Retinopathy Of Prematurity Exam Research Articles

Effects of fentanyl and sucrose on pain in retinopathy examinations with pain scale, near-infrared spectroscopy, and ultrasonography: a randomized trial.

This study aimedto compare the efficacy of intravenous, intranasal fentanyl and oral sucrose inreducing the pain response during retinopathy of prematurity examinations using premature infant pain profile (PIPP) scores. The study included 42 infants who underwent retinopathy screening examinations. The infants were divided into three groups: oral sucrose, intranasal fentanyl, and intravenous fentanyl. Vital signs (heart rate, arterial oxygen saturation, and mean arterial pressure) were recorded. The PIPP was used to determine pain severity. Cerebral oxygenation and middle cerebral artery blood flow were evaluated using near-infrared spectroscopy and Doppler ultrasonography, respectively. The data obtained were compared between groups. There was no significant difference between the three groups regarding postconceptional and postnatal ages or birth weights and weight at the time of examination. All babies had moderate pain during the examination. No correlation was observed between analgesia method and pain scores (P = 0.159). In all three groups, heart rate and mean arterial pressure increased, whereas oxygen saturation decreased during the exam compared with pre-examination values. However, heart rate (HR), mean arterial pressure (MAP) and arterial oxygen saturation (sPO2) values did not differ between groups (HR, P = 0.150; MAP, P = 0.245; sPO2, P = 0.140). The cerebral oxygenation (rSO2) values between the three groups were found to be similar [rSO2: P = 0.545, P = 0.247, P = 0.803; fractional tissue oxygen extraction (FTOE): P = 0.553, P = 0.278]. Regarding cerebral blood flow values, we also did not find any difference between the three groups [mean blood flow velocity (Vmean): P = 0.569, P = 0.975; maximum flow velocity (Vmax): P = 0.820, P = 0.997]. Intravenous and intranasal fentanyl and oral sucrose were not superior to each other in preventing pain during the examination for retinopathy of prematurity (ROP). Sucrose may be a good alternative for pain control during ROP examination. Our findings suggest that ROP exam may not affect cerebral oxygenation or cerebral blood flow. Larger scale studies are needed to determine the best pharmacological option to reduce pain during ROP exams and evaluate the effects of this procedure on cerebral oxygenation and blood flow.

Respiratory Complications in Infants with Retinopathy of Prematurity (ROP) Requiring Laser Photocoagulation.

The objective of this paper was to describe peri-procedural events and complications of infants requiring laser photocoagulation for retinopathy of prematurity (ROP) in a level IV neonatal intensive care unit. A retrospective chart review was performed of neonates requiring ROP exams from January 2017 to August 2020. Baseline maternal and neonatal characteristics, ROP exam findings, and associated treatment were analyzed. Group characteristics were compared based on the need for laser photocoagulation. Subgroup analysis of the laser group including respiratory outcomes, cardiorespiratory index (CRI) scores, and pain scores was also performed. Neonatal and maternal characteristics in the laser (n = 27) and non-laser (n = 172) groups were assessed. Of the 81.5% (22/27) that required re-intubation for laser, 36% (8/22) had >1 intubation and 18% (4/22) had >1 extubation attempt. The average duration of intubation following laser was 2.46 ± 7.13 days, with 40% (9/22) needing peri-extubation steroids and 18% (4/22) racemic epinephrine to facilitate extubation. Mean total respiratory support time post-laser was 8.65 ± 15.23 days. Mean neonatal pain, agitation, and sedation scores after laser were zero immediately after the procedure, 0.09 ± 0.33 at 12 hours, 0.11 ± 0.47 at 24 hours, and 0.11 ± 0.51 at 48 hours. The mean CRI scores were 1 ± 0 immediately after the procedure, 1.17 ± 0.4 at 12 hours, 1.41 ± 0.20 at 24 hours, and 1 ± 0 at 48 hours. Nearly all infants undergoing laser photocoagulation for ROP in our cohort required intubation and continued respiratory support. Despite stability during the procedure, complications from intubation were common. · Routine intubation for laser is associated with complications.. · Need for post-procedural respiratory support is common.. · Avoiding intubation may mitigate these neonatal complications..

