title: The positive prognostic implications of crying during exam on threshold ROP.
abstract: BACKGROUND
  Most infants cry with lid speculum, scleral depression and indirect ophthalmoscopy. This simple observation, "did the infant cry?" during the initial 31-week ROP screening exam was prospectively studied.
  
  
  METHODS
  From Fall 1989 through Summer 2003, all Alaskan infants with birthweight < or = 1500 grams were examined by RWA. After 1992, at the 31-week initial ROP screening, we recorded whether the infant was able to cry (cry), did not cry (quiet), or was intubated (vent) during indirect ophthalmoscopy with lid speculum and scleral depression.
  
  
  RESULTS
  ROP was classified as to threshold in 873 infants. Infants who were able to cry during their 31-week GA screening exam were less likely to progress to threshold (Chi square 600, 2 = 36, p < .001). Using a logistic fit of Threshold, the increased risk of ROP in infants unable to cry persisted independent of gestational age or birthweight.
  
  
  CONCLUSIONS
  Respiratory and neurologic co-morbidity may render those infants unable to cry during the first screening examination at increased risk to progress to threshold ROP.
authors.affiliation: Pediatric Ophthalmology and Strabismus Ophthalmic Associates, 542 West Second Avenue, Anchorage, Alaska 99501-2242, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Blackledge
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Lang
authors.forename: Robert W
authors.initials: RW
authors.lastname: Arnold
mesh_terms: D000413:Alaska; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003448:Crying; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D015997:Neonatal Screening; D011379:Prognosis; D011446:Prospective Studies; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D042262:Retinoscopy / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index