Background Systematic retinopathy (ROP) screening using dilated eye examination is currently performed in the neonatal intensive care unit (NICU). In France atropine 0.3% eye drops are currently used as a mydriatic agent, but no systematic assessments of clinical tolerance and efficacy have been described in the literature.
Purpose To assess the occurrence of clinical changes in infants at different time periods preceding and following atropine drops and eye examination, as well as the mydriatic efficacy of atropine in this context.
Materials and Methods Prospective pilot study, in one NICU (June–September 2012). Atropine 0.3% eye drops (one per eye) were instilled in accordance with French good practise guidelines. Data collection was performed at 3 consecutive periods (P1: H-24 to H0 pre-atropine, P2: H0 to H24 post-atropine, and P3: H24 to H48 post-atropine), and included: abdominal distension, number of episodes of regurgitation or vomiting, necrotizing enterocolitis (NEC), somnolence, number of episodes of severe oxygen desaturation (<70%), bradycardia (<100 bpm) and tachycardia (>180 bpm). Assessment of efficacy was based on possibility for screening or not. McNemar’s Exact Test and Wilcoxon-signed rank Test were used for the binary and continuous variables respectively. Significance was set at p < 0.05.
Results 18 children were screened (median gestational age at birth 27.2 weeks (IQR: 25.6–28.7), median corrected age 33.3 weeks (IQR: 32.3–34.3)). None of the variables showed a statistically significant difference between P1 and P3. Occurrence of abdominal distension (P = 0.03), number of tachycardia (P = 0.05) and oxygen desaturation events (P = 0.03) were more frequent in P2 than in P1. No differences were found in thte occurrence of other variables between P1 and P2. No NEC was diagnosed. Effective pupillary dilatation was obtained in 78% of cases.
Conclusions Our study suggests that atropine is an efficient mydriatic agent for ROP screening dilated eye exam in preterm neonates. Type and timing of the symptoms in our study suggest systemic muscarinic effects of atropine. A reduction in the concentration of the atropine eye drops could improve tolerance.
No conflict of interest.
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