Impact of Mydriatic Drops and Pain on Systemic Responses During Retinopathy of Prematurity Screening
Öz
ABSTRACT
Objective: Retinopathy of Prematurity (ROP) stands as a critical challenge faced by neonatal intensive care units (NICUs). The ROP examination usually begins when the patients are in the NICU, then are followed up in policlinics. Thus, side effects of examination procedure may occur in the home, frightening members of the family. So, our objective to investigate the impact of neonatal pain on systemic and procedural side effects of ROP examinations and mydriatic drops to improve screening safety.
Materials And Methods: The study planned as a prospective descriptive investigation, was conducted with 70 preterm infants admitted to the NICU between August and November 2012. Patients monitored during examination and 48 hours after than for vital signs and recording any side effects. Neonatal İnfant Pain Scale was performed all patients. For statistical analysis SPSS 15 was used.
Results: Adverse effects were absent in 41.4% of the infants. Flushing was noted in 22.9%, gastric residuals in 10%, vomiting in 8.6%, and a combination of flushing with apnea and gastric residuals in 2.9% of the infants. The pain group was associated with temporary increases in heart rate and body temperature, which were primarily noticeable in the first hour after the examination. There was no relationship between pain and blood pressure, oxygen saturation level, or respiratory rate.
Conclusions: A comprehensive understanding of the adverse effects associated with mydriatic drops and the examination procedure is essential. During ROP screening, infants should be carefully monitored in standardized clinical settings, with appropriate pain management strategies in place, and caregivers should receive thorough discharge education.
Keywords: Infant, Premature; Mydriatics; Pain; Retinopathy of Prematurity; Vital SignsObjective: Retinopathy of Prematurity (ROP) presents a significant challenge for neonatal intensive care units (NICUs). Therefore, the study aims to investigate the impact of neonatal pain on the systemic and procedural side effects of ROP examinations and mydriatic drops, with the aim of enhancing screening safety.
Materials And Methods: This study, designed as a prospective descriptive investigation, included 70 preterm infants admitted to the NICU between August and November 2012. Patients were monitored during the examination and for 48 hours afterwards, focusing on vital signs and any side effects. The Neonatal Infant Pain Scale was applied to all patients. Statistical analysis was conducted using SPSS version 15.
Results: Adverse effects were absent in 41.4% of the infants. Flushing was observed in 22.9%, gastric residuals were noted in 10%, vomiting occurred in 8.6%, and a combination of flushing, apnea, and gastric residuals was seen in 2.9% of the infants. The pain group exhibited temporary increases in heart rate and body temperature, most notably within the first hour after the examination. There were no significant relationships between pain and blood pressure, oxygen saturation levels, or respiratory rates (p>0.05).
Conclusions: A comprehensive understanding of the adverse effects associated with mydriatic drops and the examination procedure is essential. During ROP screenings, infants should be closely monitored in standardized clinical settings, appropriate pain management strategies should be implemented, and caregivers must receive thorough education upon discharge.
Anahtar Kelimeler
Mydriatic drops neonatal intensive care units neonatal pain preterm infants retinopathy of prematurity
Etik Beyan
This study was designed in accordance with the Helsinki Principles and received ethical approval from the Ethics Committee of Umraniye Training and Research Hospital. (Date: 16.08.2012, decision no:2012-4). The permissions of the parents of the babies included in the study were obtained via written consent.
Destekleyen Kurum
There is no conflict of interest.
Teşekkür
We would like to express our sincere gratitude to the Neonatology Division of the Department of Pediatrics at Ümraniye Training and Research Hospital for their support during this study. We also thank the parents of all participating infants for their trust and cooperation. Special thanks to the ophthalmologist and healthcare staff who contributed to the examinations and data collection.
