Evaluation of retinopathy of prematurity screening in reverse Kangaroo Mother Care: a pilot study

Abstract

Purpose: To evaluate retinopathy of prematurity (ROP) screening practice in reverse Kangaroo Mother Care (R-KMC) with respect to stress and pain to the infant.

Methods: In a pilot study we evaluated ROP screening practice in R-KMC in 20 babies at risk of ROP. The R-KMC differed from the conventional KMC with respect to the baby position where the baby lay supine on mother's chest. With the mother lying supine and the baby in R-KMC position, screening examinations were done with indirect ophthalmoscope. The outcome measures included stress (quantified by pulse, respiration, and oxygen saturation) and pain to the baby by observing facial expression (eye squeezing, crying, and brow bulge). The heart rate, respiratory rate, and SpO2 (%) were compared before and immediately after the procedure using paired t-test.

Result: Mean (±SD) gestational age and birth weight were 30.8±2.3 weeks and 1362.5±253.9 g, respectively. During examination in R- KMC position 8 babies (40%) were completely relaxed (no eye squeezing and crying), 10 (50%) were partially relaxed (no brow bulge) and 2 babies (10%) were not relaxed. A change in heart and respiration rate both by 10 per minute was recorded in 12 (60%) and 10 (50%) babies, respectively. Five babies (25%) had reduction in blood oxygen concentration below 92%. The majority of the mothers (19 of 20) were relaxed.

Conclusion: ROP screening in R-KMC can be a baby friendly screening practice with respect to stress and pain to the infant and needs further evaluation in a larger cohort.

Figures

Figure 1

(a) Baby position in conventional Kangaroo Mother Care where the baby stripped of its clothing except diaper rests on the mother's bare chest in a frog position. A piece of cloth wraps and holds the baby against the mother assisted by the support from the arms of the mother. The head lies in a lateral position making the fundus examination inconvenient. (b) Reverse Kangaroo Mother Care position where the baby is rotated 180°, other formalities remaining the same. Here the baby's eyes look straight ahead making the fundus examination easy and convenient.

Figure 2

(a) Position of the mother and baby in reverse Kangaroo Mother Care position just before examination. (b) Retinopathy of prematurity screening with indirect ophthalmoscope in reverse Kangaroo Mother Care position where the mother and the baby lie supine on the examination couch. The infant's eyes, with pupils pharmacologically dilated, are held open by an eyelid speculum. The mother restrains the baby with her upper and lower arms while an assistant holds the head steady for the ophthalmologist to view the retina with an indirect ophthalmoscope and 20 D lens.