Pain and stress assessment after retinopathy of prematurity screening examination: Indirect ophthalmoscopy versus digital retinal imaging

Abstract

BackgroundIncreasingly, neonatal clinics seek to minimize painful experiences and stress for premature infants. Fundoscopy performed with a binocular indirect ophthalmoscope is the reference examination technique for screening of retinopathy of prematurity (ROP), and it is associated with pain and stress. Wide-field digital retinal imaging is a recent technique that should be evaluated for minimizing infant pain and stress.MethodsThe purpose of the study was to assess and compare the impact of using a binocular indirect ophthalmoscope (BIO), or wide-field digital retinal imaging (WFDRI) on pain and stress in infants undergoing ROP screening examination. This was a comparative evaluation study of two screening procedures. Ophthalmologic examinations (N = 70) were performed on 24 infants with both BIO and WFDRI. Pain assessments were performed with two specific neonatal scales (Crying, requires oxygen, increased vital signs, expression and sleeplessness, CRIES and, Premature infant pain profile, PIPP) just prior to the examination, and 30 seconds, 1 hour, and 24 hours later after ending the examination.ResultsChanges over time were significantly different between BIO and WFDRI with both scales (PIPP score, p = .007, and CRIES score, p = .001). Median PIPP score (interquartile interval) at baseline was 4 (3–5). At 30 seconds the score was 8 (6–9) for BIO and 6 (5–7) for WFDRI, respectively. The increase in PIPP score between baseline and 30 seconds was significantly lower with WFDRI (p = .006). The median increase in CRIES score from baseline to 30 seconds was 1 point lower for WFDRI than for BIO (p < .001). No significant difference in response remained at 1 hour or 24 hour assessments.ConclusionsA transient short-term pain and stress response occurs with both BIO and WFDRI. Infants examined for screening of ROP with digital retinal imaging present less pain and stress at 30 seconds following completion of the exam when compared with binocular indirect ophthalmoscopy.

Comparison of strategies for grading retinal images of premature infants for referral warranted retinopathy of prematurity

“…Temporary levels of distress occur during both the clinical examination and during retinal imaging. 32,33 It is possible that examiners over-called zone I in cases where they made this determination while the infant or the infant’s eye was moving during the examination. On the other hand, the reader of the digital retinal image was able to apply a standard definition of zone I on the motionless retinal image with precision.…”

Safety of Retinopathy of Prematurity Examination and Imaging in Premature Infants

“…(12, 15–17) Clinical findings that occur during ROP screening procedures highlight the fragility of extremely premature infants, their propensity to have apnea, bradycardia and hypoxia events, as well as the pain response and oculocardiac reflex invoked by ROP evaluation procedures.…”

Risk factors for retinopathy of prematurity: insights from outlier infants

“…Studies have shown that only 20–66% of infants screened for ROP will develop ROP [7–11] and an even smaller number (5–10%) will require treatment [7, 9, 10, 12], resulting in many infants being screened unnecessarily. Screening examinations are stressful for infants [13, 14], and are known to have adverse physiologic effects, including an increase in apnea events among screened infants. [15, 16] As such, there is a significant incentive to limit unnecessary screening examinations.…”