Kaynakça
- Wood EH, Chang EY, Beck K, Hadfield BR, Quinn AR, Harper CA 3rd. 80 Years of vision: preventing blindness from retinopathy of prematurity. J Perinatol. 2021;41(6):1216-1224. doi:10.1038/s41372-021-01015-8
- Fierson WM. American Academy Of Pediatrics Section On Ophthalmology, American Academy Of Ophthalmology, American Association For Pediatric Ophthalmology And Strabismus, American Association Of Certified Orthoptists. Screening examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018;142(6):e20183061. doi:10.1542/peds.2018-3810
- Kremer LJ, Reith DM, Medlicott N, Broadbent R. Systematic review of mydriatics used for screening of retinopathy in premature infants. BMJ Pediatrics Open. 2019. 3(1):e000448. doi:10.1136/bmjpo-2019-000448
- Alpay A, Canturk US, Aydemir C. Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study. BMC Pediatr. 2019;19(1):415. doi:10.1186/s12887-019-1757-3
- Sun Y, Zhang J, Chen X, et al. Effectiveness of Gentle Human Touch for Pain Control During Examination for Retinopathy of Pre-maturity: A Randomized Controlled Trial. Front. Pediatr. 2020;8:608378. doi: 10.3389/fped.2020.608378
- Obata S, Imamura T, Kakinoki M, Yanagi T, Maruo Y, Ohji M. Systemic adverse events after screening of retinopathy of prematurity with mydriatic. PLoS One. 2021;16(9):e0256878. 2021. doi:10.1371/journal.pone.0256878
- Olsson E, Ahl H, Bengtsson K, et al. The use and reporting of neonatal pain scales: a systematic review of randomized trials. Pain. 2021;162(2):353-360. doi:10.1097/j.pain.0000000000002046
- McPherson C, Miller SP, El-Dib M, Massaro AN, Inder TE. The influence of pain, agitation, and their management on the immature brain. Pediatr Res. 2020;88(2):168-175. doi:10.1038/s41390-019-0744-6
- Seliniotaki AK, Prousali E, Lithoxopoulou M, et al. Alternative mydriasis techniques for retinopathy of prematurity screening. Int Ophthalmol. 2020;40(12):3613-3619. doi:10.1007/s10792-020-01542-x
- Onuagu V, Gardner F, Soni A, Doheny KK. Autonomic measures identify stress, pain, and instability associated with retinopathy of prematurity ophthalmologic examinations. Front Pain Res (Lausanne). 2022;3:1032513. doi:10.3389/fpain.2022.1032513
- Chiang MF, Quinn GE, Fielder AR, et al. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology. 2021;128(10):e51-e68. doi:10.1016/j.ophtha.2021.05.031
- Kappesser J, Kamper-Fuhrmann E, de Laffolie J, et al. Pain-specific Reactions or Indicators of a General Stress Response?: Investigating the Discriminant Validity of 5 Well-established Neonatal Pain Assessment Tools. Clin J Pain. 2019;35(2):101-110. doi:10.1097/AJP.0000000000000660
- Lahoti S, Jones R, Beck KD, et al. Retinopathy of Prematurity Screening Examination and Changes in Vital Signs. Ophthalmic Surg Lasers Imaging Retina. 2021;52(8):458-463. doi:10.3928/23258160-20210727-10
- Tasdemir HI. Multisensory stimulation to reduce procedural pain in retinopathy of prematurity: A randomized controlled trial. Nurs Crit Care. 2024; 1-12. doi:10.1111/nicc.13200
- Mataftsi A, Lithoxopoulou M, Seliniotaki AK, et al. Avoiding use of lid speculum and indentation reduced infantile stress during retinopathy of prematurity examinations. Acta Ophthalmol. 2022;100(1):e128-e134. doi:10.1111/aos.15085
- Jiang JB, Zhang ZW, Zhang JW, Wang YL, Nie C, Luo XQ. Systemic changes and adverse effects induced by retinopathy of prematurity screening. Int J Ophthalmol. 2016;9(8):1148-1155. doi:10.18240/ijo.2016.08.11
- Aldamri A, AlKhaldi SA, Alshuhayb BS, Almutairi RT. Adverse reactions of cycloplegic and mydriatic eye drops in routine ophthalmologic examination of pediatric patients in Saudi Arabia: A retrospective study and survey of pediatric ophthalmologists. Saudi J Ophthalmol. 2024;38(3):275-279. doi:10.4103/sjopt.sjopt_222_23
- Kara N, Arman D, Seymen Z, et al. The effects of mydriatic eye drops on cerebral blood flow and oxygenation in retinopathy of prematurity examinations. Eur J Pediatr. 2023;182:4939–4947. doi:10.1007/s00431-023-05161-3
- Kremer LJ, Medlicott N, Sime MJ, et al. Low dose or very low dose phenylephrine and cyclopentolate microdrops for retinopathy of prematurity eye examinations (The Little Eye Drop Study): a randomised controlled non-inferiority trial. Arch Dis Child Fetal Neonatal Ed. 2023;108(4):380-386. doi:10.1136/archdischild-2022-324929
Prematüre Retinopatisi Taraması Sırasında Midriatik Damlaların ve Ağrının Sistemik Yanıtlar Üzerindeki Etkisi
Öz
Amaç: Prematüre retinopatisi (ROP), yenidoğan yoğun bakım üniteleri (YYBÜ) için önemli bir klinik sorundur. Bu çalışmada, ROP taramaları sırasında uygulanan midriyatik damlaların ve yenidoğanda oluşan ağrının, sistemik ve işlemle ilişkili bulgular üzerindeki etkileri değerlendirilmiş; böylece tarama güvenliğinin artırılması hedeflenmiştir.
