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Physiologic effects of retinopathy of prematurity screening examinations
Anita J Mitchell1, Angela Green, Debra A Jeffs
1Department of Biostatistics, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. AMitchell@uams.edu
Insights
Retinopathy of prematurity (ROP) eye screenings in preterm infants can increase apnea events in the days following the procedure. Careful monitoring and nursing interventions are crucial to manage these risks and prevent complications.
Area of Science:
- Neonatal Medicine
- Ophthalmology
Background:
- Preterm infants weighing <1500g require regular eye exams for retinopathy of prematurity (ROP) screening.
- ROP screening involves mydriatic eye drops and physical eye manipulation, potentially causing systemic absorption and infant stress.
- Adverse physiologic events may occur during and after ROP examinations.
Purpose of the Study:
- To monitor infant health status and adverse physiologic events in the 2 days following ROP eye screening.
- To identify potential risks associated with ROP examinations in preterm infants.
Main Methods:
- A prospective, descriptive pilot study involving 50 preterm infants (mean gestational age 32 weeks) undergoing their first ROP exam.
- Physiologic parameters (respiratory, cardiovascular, gastrointestinal, neurological) were tracked before and for 2 days post-examination.
- Statistical analysis included McNemar's test and the signed rank test to compare pre- and post-examination data.
Main Results:
- A significant increase in apnea events was observed 24-48 hours post-ROP examination (P=.04) in infants not on ventilators.
- Oxygen desaturation events were significantly more frequent in infants with apnea compared to those without (P<.002 and P<.001).
- No significant changes were noted in heart rate, cyanosis, gastric residuals, or seizures.
Conclusions:
- ROP examinations may be linked to an increased incidence of clinically significant apnea in preterm infants.
- Nursing care should include vigilant monitoring during and after ROP screenings.
- Further research into nursing interventions to mitigate adverse physiologic events is warranted.
Purpose:
Preterm infants weighing less than 1500 g 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 2 days after 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 2 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 = .04) in the 24- to 48-hour period after the eye examination compared with 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 < .002; 25-48 hours after examination, P < .001). There were no significant differences in heart rate, cyanosis, gastric residuals, or seizures after the eye examinations.
Conclusions:
The 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.
