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Interdisciplinary collaborative eye examinations to protect preterm infant neurodevelopment: a quality improvement
Dana B McCarty1, Erika Clary-Williams2, Kristen D LeBLond3
1Division of Physical Therapy, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Frontiers in Psychology
|May 21, 2024
Summary
A new Collaborative Eye Exam Model (CEEM) in the Neonatal Intensive Care Unit (NICU) reduced desaturation events and improved heart rate recovery in preterm infants undergoing eye exams for Retinopathy of Prematurity (ROP). Staff found the CEEM improved the exam experience.
Area of Science:
- Neonatal care
- Ophthalmology
- Pediatric critical care
Background:
- Infants born prematurely require routine eye exams for Retinopathy of Prematurity (ROP) screening in the Neonatal Intensive Care Unit (NICU).
- Preterm infants have underdeveloped sensory systems, and painful stimuli during exams can negatively impact developmental outcomes.
- Current eye exam protocols may cause distress and physiological instability in vulnerable infants.
Purpose of the Study:
- To evaluate the effectiveness of a novel Collaborative Eye Exam Model (CEEM) designed to minimize pain and improve physiological stability during ROP screening in preterm infants.
- To compare pain scores and vital sign changes between the CEEM and standard of care (SC) eye exams.
- To gather stakeholder feedback on the CEEM's impact on infant and staff experience.
Main Methods:
- An interdisciplinary NICU team developed the CEEM, incorporating pain management best practices.
- Pain scores and vital signs (heart rate, oxygen saturation) were systematically recorded before, during, and after eye exams.
- Mixed-effects regression models analyzed the relationship between the CEEM, birth gestational age (BGA), postmenstrual age (PMA), and physiological outcomes.
- Survey feedback was collected from NICU staff regarding their experience with the CEEM.
Main Results:
- The CEEM significantly reduced desaturation events (p=0.003) and improved heart rate recovery (p=0.04) compared to SC, particularly in infants with earlier BGA.
- While no differences in pain scores were observed, the CEEM showed a trend towards reduced bradycardia and tachycardia in some analyses.
- Stakeholders reported a significant improvement in both infant and staff experience with the CEEM.
Conclusions:
- The CEEM is a promising intervention for improving physiological stability and the overall experience during ROP screening eye exams in preterm infants.
- Infants may experience differential benefits from the CEEM based on their specific birth gestational age and postmenstrual age.
- The CEEM demonstrates the value of interdisciplinary collaboration in optimizing care for high-risk neonates.
