Comparing infant pain and stress during retinopathy of prematurity screening using ophthalmoscopy and non-contact imaging

The current standard of care for retinopathy of prematurity (ROP) screening eye examinations, binocular indirect ophthalmoscopy (BIO), is associated with discomfort and stress in infants. In this study, we compared pain scores and vital signs during examination with BIO and non-contact laser speckle contrast imaging (LSCI). Preterm neonates underwent retinal exam with BIO and LSCI during ROP screening. Infant stress was scored using the Neonatal Pain, Agitation, and Sedation Scale (N-PASS), and collected with vital signs, before, during, and after eye examination. Seventy-one infants with gestational ages 22-32 weeks and birthweights 400-1900 g underwent 196 BIO examinations and 101 LSCI examinations. N-PASS scores during BIO were significantly higher than LSCI (8.8 vs. 3.7, p < 0.0001). Maximum heart rate was significantly higher during BIO compared to LSCI (182 ± 19 beats per minute vs. 175 ± 20 beats per minute, p = 0.008). Minimum oxygen saturation was significantly lower during BIO compared to LSCI (83 ± 12% vs. 86 ± 10%, p = 0.035). After BIO, vital sign instability remained for 30 s, whereas vital signs returned to baseline after LSCI. We found lower pain scores and more stable vital signs during LSCI compared to BIO.