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

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.