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Updated: Jun 25, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Must screening examinations for retinopathy of prematurity necessarily be painful?
Lieselotte Kirchner1, Valerie Jeitler, Arnold Pollak
1Division of General Pediatrics and Neonatology, Medical University of Vienna, Vienna, Austria.
Insights
Ophthalmoscopy without eyelid specula and scleral indentation significantly reduces pain and stress in premature infants. Minimizing examination time and avoiding invasive tools improves infant well-being during eye exams.
Area of Science:
- Neonatal ophthalmology
- Pediatric patient care
Background:
- Neonatal eye examinations are crucial for detecting conditions.
- Standard examination procedures may cause pain and distress in premature infants.
Purpose of the Study:
- To evaluate the impact of examination techniques on pain and stress in premature infants.
- To compare the effects of using eyelid specula and scleral indentation versus a minimally invasive approach.
Main Methods:
- Ninety-two premature infants were studied across three neonatal wards.
- One group underwent standard examination with specula and indentation; the other had a minimized, non-invasive exam.
- Pain and stress were assessed using the Neonatal Infant Pain Score and heart rate monitoring.
Main Results:
- No significant differences in baseline demographics or vitals between groups.
- Infants examined with specula and indentation showed significantly higher heart rates and pain scores.
- Higher scores correlated with longer examination duration in the standard group.
Conclusions:
- Indirect ophthalmoscopy without specula and scleral indentation is less stressful for infants.
- Minimally invasive eye examination techniques are recommended for premature infants.
Purpose:
This study investigates the impact of the length of the examination, the insertion of eyelid specula, and the indentation of the globe on the pain and stress sensation of premature infants.
Methods:
Ninety-two premature infants in three neonatal wards were included. In two wards, the patients were examined using eyelid specula and scleral indentation as recommended in the official guidelines. In the third ward, the investigation time was minimized and ophthalmoscopy was performed without eyelid specula and scleral indentation. Physical and mental disturbance of the patients was assessed by the Neonatal Infant Pain Score and by monitoring the heart rate. The results were divided into two groups: in the one, eyelid specula and scleral indentation were used, whereas in the other one, they were not used. An independent-samples t-test was performed, which allowed us to calculate the correlation between the way the examination was executed and the condition of the patients.
Results:
Demographic data and baseline values of heart rate and pain score did not differ between the two groups. Heart rate and pain score during and after the investigation were significantly higher and increased significantly with the duration of the examination for the patients who were investigated using lid specula and scleral indentation.
Conclusion:
Our study shows that indirect ophthalmoscopy without specula causes significantly less stress to infants than screening with lid specula and scleral indentation.
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