Physiologic Effects of Retinopathy of Prematurity Screening Examinations

Abstract

Purpose Preterm infants weighing <1500 grams routinely undergo a series of eye examinations to screen for retinopathy of prematurity (ROP). While these examinations are important for the prevention of blindness, infants may suffer adverse physiologic events during and after the examination. The procedure includes administration of mydriatic eye drops that may be absorbed systemically and physical manipulation of the eye that is accompanied by stress and pain. The purpose of the study was to monitor changes in infant health status and adverse physiologic events in the two days following ROP eye screening. Subjects The study used 50 preterm infants with a mean gestational age of 32 weeks, undergoing their first ROP examination in a NICU located in a university medical center. Design This pilot study used a prospective, descriptive design. Methods Physiologic changes and illness events were recorded before and for two days after the eye examination, using tools that tracked parameters of respiratory, cardiovascular, gastrointestinal, and neurological status. Data were collected directly from daily audits of medical records. McNemar’s test for comparing paired proportions and the signed rank test were used for comparing significance of physiologic changes before and after the ROP eye examination. Principal results Apnea events increased significantly (p=0.04) in the 24–48 hour period after the eye examination compared to apnea events before the eye examination. These results were based on 39 infants who were not receiving ventilator support. There was a significant difference in the frequency of oxygen desaturation events between infants with and without apnea (0–24 hours after examination p<0.002, 25–48 hours after examination, p<0.001). There were no significant differences in heart rate, cyanosis, gastric residuals, or seizures after the eye examinations. Conclusions ROP examinations may be associated with increased apnea, a clinically significant problem. Nursing implications include careful monitoring of infants during and after ROP eye examinations, discharge teaching for caregivers, and continued research on nursing interventions to prevent adverse physiologic events.

Risk factors for retinopathy of prematurity: insights from outlier infants

“…Screening examinations are stressful for infants [13, 14], and are known to have adverse physiologic effects, including an increase in apnea events among screened infants. [15, 16] As such, there is a significant incentive to limit unnecessary screening examinations. [11, 15–17] At the same time, this must be balanced against the concern that some infants with birth weight >1500 grams are known to develop treatment-requiring ROP and might not be screened under the current guidelines.…”

Retinopathy of prematurity screening leading to cardiopulmonary arrest: fatal complication of a benign procedure

“…Phenylephrine is an α-adrenergic medication which causes mydriasis without cycloplegia by direct action on the pupillary dilator muscle α-adrenergic receptors 1. Tropicamide is an anticholinergic agent that causes cycloplegia and mydriasis by inhibiting pupillary constriction, ciliary muscle contraction and also by blocking the pupillary sphincter muscle 2.…”

“…Cardiopulmonary adverse effects of tropicamide include apnoea, tachycardia and oxygen desaturation which in the presence of phenylephrine can be synergistic leading to CPA 1 6…”

Palidez peri orbitaria post aplicación de midriaticos en neonatos con hidrocefalia asociado a efectos sistémicos

“…These may be related to the manipulation performed during the ophthalmologic examination, or to the medication used to generate mydriasis 5,6 . These side effects can occur immediately, such as altered vital signs, changes in heart rate, blood pressure, apnea events, hypoxemia among others 7 . However, there is a risk of late alterations such as delayed gastric emptying, intolerance of the oral route and increase of ventilatory parameters 8 .…”