To ensure the quality and safety of the retinopathy of prematurity (ROP) screening exam, the Pan American Health Organization's Clinical Practice Guidelines emphasize the importance of preparing the infant for fundus examination, including appropriate pain management and comfort during the procedure.
Before the ROP screening exam, to dilate the newborn's pupil, it is recommended:
- Instill one drop of a combined solution of 2.5% phenylephrine with 0.5% tropicamide in each eye, in two or three doses, 15 minutes apart, at least one hour before the exam. Adjust the concentration according to the availability and presentation of the medication, with an epinephrine concentration of no more than 2.5%.
- Use the lowest available concentration and the fewest doses to minimize adverse events and pain in newborns. During the ophthalmologic examination, it is recommended to:
- Monitor the newborn's heart rate, respiratory rate, and blood pressure.
- Use anesthetic drops before the ophthalmologic examination (e.g., 0.5% proparacaine hydrochloride, one to two drops, 30 to 60 seconds beforehand) if an eyelid retractor (speculum) or scleral indentation will be used.
- Use stress and pain reduction techniques, such as administering a sucrose solution, supporting the newborn on the lap, and/or using a pacifier.
