[Are mydriatic eyedrops dangerous for pre-term infants?]

Area of Science:

• Neonatal ophthalmology
• Pediatric gastroenterology
• Clinical pharmacology

Background:

• Funduscopic examination is crucial for detecting retinopathy of prematurity in preterm infants.
• Mydriatic eyedrops are routinely used for this examination but are associated with potential systemic side effects, particularly gastrointestinal disturbances.

Observation:

• A case report details a preterm infant (28 weeks 5 days gestation) with Down syndrome who developed necrotizing enterocolitis.
• The infant experienced fatal necrotizing enterocolitis following the administration of a single drop of 0.3% atropine in each eye.
• The temporal relationship, administration method, and clinical presentation suggest a causal link between atropine instillation and the infant's condition.

Findings:

• Systemic absorption of atropine from topical ocular administration can lead to significant adverse events in preterm neonates.
• Necrotizing enterocolitis is a severe gastrointestinal complication that may be precipitated by mydriatic eyedrops in vulnerable preterm infants.
• Literature review indicates frequent side effects of mydriatic eyedrops in preterm infants, raising concerns about atropine hypersensitivity, especially in those with Down syndrome.

Implications:

• The findings necessitate a re-evaluation of the safety profile and administration protocols for mydriatic eyedrops in preterm neonates.
• Further research is warranted to investigate potential atropine hypersensitivity in preterm infants, particularly those with genetic syndromes like Down syndrome.
• Clinicians should maintain a high index of suspicion for gastrointestinal complications following mydriatic use in preterm infants and consider alternative screening methods if necessary.