The positive prognostic implications of crying during exam on threshold ROP
Jon Blackledge1, Dustin M Lang, Robert W Arnold
1Pediatric Ophthalmology and Strabismus Ophthalmic Associates, 542 West Second Avenue, Anchorage, Alaska 99501-2242, USA.
Insights
Infants unable to cry during ROP screening are at higher risk for threshold retinopathy of prematurity. This finding highlights the importance of monitoring infant crying during eye exams for early detection and intervention.
Area of Science:
- Ophthalmology
- Neonatology
- Perinatal Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Routine screening for ROP is crucial for timely intervention and prevention of vision loss.
Purpose of the Study:
- To investigate the association between an infant's ability to cry during ROP screening and the progression to threshold ROP.
- To determine if the absence of crying is an independent risk factor for severe ROP.
Main Methods:
- A prospective study of Alaskan infants with birthweight ≤ 1500 grams from 1989-2003.
- Observation of infant crying status (cry, quiet, or intubated) during the 31-week ROP screening exam, including indirect ophthalmoscopy with lid speculum and scleral depression.
Main Results:
- A total of 873 infants were classified for threshold ROP.
- Infants who cried during the screening were significantly less likely to progress to threshold ROP (p < .001).
- The increased risk of threshold ROP in non-crying infants remained significant, independent of gestational age and birthweight.
Conclusions:
- The inability to cry during the initial ROP screening may indicate underlying respiratory or neurologic issues.
- These co-morbidities place infants at a higher risk for progressing to threshold ROP.
- Monitoring infant crying behavior during ROP screening can aid in identifying high-risk infants requiring closer observation and management.
Introduction:
Most infants cry with lid speculum, scleral depression and indirect ophthalmoscopy. This simple observation, "did the infant cry?" during the initial 31-week ROP screening exam was prospectively studied.
Methods:
From Fall 1989 through Summer 2003, all Alaskan infants with birthweight < or = 1500 grams were examined by RWA. After 1992, at the 31-week initial ROP screening, we recorded whether the infant was able to cry (cry), did not cry (quiet), or was intubated (vent) during indirect ophthalmoscopy with lid speculum and scleral depression.
Results:
ROP was classified as to threshold in 873 infants. Infants who were able to cry during their 31-week GA screening exam were less likely to progress to threshold (Chi square 600, 2 = 36, p < .001). Using a logistic fit of Threshold, the increased risk of ROP in infants unable to cry persisted independent of gestational age or birthweight.
Conclusions:
Respiratory and neurologic co-morbidity may render those infants unable to cry during the first screening examination at increased risk to progress to threshold ROP.
