Uzun İrfan, Mutaf Çağri
Department of Ophthalmology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
Medicine (Baltimore). 2025 Jul 25;104(30):e43578. doi: 10.1097/MD.0000000000043578.
Retinopathy of prematurity (ROP) is a major cause of blindness in premature babies, and screening can be stressful and painful for infants. This study investigates the efficacy of a novel method of scleral indentation involving a local anesthetic-impregnated cotton swab without the use of an eyelid speculum to reduce pain and stress in premature infants during ROP screening.
This prospective, single-center, parallel-group, randomized controlled study was conducted between July 2024 and February 2025 at Harran University Faculty of Medicine, Ophthalmology Outpatient Clinic. Two hundred premature newborns requiring ROP screening were randomized into 2 equal groups: a new technique group (Group 1) and a standard screening group (Group 2). In the intervention group, the eyelids were gently opened manually, and scleral indentation was performed using a cotton swab soaked in 0.5% proparacaine, which served both as a depressor and a comfort aid during binocular indirect ophthalmoscopy. Pain and stress responses were assessed using the premature infant pain profile-revised.
Mean total premature infant pain profile-revised scores during the screening examination were significantly lower in Group 1 (6.99 ± 1.81) than in Group 2 (9.44 ± 2.63) (P < .001). Similarly, mean total scores 1 minute after the examination were significantly lower in Group 1 (1.92 ± 1.15) than in Group 2 (3.45 ± 1.82) (P < .001). The mean duration of crying during the screening examination was significantly shorter in Group 1 (51.4 ± 7.22 seconds) compared to Group 2 (56.5 ± 12.2 seconds) (P < .001). Mean heart rates during scanning were significantly lower in Group 1 (167 ± 22.8 bpm) than in Group 2 (186 ± 19.3 bpm) (P < .001), and this difference persisted after 5 minutes (P = .001). Multivariate linear regression analysis demonstrated that the intervention group experienced significantly lower total scores during the examination, shorter crying duration, and reduced heart rate, compared to the control group.
The new ROP screening method is associated with less pain and stress in premature infants compared to the standard method. This new approach could be an important alternative to make ROP screening more comfortable for infants.
早产儿视网膜病变（ROP）是导致早产儿失明的主要原因，而筛查对婴儿来说可能会带来压力和痛苦。本研究调查了一种新型巩膜压陷方法的效果，该方法使用浸有局部麻醉剂的棉签，不使用眼睑撑开器，以减轻ROP筛查期间早产儿的疼痛和压力。
这项前瞻性、单中心、平行组、随机对照研究于2024年7月至2025年2月在哈兰大学医学院眼科门诊进行。200名需要进行ROP筛查的早产新生儿被随机分为两组：新技术组（第1组）和标准筛查组（第2组）。在干预组中，手动轻轻撑开眼睑，使用浸有0.5%丙美卡因的棉签进行巩膜压陷，在双目间接检眼镜检查期间，该棉签既作为压下器又作为舒适辅助工具。使用修订后的早产儿疼痛量表评估疼痛和压力反应。
筛查检查期间，第1组（6.99±1.81）的平均总早产儿疼痛量表修订评分显著低于第2组（9.44±2.63）（P<.001）。同样，检查后1分钟的平均总分，第1组（1.92±1.15）显著低于第2组（3.45±1.82）（P<.001）。筛查检查期间第1组的平均哭闹持续时间（51.4±7.22秒）明显短于第2组（56.5±12.2秒）（P<.001）。扫描期间第1组的平均心率（167±22.8次/分钟）显著低于第2组（186±19.3次/分钟）（P<.001），且5分钟后这种差异仍然存在（P=.001）。多变量线性回归分析表明，与对照组相比，干预组在检查期间的总分显著更低，哭闹持续时间更短，心率降低。
与标准方法相比，新的ROP筛查方法在早产儿中引起的疼痛和压力更小。这种新方法可能是使ROP筛查对婴儿更舒适的重要替代方法。