Effects of fetal haemoglobin on systemic oxygenation in preterm infants and the development of retinopathy of prematurity PacIFiHER Report No. 2

Background/aimsFetal haemoglobin (HbF) has an oxyhaemoglobin dissociation curve that may affect systemic oxygenation and the development of retinopathy of prematurity (ROP). The study aim is to characterise the effects of...

Oculocardiac reflex during retinopathy of prematurity exams

Oculocardiac reflex during retinopathy of prematurity exams

Retinopathy of Prematurity Screening Examination and Changes in Vital Signs.

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. 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. 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. 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.].

Magnetic Non-invasive Auricular Acupuncture During Eye-Exam for Retinopathy of Prematurity in Preterm Infants: A Multicentre Randomized Controlled Trial.

Background: Eye exam for Retinopathy of prematurity (ROP) is a painful procedure and pharmacological analgesia might be ineffective. We hypothesized that magnetic auricular acupuncture (MAA) compared to placebo will decrease pain during ROP exam in preterm infants.Methods: Multicentre randomized controlled trial conducted in three hospitals (Australia, Canada, and Malaysia). Eligibility: >32 weeks, ROP exam, not sedated, and parental consent. A total of 100 infants were randomized (1:1) to MAA (n = 50) or placebo (n = 50). MAA stickers or placebo were placed on both ears by an unblinded investigator. Pain was assessed using the Premature Infant Pain Profile. Primary analyses were by intention-to-treat. ClinicalTrials.gov:NCT03650621.Findings: The mean (standard deviation, SD) gestation, birthweight, and postnatal age were (MAA 28(3) vs. placebo 28(2) weeks; MAA 1,057(455) vs. placebo 952(273) g; MAA 7(3) vs. placebo 7(3) weeks. Placebo infants had significantly higher PIPP scores during [mean difference 1.6 points (95%CI 0.1–3.1)] and 1 h mean difference 1.5 points (95%CI 0.7–2.2) after the procedure (p < 0.03). Heart rate was lower (173(22) vs. 184(18)/min) and oxygen saturations were higher (93.8(6.2) vs. 91.7(6.1)%, p = 0.05) in MAA infants. No adverse effects.Interpretation: MAA may reduce physiological pain responses during and after ROP exam in preterm infants. Assessment of long-term effects are warranted.Clinical trial registration: www.ClinicalTrials.gov, identifier: NCT03650621.

Oculocardiac Reflex During ROP Exams.

PurposeReducing physiologic stress including bradycardia during staging eye exams for retinopathy of prematurity (ROP) is desirable. We observed heart rate change during routine retinopathy of prematurity eye examinations and compared the response with our ongoing study of oculocardiac reflex (OCR) elicited by uniform EOM tension during strabismus surgery.Patients and MethodsElectrocardiograph was prospectively monitored during ROP exams featuring indirect ophthalmoscopy with Alfonso lid speculum and see-through scleral depressor without topical anesthesia. Clinical data were retrieved from ROP-Check software. OCR was defined as maximally changed heart rate (HR) as a percent of baseline. Strabismus surgery patients under general anesthesia served as controls.ResultsFrom 10/2017 to 9/2020, 281 infants had ROP exams, and the median OCR was 55.9% of baseline HR (IQR 41.4% to 72.6%), the kurtosis 0.93 and skewness 1.01 representing a drop from HR 169 ± 16 bpm to 102 ± 39 bpm. In comparison, 1493 adult and pediatric strabismus surgery patients had less OCR median bradycardia 87.8% (IQR 72–98%), kurtosis 1.60 and skewness −1.18. ROP %OCR correlated with birth gestational age (%OCR = 2.5 (GA) – 11, r(279)=0.33, p<0.01) and with birthweight (%OCR = 0.02 (BW) + 38, r(279) =0.35, p<0.01). The duration of bradycardia induced by ROP exam averaged 92 ± 34 seconds (range 34–240 seconds).ConclusionBradycardia is common during eye exams in the smallest premature infants with greater degree, more rapid onset and longer duration than OCR during strabismus surgery.

