Systemic changes and adverse effects induced by retinopathy of prematurity screening
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Published on: April 2, 2021
Jing-Bo Jiang1, Zhi-Wei Zhang2, Jia-Wen Zhang3
1Department of Neonatology, Guangdong Province Women and Children's Hospital, Guangzhou 511400, Guangdong Province, China; Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China.
Insights
Retinopathy of prematurity (ROP) screening can cause significant physiological stress in premature infants, leading to increased gastrointestinal issues like necrotizing enterocolitis (NEC) and vital sign fluctuations.
Area of Science:
- Neonatal ophthalmology
- Pediatric critical care
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- ROP screening is crucial for early detection and intervention.
- Systemic effects of ROP screening are not well-documented.
Purpose of the Study:
- To estimate potential systemic events during and after ROP screening in premature infants.
- To identify physiological and pathological changes associated with ROP screening.
Main Methods:
- Prospective, descriptive study design.
- Monitoring of vital signs (BP, saturation, pulse, temperature) before, during, and after ROP screening.
- Assessment of adverse events in cardiovascular, respiratory, gastric, urinary, and nervous systems up to 72 hours post-screening.
Main Results:
- ROP screening caused significant fluctuations in blood pressure, pulse rate, and oxygen saturation.
- Premature infants (<31 weeks postconceptional age) showed increased incidence of apnea, necrotizing enterocolitis (NEC), gastric residual, and upper digestive tract hemorrhage.
- These changes were statistically significant (P<0.01).
Conclusions:
- ROP screening is associated with adverse gastrointestinal events, including NEC.
- Physiological stress during ROP screening can manifest as vital sign instability and altered breath patterns.
- These findings highlight the need for careful monitoring during and after ROP screening.
Aim:
To estimate the potential systemic events during and after retinopathy of prematurity (ROP) screening.
Methods:
A prospective and descriptive designed study was conducted to detect the physiologic and pathological changes 24h before, during, and 72h after ROP screening. Control blood pressure (BP), saturation, pulse rate, and body temperature were routinely taken at various time internals before and after screening. Adverse effects pertain to cardiovascular system, respiratory system, gastric system, urinary system and nervous system were retrospect 0-72h after ROP screening at a 24-hour interval.
Results:
Totally 1254 prematurity babies receiving ROP screening during Jan. 1(st) 2013 to Dec. 31(th) 2013 were enrolled in our survey. Compared to control vital sign data taken before the examination, there was a fluctuation in the diastolic BP with the increased 3.03 mm Hg (P=0.04) after 3 doses of mydriatic drops. Immediately after the examination, there was a further 12.64 mm Hg (P<0.01) increase in systolic BP and a 7.24 mm Hg (P<0.01) in diastolic BP. The mean pulse rate during examination was 22.4 bpm (P<0.01) higher than the 133.3±9.0 bpm control level. The oxygen saturation shared an average drop of 5% (P<0.01) during screening. In prematurity with postconceptional age less than 31wk, the incidence of apnea (23.5%), necrotizing enterocolitis (NEC) (8.7%), gastric residual (25.4%) and upper digestive tract hemorrhage (6.4%) also demonstrated a significant rise (P<0.01).
Conclusion:
In our study sample, ROP screening was associated with NEC, gastric residual and upper digestive tract hemorrhage. These gastrointestinal side effects, along with breath activity pattern change and vital signs indicators fluctuation, may be results of additional stress responses.
