Retinopathy of prematurity: eye-shielding might reduce stress after dilated exam

  • Szigiato AA & al.
  • JAMA Ophthalmol
  • 5 Sep 2019

  • International Clinical Digest
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Takeaway

  • After dilated exam for retinopathy of prematurity (ROP), a phototherapy mask to shield infant eyes might reduce stress incidents.
  • The study is limited by unequal use of ventilator support, a confounding stress factor in this trial.

Why this matters

  • ROP screenings effectively prevent blindness in this high-risk group, but these infants also show signs of stress in the 12 hours after dilated examination.
  • Editorial: the main limitation is unfortunate, and the results need to be validated, but the authors did a “nice job” separating out signal from noise in this work. 

Key results

  • Ventilator support: 35.7% in intervention group vs 56.5% in control group.
  • Stressful event rates differed between groups at 12 hours post-exam, but not significantly:
    • Rate ratio: 0.57 (95% CI, 0.3-1.2; P=.12).
  • Younger gestational age, lower birth weight, ventilator support, hyponatraemia were all associated with increased stress. 
  • No adverse events with the eye masks.

Study design

  • Randomised trial, infants (mean gestational age, 27.9 weeks; 63% boys) in neonatal ICUs, Toronto.
  • 55 infants (30 in treatment, wearing phototherapy mask ≥4 hours post-exam).
  • Outcomes: desaturation, apnoeic, bradycardic events within 12 hours.
  • Funding: Phototherapy masks from Natus.

Limitations

  • Staff knew group status.
  • Small study.

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