Preterm Infant Stress During Noncontact Handheld Optical Coherence Tomography and Contact Fundus Photography.

IMPORTANCE: Limiting the stress of retinopathy of prematurity (ROP) assessments may be beneficial for preterm infants. OBJECTIVE: To compare stress in preterm infants from noncontact optical coherence tomography (OCT) vs contact fundus photography during ROP examinations. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study at an intensive care nursery in a single tertiary care center. Included were infants enrolled in Retinal Microanatomy in ROP (BabySTEPS2) from June 2023 to January 2025. EXPOSURES: During clinically indicated ROP examinations, research imaging with an investigational handheld noncontact OCT system (Duke University) and a contact fundus camera was performed in randomized order in the study eye by expert imagers. Stress data were captured by bedside research nurses. MAIN OUTCOMES AND MEASURES: Modified CRIES (C, crying; R, requires increased oxygen administration; I, increased vital signs; E, expression; S, sleeplessness) neonatal pain score (cry score 0-4, facial expression score 0-2), heart rate, oxygen saturation, and adverse events (AEs) were collected up to 5 minutes before, during, and 1 to 5 minutes after imaging with each device. RESULTS: A total of 59 preterm infants (mean [SD] gestational age, 26.1 [2.0] weeks; 35 male [59.3%]) underwent 397 OCT and fundus photography imaging sessions. Regardless of device order, for OCT compared with fundus photography, there was less change in (1) cry score from baseline to during imaging (mean [SD], 0.12 [0.60] vs 1.70 [1.00]; mean difference, -1.59; 95% CI, -1.75 to -1.42) and after imaging (-0.07 [0.43] vs 0.31 [0.67]; mean difference, -0.38; 95% CI, -0.47 to -0.28; P < .001 for both), (2) facial expression score from baseline to during imaging (16.8% vs 75.8%) and after imaging (2.6% vs 22.5%; P < .001 for both), and (3) heart rate from baseline to during imaging (mean [SD], -5.2 [16.1] bpm vs 10.9 [23.1] bpm; mean difference, -16.1 bpm; 95% CI, -19.2 to -13.0 bpm) and after imaging (-7.2 [17.2] vs 18.8 [21.4] bpm; mean difference, -25.9 bpm; 95% CI, -29.3 to -22.6 bpm; P < .001 for both). Thirty-two AEs (tachycardia, bradycardia, hypoxia, or emesis) occurred in 28 of 399 imaging sessions (7.0%), and 26 of 32 (81.3%) were during or after fundus photography. No ocular, unexpected, or severe AEs occurred. CONCLUSIONS AND RELEVANCE: In this cohort study, although the role of handheld OCT in ROP screening remains under investigation, findings suggest that noncontact handheld OCT was less stressful to preterm infants undergoing ROP examination and resulted in fewer associated AEs compared with contact fundus photography.

Duke Scholars

Author Sharon Fridovich Freedman Ophthalmology

Author Grace Prakalapakorn Ophthalmology

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