The use of eyemasks for reducing neonatal stress following dilated retinal examination

THIRD PRIZE, COS AWARDS FOR EXCELLENCE IN OPHTHALMIC RESEARCH

Authors: Andrei-Alexandru Szigiato, Mathew F. Speckert, Jeanne Zielonka, Kathleen Hollamby, Mary Debono, Filiberto Altomare, Eugene Ng, Rosane Nisenbaum, Michael Sgro
Author Disclosure Block: A. Szigiato: None. M.F. Speckert: None. J. Zielonka: None. K. Hollamby: None. M. Debono: None. F. Altomare: None. E. Ng: None. R. Nisenbaum: None. M. Sgro: None.

Abstract Body:

Purpose: Dilated retinal examination is routinely performed for low birthweight, preterm infants at risk of developing retinopathy of prematurity (ROP). While these examinations help prevent blindness, they can be physiologically stressful for infants. Changes in oxygen saturation, blood pressure and heart rate occur during the exam and increased apneic episodes have been reported the 24h-48hs afterward. We postulate that photosensitivity during mydriasis contributes to exam stress and that reducing light stimulation with a phototherapy mask can make infants more comfortable.

Study Design: Multi-centre randomized clinical study.

Methods: After informed consent was obtained, infants with a birthweight <1500g or gestational age of ≤32 weeks scheduled for their first ROP screening were randomized to receive either routine care or a phototherapy mask during pupil dilation in addition to routine care, worn for a minimum of 4hrs. Dilated retinal exams were performed by retinal surgeons and fellows. The primary outcome was the frequency of any desaturation, bradycardic event, or apneic event 12 hours following the examination, compared to baseline. Heart rate, respiratory rate and oxygen saturation were also recorded for 4 hours following the examination.

Results: A total of 51 infants were examined; 28 randomized to the masked group and 23 to the control group. 10 and 13 infants were on ventilator support at the time of examination in each group, respectively. There was a 57.7% decrease in all stressful events in the masked group compared to controls in the 12 hour post-exam period (Rate Ratio=0.42, 95% CI 0.2-0.9, P=0.024). There was a 61.3% decrease in bradycardic events in the masked group compared to controls (RR=0.39, 95% CI 0.2-1.0, P=0.042). Heart rate was higher in both groups after the exam (Mean HR: 164.67 bpm post vs 157.3 bpm pre; P=0.04), with no difference in between groups (Effect by group P=0.31). There was no significant difference seen in either group in respiratory rate or oxygen saturation at 2 or 4 hours after the ROP examination. Risk factors associated with increased stress included younger gestational age (RR=1.32 95%CI [1.2-1.5] per week), lower birthweight (RR=1.39 [1.2-1.5] per 100g), ventilator support around the time of exam (RR=2.67 [1.3-5.6]), intraventricular hemorrhage (RR=3.78 [1.9-7.3]), and hyponatremia (RR=3.42 [1.8-6.6]). No adverse events occurred while using eye masks.

Conclusions: Infants who wore a phototherapy mask during pupillary dilation had lower rates of stressful episodes following dilated retinal examination, particularly lower episodes of bradycardia.