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Systemic Absorption of Cyclopentolate and Adverse Events After Retinopathy of Prematurity Exams
Anita Mitchell1, Richard W Hall2, Stephen W Erickson3
1a Department of Nursing Science , College of Nursing, University of Arkansas for Medical Sciences , Little Rock , AR , USA.
Insights
Cyclopentolate levels were detected in preterm infants after Retinopathy of Prematurity Eye Exams (ROPEE). Higher levels correlated with gastric residuals in infants not on oxygen, suggesting altered drug absorption.
Area of Science:
- Neonatal ophthalmology
- Pharmacokinetics
- Pediatric pharmacology
Background:
- Retinopathy of Prematurity Eye Exams (ROPEE) utilize mydriatic drops.
- Systemic absorption of cyclopentolate may cause adverse events in preterm infants.
Purpose of the Study:
- To analyze the association between adverse events and systemic drug levels in neonates undergoing ROPEE.
- To quantify cyclopentolate and phenylephrine levels post-ROPEE.
Main Methods:
- 25 preterm infants were enrolled in a study during routine ROP screening.
- Blood samples were collected pre- and post-mydriatic drops for drug analysis using liquid chromatography-mass spectrometry.
- Relationships between drug levels and adverse events were assessed.
Main Results:
- Cyclopentolate was detected in 15 of 18 infants (range 6-53 ng/ml); phenylephrine was not detected.
- Significantly higher cyclopentolate levels were observed in infants receiving oxygen (p=0.01).
- A significant association was found between cyclopentolate levels and gastric residuals in tube-fed infants not on oxygen (p=0.01).
Conclusions:
- Cyclopentolate levels exhibit variability in preterm infants post-ROPEE.
- Cyclopentolate levels are positively associated with increased gastric residuals.
- Oxygen administration may influence cyclopentolate absorption and metabolism, necessitating risk prediction for adverse events.
Purpose:
Preterm infants undergoing Retinopathy of Prematurity Eye Exams (ROPEE) may experience adverse events, possibly from systemic absorption of cyclopentolate. The purpose of this study was to analyze the association between adverse events and drug levels found in neonates undergoing ROPEE.
Materials And Methods:
25 infants were randomized into two groups during routine ROP screening: 5 infants for blood collection before mydriatic drops and 20 for blood collection 1 h after eye drops. Blood was collected onto dried blood spot cards, extracted, and analyzed for cyclopentolate and phenylephrine using liquid chromatography and mass spectrometry. Relationships between drug levels and adverse events were assessed.
Results:
Cyclopentolate (range 6-53 ng/ml) was observed in 15 of 18 infants, while phenylephrine was not detected. Levels of cyclopentolate were significantly higher in infants who were on oxygen (p = 0.01). There was a significant association between cyclopentolate levels and gastric residuals in tube-fed infants not receiving oxygen (p = 0.01).
Conclusions:
Cyclopentolate levels varied among preterm infants after ROPEE. Cyclopentolate was positively associated with increased gastric residuals. Underlying medical conditions requiring oxygen administration may affect absorption and metabolism of cyclopentolate. There is a need to predict infants at risk for high blood levels of cyclopentolate in order to prevent or treat adverse events after ROPEE.
