Apnea after Routine Eye Examinations in Premature Infants

Abstract

To determine the frequency of cardiorespiratory events following routine exams for retinopathy of prematurity (ROP). This is a retrospective review of 79 premature infants in the neonatal intensive care unit at the University of Rochester Medical Center. The baseline for each infant (mean cardiorespiratory events in the 72 hours before the exam) was compared with the number of cardiorespiratory events during the subsequent 24 hours using generalized estimating equation and the Mantel-Haenszel chi-square test to determine if there was an association between cardiorespiratory events and potential risk factors. Approximately 19 to 25% of infants experienced an increase in cardiorespiratory events in the 24 hours following their eye exams. These newborns were generally of a younger gestational age and lower birthweight. The frequency of cardiorespiratory events following routine ROP exams is similar to that following routine immunizations in this population. Thus, in infants being continuously monitored during the 24 hours after the exam, alterations in medical care in the absence of other clinical signs suggestive of sepsis or clinical deterioration may not be required, limiting unnecessary antibiotic exposure, prolonged caffeine administration, unwarranted gastroesophageal reflux treatment, and undue family stress.

<p>Oculocardiac Reflex During ROP Exams</p>

“…13 Ongoing close monitoring is also indicated due to an increased frequency of cardiorespiratory events in the hours after the exam. 18 Infants receiving supplemental oxygen may be at particular risk of cardiac disturbance during exams. 19 Heart rate variability as an indicator of autonomic nervous system function may be an independent risk factor for Type 1 ROP.…”

Differential effects of the retinopathy of prematurity exam on the physiology of premature infants

“…It is well documented that the ROP eye examination procedure that includes administration of topical mydriatics can result in signs of pain and stress (2–4) increased apnea events (5,6) and increased incidence of delayed gastric emptying (7). However, it is unclear which groups of infants will present with adverse effects and which component of the eye exam alters normal physiology.…”

“…Although these eye examinations are the standard of care for the detection of ROP, the potential effect of mydriatic drugs absorbed systemically and the pain and stress associated with the physical manipulation of the eye during the exam (2–4) could result in adverse effects in neonates, despite the administration of oral sucrose and topical anesthetic. Documented adverse effects also include increased apnea events (5,6), and increased incidence of delayed gastric emptying (7). The characteristics of these negative after-effects are currently unknown and only an undetermined subset of the premature infant population present negative complications.…”