Music therapy and retinopathy of prematurity screening: using recorded maternal singing and heartbeat for post exam recovery.

Explore a music therapy (MT) intervention to support infant recovery post retinopathy of prematurity (ROP) exam. Prospective, double-masked, randomized, parallel group study of 100 preterm infants exposed to MT (recorded maternal singing/heartbeat) or standard care (SC). Premature Infant Pain Profile (PIPP) measured at: baseline, during the exam, and 1 and 5 min post exam. Recovery PIPP scores were less with MT vs. SC, but statistical significance not achieved (Mean ± sd: MT 1 min [5.81 ± 2.93] and 5 min [3.91 ± 1.73] vs. SC 1 min [6.40 ± 2.78] and 5 min [4.76 ± 2.07], p = 0.07). Recovery PIPP sores were significantly higher with SC compared to MT when eye exams were longer (p = 0.049) or when exams were more painful (p = 0.04). Recorded maternal singing and heartbeat can support recovery post ROP exam. For longer/more painful ROP exams, MT may be more effective than SC promoting recovery post exam.

Lower foetal haemoglobin levels at 31- and 34-weeks post menstrual age is associated with the development of retinopathy of prematurity : PacIFiHER Report No. 1 PacIFiHER Study Group (Preterm Infants and Fetal Haemoglobin in ROP).

Previous studies have suggested that lower mean foetal haemoglobin (HbF) levels is associated with an increased risk for developing retinopathy of prematurity (ROP). Lower HbF levels may lead to high oxygen exposure to the developing retina thereby increasing the risk of acute ROP. In this study, we characterize the temporal relationship of HbF levels and the development of ROP. This is a single institution prospective observational cohort study. Preterm infants (born <31 weeks gestational age or <1500 g) with HbF measured at birth (cord blood), 31-, 34-, and 37-weeks post menstrual age (PMA); and at least one ROP exam, were enrolled. A total of 60 preterm infants (28 females, 47%) were enrolled. At 31-, 34-, 37-weeks PMA, infants with ROP (mild = Type 2 or less severe and severe = Type 1 ROP) had statistically lower percentages of HbF than infants with no ROP (28.2 ± 15 and 9.7 ± 2.9 vs 67.1 ± 29.6; p < 0.0001; 23.3 ± 14.7 and 32.5 vs 60.1 ± 25; p < 0.005; 31.9 ± 15.8 and 41.6 vs 60.2 ± 20.0; p < 0.0019). Infants with HbF levels in the lowest tercile at 31-weeks PMA were 7.6 times more likely to develop mild and severe ROP (95% CI 2.1-24.0, p value = 0.0006) and this risk increased to 12.3 times (95% CI: 2.6-59.0, p value = 0.0017) at 34-weeks PMA. Low HbF levels at 31- and 34-weeks PMA are associated with significantly increased risk of developing ROP. The decrease in HbF precedes the development of ROP and may be important in its pathogenesis.

Music therapy may decrease apnea associated with retinopathy of prematurity exams

Many premature newborns need to be screened for retinopathy of prematurity (ROP). During and after ROP screening exams, newborns are at high risk for apnea, bradycardia and desaturation (ABD). NICU music therapy (NICU MT), has been shown to improve physiologic stability, including heart rate and oxygen saturations.

Differential effects of the retinopathy of prematurity exam on the physiology of premature infants.