Materyal ve Metot: Prospektif tanımlayıcı nitelikteki bu çalışmaya, Ağustos–Kasım 2012 tarihleri arasında YYBÜ’ye yatırılan 70 prematüre bebek dahil edildi. Tüm hastalar, ROP muayenesi sırasında ve sonrasındaki 48 saat boyunca, yaşamsal bulgular ve gelişebilecek yan etkiler açısından takip edildi. Ağrı değerlendirmesi için tüm bebeklere Yenidoğan Bebek Ağrı Ölçeği (NIPS) uygulandı. İstatistiksel analizler SPSS 15.0 programı ile gerçekleştirildi.
Bulgular: Bebeklerin %41,4’ünde herhangi bir yan etki gözlenmedi. %22,9’unda ciltte kızarıklık, %10’unda mide içeriği artışı, %8,6’sında kusma ve %2,9’unda ciltte kızarıklık, apne ve mide içeriği artışının birlikte görüldüğü belirlendi. Ağrı hisseden grupta, özellikle muayeneden sonraki ilk saatte kalp hızı ve vücut sıcaklığında geçici artış izlendi. Ağrı ile kan basıncı, oksijen satürasyonu ve solunum hızı arasında anlamlı bir ilişki saptanmadı (p>0,05).
Sonuç: ROP taramaları sırasında uygulanan midriyatik damlalar ve muayene işlemiyle ilişkili olumsuz etkilerin iyi anlaşılması büyük önem taşımaktadır. Bu süreçte bebeklerin standart klinik koşullarda yakından izlenmesi, etkili ağrı yönetimi sağlanması ve taburculuk öncesinde bakım veren kişilere yeterli eğitim verilmesi gereklidir.
Anahtar Kelimeler
Midriyatik damlalar prematüre bebekler prematüre retinopatisi yenidoğan ağrısı yenidoğan yoğun bakım üniteleri
Kaynakça
- Wood EH, Chang EY, Beck K, Hadfield BR, Quinn AR, Harper CA 3rd. 80 Years of vision: preventing blindness from retinopathy of prematurity. J Perinatol. 2021;41(6):1216-1224. doi:10.1038/s41372-021-01015-8
- Fierson WM. American Academy Of Pediatrics Section On Ophthalmology, American Academy Of Ophthalmology, American Association For Pediatric Ophthalmology And Strabismus, American Association Of Certified Orthoptists. Screening examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018;142(6):e20183061. doi:10.1542/peds.2018-3810
- Kremer LJ, Reith DM, Medlicott N, Broadbent R. Systematic review of mydriatics used for screening of retinopathy in premature infants. BMJ Pediatrics Open. 2019. 3(1):e000448. doi:10.1136/bmjpo-2019-000448
- Alpay A, Canturk US, Aydemir C. Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study. BMC Pediatr. 2019;19(1):415. doi:10.1186/s12887-019-1757-3
- Sun Y, Zhang J, Chen X, et al. Effectiveness of Gentle Human Touch for Pain Control During Examination for Retinopathy of Pre-maturity: A Randomized Controlled Trial. Front. Pediatr. 2020;8:608378. doi: 10.3389/fped.2020.608378
- Obata S, Imamura T, Kakinoki M, Yanagi T, Maruo Y, Ohji M. Systemic adverse events after screening of retinopathy of prematurity with mydriatic. PLoS One. 2021;16(9):e0256878. 2021. doi:10.1371/journal.pone.0256878
- Olsson E, Ahl H, Bengtsson K, et al. The use and reporting of neonatal pain scales: a systematic review of randomized trials. Pain. 2021;162(2):353-360. doi:10.1097/j.pain.0000000000002046
- McPherson C, Miller SP, El-Dib M, Massaro AN, Inder TE. The influence of pain, agitation, and their management on the immature brain. Pediatr Res. 2020;88(2):168-175. doi:10.1038/s41390-019-0744-6
