressful ROP screening approach for vulnerable infants.
Main Methods:
- A prospective, randomized, cross-over pilot study involving 15 premature infants.
- Comparison of RetCam 120, indirect ophthalmoscopy with a speculum, and indirect ophthalmoscopy without a speculum.
- Measurement of physiological indices (pulse, blood pressure, oxygen saturation) and behavioral pain responses.
Main Results:
- RetCam 120 and indirect ophthalmoscopy with a speculum induced greater changes in pulse and blood pressure compared to indirect ophthalmoscopy alone.
- Increased facial pain responses were observed during and immediately after using RetCam 120 and indirect ophthalmoscopy with a speculum.
- RetCam 120 screening resulted in more significant oxygen desaturation.
Conclusions:
- Indirect ophthalmoscopy without a speculum appears to be the least stressful method for ROP screening.
- Physiological and behavioral stress indicators should guide the selection of ROP screening methods, especially for critically ill infants.
Purpose:
This pilot study compared the physiological and behavioural changes in premature infants undergoing three different methods of screening for retinopathy of prematurity (ROP).
Study Design:
Prospective randomized cross-over pilot study.
Subjects And Methods:
Fifteen premature infants requiring screening for ROP were recruited, and physiological and behavioural responses produced by three different methods of screening were compared. The screening methods employed a RetCam 120 and an indirect ophthalmoscope with and without an eyelid speculum. Physiological indices (change in pulse, mean blood pressure and oxygen saturation) and facial responses to pain (brow bulge, eye squeeze, nasolabial fold, mouth opening and the presence of cry) were recorded at five points: before, during and immediately after screening and 10 and 30 min after examination.
Results:
Screening with the RetCam 120 and the indirect ophthalmoscope with a speculum both caused a greater change in pulse and mean blood pressure and an increase in facial responses to pain during and immediately after screening as compared to the indirect ophthalmoscope without the speculum. RetCam 120 screening caused greater desaturation than the other methods.
Conclusions:
Although this was a small sample which limits absolute conclusions, the study showed that screening using a RetCam or a speculum and indirect ophthalmoscope caused more stress to the infant, as indicated by physiological and behavioural changes, than simply screening using an indirect ophthalmoscope without a speculum. These effects should be considered when deciding on the appropriate screening method for examining particularly sick infants.