Objective:To compare the differential effects of the retinopathy of prematurity (ROP) examination on the physiology of premature infants with and without oxygen support.Study Design:We collected data from 42 premature infants (room air = 19, oxygen support = 23) and compared physiological metrics including heart rate (HR), systemic peripheral saturation (SpO2), mesenteric tissue oxygen saturation (StO2) and clinical events (oxygen desaturation episodes, bradycardia events, and gastric residuals).Results:We found significant differences between groups in HR during and briefly after the exam, and in mesenteric StO2, during eye drop administration, eye exam, and up to 8 minutes after the exam. SpO2 was significantly different between the groups at all time points. Gastric residuals were higher after the exam in infants on oxygen support, compared to baseline.Conclusion:Premature infants on oxygen support may be at a higher risk of adverse physiologic effects in response to the ROP exam.

Use of real-time semiquantitative PCR data in management of a neonatal intensive care unit adenovirus outbreak.

To describe an adenovirus outbreak in a neonatal intensive care unit (NICU), including the use of qualitative and semiquantitative real-time polymerase chain reaction (qPCR) data to inform the outbreak response. Mixed prospective and retrospective observational study. A level IV NICU in the southeastern United States.PatientsTwo adenovirus cases were identified in a NICU. Screening of all inpatients with qPCR on nasopharyngeal specimens revealed 11 additional cases.InterventionsOutbreak response procedures, including enhanced infection control policies, were instituted. Serial qPCR studies were used to screen for new infections among exposed infants and to monitor viral clearance among cases. Changes to retinopathy of prematurity (ROP) exam procedures were made after an association was noted in those patients. At the end of the outbreak, a retrospective review allowed for comparison of clinical factors between the infected and uninfected groups. There were no new cases among patients after outbreak identification. One adenovirus-infected patient died; the others recovered their clinical baselines. The ROP exams were associated with an increased risk of infection (odds ratio [OR], 84.6; 95% confidence interval [CI], 4.5-1,601). The duration of the outbreak response was 33 days, and the previously described second wave of cases after the end of the outbreak did not occur. Revisions to infection control policies remained in effect following the outbreak. Retinopathy of prematurity exams are potential mechanisms of adenovirus transmission, and autoclaved or single-use instruments should be used to minimize this risk. Real-time molecular diagnostic and quantification data guided outbreak response procedures, which rapidly contained and fully terminated a NICU adenovirus outbreak.

RETINOPATHY OF PREMATURITY PRACTICES: A NATIONAL SURVEY OF CANADIAN NEONATAL INTENSIVE CARE UNITS

BACKGROUND: Retinopathy of prematurity (ROP) accounts for significant morbidity in preterm infants. Early detection and treatment helps prevent adverse sequelae. The objective of this study was to survey the current screening inclusion criteria, treatment options, supportive care and post screening events for ROP in tertiary level Neonatal Intensive Care Units (NICU’s) in Canada. OBJECTIVES: The objective of this study was to survey the current screening inclusion criteria, treatment options, supportive care and post screening events for ROP in tertiary level Neonatal Intensive Care Units (NICUs) in Canada. DESIGN/METHODS: The study was designed as a prospective observational study where a survey was sent out to all 29 level three NICU’s across Canada. Following ethics exemption from the local research ethics board, a cross sectional survey was distributed across all level three NICU’s in Canada from September 1 to December 30, 2015. The tool was designed to elicit information on the screening practices for detection of ROP in tertiary NICU’s. In addition, information on the ROP screening processes, including the timing of screening and grounds for screening infants outside the criteria were collected. The survey also explored the screening process from an organizational standpoint in terms of the person responsible for initiating the screening processes, choice of mydriatics as well as organizing follow up. The practice and use of supportive measures during ROP screening and treatment options provided were also captured.The primary outcome was defined as adherence to the current CPS/COS or AAP guidelines. Specifically, guideline adherence was assessed for the following criteria: inclusion of an infant for ROP screening, age at which first ROP exam was initiated, circumstances where infants outside the screening criteria were deemed eligible for inclusion in the screening process and appropriate follow up processes. Secondary outcomes were defined as the supportive practices in use during the ROP screening examination. This includes the type and dose of mydriatics used, and measures to reduce photophobia and discomfort after ROP related therapeutic interventions. We also assessed healthcare system perspectives related to ROP screening and treatment. This was determined by the availability of dedicated personnel to coordinate the exam, pre-printed order sheets for medication and equipment required, measures to ensure appropriate follow up, use of RetCam (Clarity Medical Systems INC.), ROP treatment options (Anti vascular endothelial growth factor [anti-VEGF] and/or Laser) and treatment location. RESULTS: Twenty two level three nurseries responded to the survey (76 % response rate). Ten different ROP screening inclusion criteria were found to be in use with significant variation in gestational age and birth weight criteria. Reasons for screening babies outside any given unit’s inclusion criteria included unstable clinical course or high oxygen demand as decided by the attending neonatologist. Many other national variations also exist regarding the supportive, procedural and treatment protocols surrounding ROP screening such as Ret Cam use, use of mydriatics and preprinted order sheets. From a treatment standpoint, 50 percent of the centers preferred laser while the remaing 50 percent prefereed Anti VEGF(Vascular Endothelial Growth factor) CONCLUSION: Despite national guidelines, there exists significant variation in ROP screening inclusion criteria practices among neonatal units in Canada. For the many other aspects of ROP screening and treatment, for which there are no national guidelines there also exists significant variations in practice patterns. There is therefore an urgent need for better evidence based screening guidelines as well as a need to standardize supportive measures surrounding ROP screening and treatment, followed by efforts to encourage national uptake of these recommendations.

