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Preterm Infant Stress During Handheld Optical Coherence Tomography vs Binocular Indirect Ophthalmoscopy Examination
Shwetha Mangalesh1, Neeru Sarin1, Brendan McGeehan2
1Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina.
Insights
Investigational optical coherence tomography (OCT) imaging for retinopathy of prematurity (ROP) causes less infant stress than binocular indirect ophthalmoscopy (BIO). OCT is a potentially less stressful alternative for ROP screening in preterm infants.
Area of Science:
- Neonatal ophthalmology
- Medical imaging technologies
- Infant distress assessment
Background:
- Binocular indirect ophthalmoscopy (BIO) is a standard method for diagnosing retinopathy of prematurity (ROP).
- BIO examinations are known to cause significant stress in preterm infants.
Purpose of the Study:
- To compare the level of infant stress induced by investigational optical coherence tomography (OCT) imaging versus standard BIO for ROP assessment.
- To evaluate the potential of OCT as a less stressful diagnostic tool for ROP.
Main Methods:
- A cross-sectional study was conducted in a neonatal intensive care unit.
- Infant stress was measured using a validated neonatal pain assessment tool during OCT imaging and BIO examinations of each eye.
- Data were collected from 16 preterm infants undergoing 71 eye examinations.
Main Results:
- Infant stress indicators, including crying, facial expression, and heart rate, were significantly lower during OCT imaging compared to BIO examinations.
- Specifically, infant cry scores decreased by -1.65 to -1.87, facial expressions indicating distress were reduced by 79-83%, and heart rate changes were lower by 20-23 beats per minute during OCT.
- Changes in respiratory rate and oxygen saturation did not significantly differ between the two examination methods.
Conclusions:
- Investigational OCT imaging appears to be less stressful for preterm infants than traditional BIO examinations for ROP.
- OCT may offer a more comfortable alternative for ROP screening, although its role in ROP management requires further investigation.
Importance:
Binocular indirect ophthalmoscopy (BIO) examination for retinopathy of prematurity (ROP) is a well-known cause of repeated preterm infant stress.
Objective:
To compare stress during investigational optical coherence tomography (OCT) imaging to that during BIO for ROP.
Design, Setting, And Participants:
This cross-sectional study examined infants at the bedside in the intensive care nursery. Consecutive preterm infants enrolled in Study of Eye Imaging in Preterm Infants (BabySTEPS) who had any research OCT imaging as part of the study. Patients were recruited from June to November 2019, and analysis began April 2020.
Main Outcomes And Measures:
Infant stress was measured using modified components of a neonatal pain assessment tool before (baseline) and during OCT imaging and BIO examination of each eye.
Results:
For 71 eye examinations of 16 infants (mean [SD] gestational age, 27 [3] weeks; birth weight, 869 [277] g), change from baseline to each eye examination was lower during OCT imaging than during BIO and the difference between OCT imaging and BIO at each eye examination was significant for the following: infant cry score (first eye examination: mean [SD], 0.03 [0.3] vs 1.68 [1.2]; -1.65 [95% CI, -1.91 to -1.39]; second eye examination: mean [SD], 0.1 [0.3] vs 1.97 [1.2]; -1.87 [95% CI, -2.19 to -1.54]), facial expression (first eye: 3 [4%] vs 59 [83%]; -79% [95% CI, -87% to -72%]; second eye: 4 [6%] vs 61 [88%]; -83% [95% CI, -89% to -76%]), and heart rate (first eye: mean [SD], -7 [16] vs 13 [18]; -20 [95% CI, -26 to -14]); second eye: mean [SD], -3 [18] vs 20 [20] beats per minute; -23 [95% CI, -29 to -18]) (P < .001 for all). Change in respiratory rate and oxygen saturation did not differ between OCT imaging and BIO.
Conclusions And Relevance:
While the role of OCT alone or in combination with BIO is currently unknown for ROP, these findings suggest that investigational OCT imaging of ROP is less stressful than BIO examination by a trained ophthalmologist.
