title: Must screening examinations for retinopathy of prematurity necessarily be painful?
abstract: OBJECTIVE
  This study investigates the impact of the length of the examination, the insertion of eyelid specula, and the indentation of the globe on the pain and stress sensation of premature infants.
  
  
  METHODS
  Ninety-two premature infants in three neonatal wards were included. In two wards, the patients were examined using eyelid specula and scleral indentation as recommended in the official guidelines. In the third ward, the investigation time was minimized and ophthalmoscopy was performed without eyelid specula and scleral indentation. Physical and mental disturbance of the patients was assessed by the Neonatal Infant Pain Score and by monitoring the heart rate. The results were divided into two groups: in the one, eyelid specula and scleral indentation were used, whereas in the other one, they were not used. An independent-samples t-test was performed, which allowed us to calculate the correlation between the way the examination was executed and the condition of the patients.
  
  
  RESULTS
  Demographic data and baseline values of heart rate and pain score did not differ between the two groups. Heart rate and pain score during and after the investigation were significantly higher and increased significantly with the duration of the examination for the patients who were investigated using lid specula and scleral indentation.
  
  
  CONCLUSIONS
  Our study shows that indirect ophthalmoscopy without specula causes significantly less stress to infants than screening with lid specula and scleral indentation.
authors.affiliation: Division of General Pediatrics and Neonatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Lieselotte
authors.initials: L
authors.lastname: Kirchner
authors.forename: Valerie
authors.initials: V
authors.lastname: Jeitler
authors.forename: Arnold
authors.initials: A
authors.lastname: Pollak
authors.forename: Andrea
authors.initials: A
authors.lastname: Müllner-Eidenböck
authors.forename: Robert
authors.initials: R
authors.lastname: Weinzettel
authors.forename: Raimund
authors.initials: R
authors.lastname: Kraschl
authors.forename: Thomas
authors.initials: T
authors.lastname: Waldhör
authors.forename: Martin
authors.initials: M
authors.lastname: Wald
mesh_terms: D001724:Birth Weight; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation*; D005865:Gestational Age; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009887:Ophthalmoscopy / Q000379:methods*; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D013315:Stress, Psychological / Q000175:diagnosis*; D013997:Time Factors