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Published on: December 31, 2015
Preterm Infant Stress During Noncontact Handheld Optical Coherence Tomography and Contact Fundus Photography
Angela S Li1, Neeru Sarin1, Jocelyn He2
1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Insights
Noncontact handheld optical coherence tomography (OCT) caused less stress in preterm infants during retinopathy of prematurity (ROP) examinations compared to contact fundus photography. This new OCT method also led to fewer adverse events, improving infant comfort and safety.
Area of Science:
- Neonatal ophthalmology
- Medical imaging technology
- Pediatric critical care
Background:
- Retinopathy of prematurity (ROP) assessments can induce stress in preterm infants.
- Minimizing stress during ROP examinations is crucial for infant well-being.
- Evaluating novel imaging techniques for less invasive ROP screening is important.
Purpose of the Study:
- To compare the stress levels of preterm infants during ROP examinations using noncontact optical coherence tomography (OCT) versus contact fundus photography.
- To assess adverse events associated with each imaging modality.
Main Methods:
- A prospective cohort study was conducted in a single tertiary care center's intensive care nursery.
- Preterm infants underwent ROP examinations using both investigational handheld noncontact OCT and contact fundus camera in a randomized order.
- Infant stress was measured using the Modified CRIES score, heart rate, and oxygen saturation, with adverse events also recorded.
Main Results:
- Noncontact OCT resulted in significantly lower changes in cry score, facial expression score, and heart rate compared to fundus photography.
- Adverse events, including tachycardia, bradycardia, and hypoxia, were significantly less frequent with OCT imaging.
- No ocular, unexpected, or severe adverse events were reported for either imaging method.
Conclusions:
- Noncontact handheld OCT appears to be a less stressful imaging modality for preterm infants undergoing ROP examinations.
- The use of noncontact OCT may reduce the incidence of adverse events associated with ROP screening.
- Further investigation into the role of handheld OCT for ROP screening is warranted.
Importance:
Limiting the stress of retinopathy of prematurity (ROP) assessments may be beneficial for preterm infants.
Objective:
To compare stress in preterm infants from noncontact optical coherence tomography (OCT) vs contact fundus photography during ROP examinations.
Design, Setting, And Participants:
This was a prospective cohort study at an intensive care nursery in a single tertiary care center. Included were infants enrolled in Retinal Microanatomy in ROP (BabySTEPS2) from June 2023 to January 2025.
Exposures:
During clinically indicated ROP examinations, research imaging with an investigational handheld noncontact OCT system (Duke University) and a contact fundus camera was performed in randomized order in the study eye by expert imagers. Stress data were captured by bedside research nurses.
Main Outcomes And Measures:
Modified CRIES (C, crying; R, requires increased oxygen administration; I, increased vital signs; E, expression; S, sleeplessness) neonatal pain score (cry score 0-4, facial expression score 0-2), heart rate, oxygen saturation, and adverse events (AEs) were collected up to 5 minutes before, during, and 1 to 5 minutes after imaging with each device.
Results:
A total of 59 preterm infants (mean [SD] gestational age, 26.1 [2.0] weeks; 35 male [59.3%]) underwent 397 OCT and fundus photography imaging sessions. Regardless of device order, for OCT compared with fundus photography, there was less change in (1) cry score from baseline to during imaging (mean [SD], 0.12 [0.60] vs 1.70 [1.00]; mean difference, -1.59; 95% CI, -1.75 to -1.42) and after imaging (-0.07 [0.43] vs 0.31 [0.67]; mean difference, -0.38; 95% CI, -0.47 to -0.28; P < .001 for both), (2) facial expression score from baseline to during imaging (16.8% vs 75.8%) and after imaging (2.6% vs 22.5%; P < .001 for both), and (3) heart rate from baseline to during imaging (mean [SD], -5.2 [16.1] bpm vs 10.9 [23.1] bpm; mean difference, -16.1 bpm; 95% CI, -19.2 to -13.0 bpm) and after imaging (-7.2 [17.2] vs 18.8 [21.4] bpm; mean difference, -25.9 bpm; 95% CI, -29.3 to -22.6 bpm; P < .001 for both). Thirty-two AEs (tachycardia, bradycardia, hypoxia, or emesis) occurred in 28 of 399 imaging sessions (7.0%), and 26 of 32 (81.3%) were during or after fundus photography. No ocular, unexpected, or severe AEs occurred.
Conclusions And Relevance:
In this cohort study, although the role of handheld OCT in ROP screening remains under investigation, findings suggest that noncontact handheld OCT was less stressful to preterm infants undergoing ROP examination and resulted in fewer associated AEs compared with contact fundus photography.
