A common sense solution to a common problem — Reducing neonatal stress with eye masks following dilated retinal examination

By Jennifer Stranges

A joint project by St. Michael’s Hospital’s departments of Pediatrics and Ophthalmology has resulted in a paper published in JAMA Ophthalmology about improving the eye care of premature infants.

The study explored whether shielding a premature infant’s eyes after retinopathy of prematurity (ROP) testing would reduce the stress associated with the exam. ROP is a disease of the eyes that occurs only in premature infants and when untreated, can permanently damage an infant’s eye and in rare cases lead to permanent blindness.

We spoke with Dr. Michael Sgro, chief of the Department of Pediatrics at St. Michael’s and lead author of the study, about the findings — which were described by Dr. Douglas Campbell, director of the St. Michael’s NICU, as: a common sense solution to a common problem.

What did your study explore and why did you explore this topic?

Premature babies are at high risk for ROP and are screened for it with an eye exam. The exam is done on high risk premature infants on a weekly or bi-weekly basis until the infant’s eyes are mature. To perform the exam, the baby’s eyes must be dilated in order for the ophthalmologist to be able to see the infant’s retina.

The study was designed to attempt a method to reduce the stress around the eye exam. We are well aware that adults find having their pupils dilated uncomfortable as a large amount of light enters the eye. In our study, we placed a simple eye mask over the baby’s eyes after their eyes were dilated, as well as before and after the eye exam. This simple solution reduced the stressors.

What are some of the indicators of stress in infants this study measured for?

The stress associated with the eye exam presents in preterm infants with irregularities and through their vital signs. Specifically, they can have brief episodes where they stop breathing and their heart rate decreases. There are times when these episodes need to be treated with extra oxygen.

The study used phototherapy masks on the infants. What is a phototherapy mask and how was it used?

Phototherapy masks are traditionally used in infants that have significant jaundice and require phototherapy. Infants under phototherapy for jaundice routinely have a mask placed over their eyes to protect their eyes from the bright light. We chose to use these masks as they are already used in infants and our group knew they were safe.

The study found that when infants wore a phototherapy mask after the screening exam for ROP, stressful events were reduced during the 12-hour post-exam period. What is the meaning of those findings?

Premature infants undergo many stressful medical procedures during their stay in the NICU. Any means we can find to reduce the stresses should improve their stay in hospital as well as the infant’s long-term outcome.

What about the study’s findings surprised you?

The main surprise I had was that this small study showed a significantly improved short-term outcome in infants using the eye masks. This study was originally designed to be a pilot study and we had initially felt we would need a larger group to improve its effectiveness.

What’s next for the research and for the application of the research in the NICU?

I would hope that covering infants’ eyes with masks after their eyes are dilated for the exam will become routine practice within intensive care units to help reduce stress on infants.

I believe the next step is knowledge translation to ensure that this becomes common practice.

This paper is an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.