Apnea after Routine Eye Examinations in Premature Infants.

Objective To determine the frequency of cardiorespiratory events following routine exams for retinopathy of prematurity (ROP). Study Design This is a retrospective review of 79 premature infants in the neonatal intensive care unit at the University of Rochester Medical Center. The baseline for each infant (mean cardiorespiratory events in the 72 hours before the exam) was compared with the number of cardiorespiratory events during the subsequent 24 hours using generalized estimating equation and the Mantel-Haenszel chi-square test to determine if there was an association between cardiorespiratory events and potential risk factors. Results Approximately 19 to 25% of infants experienced an increase in cardiorespiratory events in the 24 hours following their eye exams. These newborns were generally of a younger gestational age and lower birthweight. Conclusion The frequency of cardiorespiratory events following routine ROP exams is similar to that following routine immunizations in this population. Thus, in infants being continuously monitored during the 24 hours after the exam, alterations in medical care in the absence of other clinical signs suggestive of sepsis or clinical deterioration may not be required, limiting unnecessary antibiotic exposure, prolonged caffeine administration, unwarranted gastroesophageal reflux treatment, and undue family stress.

Systemic Absorption of Cyclopentolate and Adverse Events After Retinopathy of Prematurity Exams

ABSTRACTPurpose: 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.

The pain response to mydriatic eyedrops in preterm infants

ObjectiveEvaluate physiologic and behavioral pain responses of premature infants following instillation of mydriatic eye drops for ROP examinations. While burning and stinging occurs in older patients, the infant pain response is not well characterized.Study DesignVital sign and video monitor recorded infant responses before, during, and after mydriatic (tropicamide 1%, phenylephrine 2.5%) administration upon first ROP exam. Two masked observers graded Premature Infant Pain Profile (PIPP) scores immediately prior and following eye drop administration. Scores <7 indicate no/minimal pain, 7-12 slight/moderate, >12 severe.ResultsTwenty infants had mean pre-mydriatic PIPP score 3.6 (SD 1.6), mean post-mydriatic score 5.7 (SD 3.4), mean change 2.1 (SD 3.4)(p=0.01). One (5%) had pre-mydriatic PIPP score ≥7, seven (35%) post scores ≥7 (p=0.07) with one >12.ConclusionsMydriatic drops cause a clinically significant pain response in one third of infants. Non-pharmacologic supportive measures are recommended for all infants until predictive factors are defined.