Retinopathy of Prematurity Screening Examination and Changes in Vital Signs

Abstract

BACKGROUND AND OBJECTIVE: Dilation and examination during retinopathy of prematurity (ROP) screening can cause systemic complications and even life-threatening adverse events (AEs). The main objective of this study is to assess the prevalence and significance of AEs and changes in vital signs during ROP screenings, and to correlate birth weight, gestational age, and length of exam as possible predictors of these changes. PATIENTS AND METHODS: This is a prospective, observational study that includes 1,360 screening exams from 680 premature infants in two neonatal intensive care units. Systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and oxygen saturation were monitored from the time that dilating drops were administered until 4 hours after the examination was completed. Any clinical deterioration or complication was documented. RESULTS: Of 1,360 infant screening exams, 153 (11%) screening exams resulted in at least one change in vital sign that alerted the monitor. There was one serious AE requiring bag valve mask resuscitation 30 minutes after dilating drops were placed. Gestational age, birth weight, and length of ROP exam were not significant predictors of AEs. There were statistically significant changes when comparing pre- and post-vital signs following dilation and funduscopy exam. CONCLUSIONS: Although ROP screening exams are essential for at-risk neonates, mydriatic drops and retinal exams can result in changes to vital signs and AEs. It is important to closely monitor neonates during these examinations. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:458–463.]

Low dose or very low dose phenylephrine and cyclopentolate microdrops for retinopathy of prematurity eye examinations (The Little Eye Drop Study): a randomised controlled non-inferiority trial

“…None of these complications were observed during our study. There is conflicting evidence in literature about clinically significant changes in blood pressure and respiratory rates in preterm infants following mydriatic use 6 28. In Māori infants, we found a small but statistically significant elevation in blood pressure in infants in the LD group, although the clinical implication of this finding is limited due to the small sample size.…”

Validation and Feasibility of the Postnatal Growth and Retinopathy of Prematurity Retinal Screening Criteria at a Level IV Tertiary Care Neonatal Intensive Care Unit

“…Ocular manipulation and eye mydriatic drop exposure during retinal examinations are associated with increased risk of apnea and oxygen desaturations, 7 bradycardia 8 or tachycardia, and emesis. 9 Additionally, vital sign changes and discomfort for infants during screening examinations have been well documented 9 10 11 with the risk of subsequent clinical deterioration.…”