- Seliniotaki AK, Prousali E, Lithoxopoulou M, et al. Alternative mydriasis techniques for retinopathy of prematurity screening. Int Ophthalmol. 2020;40(12):3613-3619. doi:10.1007/s10792-020-01542-x
- Onuagu V, Gardner F, Soni A, Doheny KK. Autonomic measures identify stress, pain, and instability associated with retinopathy of prematurity ophthalmologic examinations. Front Pain Res (Lausanne). 2022;3:1032513. doi:10.3389/fpain.2022.1032513
- Chiang MF, Quinn GE, Fielder AR, et al. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology. 2021;128(10):e51-e68. doi:10.1016/j.ophtha.2021.05.031
- Kappesser J, Kamper-Fuhrmann E, de Laffolie J, et al. Pain-specific Reactions or Indicators of a General Stress Response?: Investigating the Discriminant Validity of 5 Well-established Neonatal Pain Assessment Tools. Clin J Pain. 2019;35(2):101-110. doi:10.1097/AJP.0000000000000660
- Lahoti S, Jones R, Beck KD, et al. Retinopathy of Prematurity Screening Examination and Changes in Vital Signs. Ophthalmic Surg Lasers Imaging Retina. 2021;52(8):458-463. doi:10.3928/23258160-20210727-10
- Tasdemir HI. Multisensory stimulation to reduce procedural pain in retinopathy of prematurity: A randomized controlled trial. Nurs Crit Care. 2024; 1-12. doi:10.1111/nicc.13200
- Mataftsi A, Lithoxopoulou M, Seliniotaki AK, et al. Avoiding use of lid speculum and indentation reduced infantile stress during retinopathy of prematurity examinations. Acta Ophthalmol. 2022;100(1):e128-e134. doi:10.1111/aos.15085
- Jiang JB, Zhang ZW, Zhang JW, Wang YL, Nie C, Luo XQ. Systemic changes and adverse effects induced by retinopathy of prematurity screening. Int J Ophthalmol. 2016;9(8):1148-1155. doi:10.18240/ijo.2016.08.11
- Aldamri A, AlKhaldi SA, Alshuhayb BS, Almutairi RT. Adverse reactions of cycloplegic and mydriatic eye drops in routine ophthalmologic examination of pediatric patients in Saudi Arabia: A retrospective study and survey of pediatric ophthalmologists. Saudi J Ophthalmol. 2024;38(3):275-279. doi:10.4103/sjopt.sjopt_222_23
- Kara N, Arman D, Seymen Z, et al. The effects of mydriatic eye drops on cerebral blood flow and oxygenation in retinopathy of prematurity examinations. Eur J Pediatr. 2023;182:4939–4947. doi:10.1007/s00431-023-05161-3
- Kremer LJ, Medlicott N, Sime MJ, et al. Low dose or very low dose phenylephrine and cyclopentolate microdrops for retinopathy of prematurity eye examinations (The Little Eye Drop Study): a randomised controlled non-inferiority trial. Arch Dis Child Fetal Neonatal Ed. 2023;108(4):380-386. doi:10.1136/archdischild-2022-324929
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Çocuk Sağlığı ve Hastalıkları (Diğer) |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 24 Haziran 2025 |
| Yayımlanma Tarihi | 30 Haziran 2025 |
| Gönderilme Tarihi | 7 Şubat 2025 |
| Kabul Tarihi | 12 Nisan 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 10 Sayı: 2 |
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