Preterm infants weighing less than 1500 g routinely undergo a series of eye examinations to screen for retinopathy of prematurity (ROP). While these examinations are important for the prevention of blindness, infants may suffer adverse physiologic events during and after the examination. The procedure includes administration of mydriatic eye drops that may be absorbed systemically and physical manipulation of the eye that is accompanied by stress and pain. The purpose of the study was to monitor changes in infant health status and adverse physiologic events in the 2 days after ROP eye screening.
The study used 50 preterm infants with a mean gestational age of 32 weeks, undergoing their first ROP examination in a NICU located in a university medical center.
This pilot study used a prospective, descriptive design.
Physiologic changes and illness events were recorded before and for 2 days after the eye examination, using tools that tracked parameters of respiratory, cardiovascular, gastrointestinal, and neurological status. Data were collected directly from daily audits of medical records. McNemar's test for comparing paired proportions and the signed rank test were used for comparing significance of physiologic changes before and after the ROP eye examination.
Apnea events increased significantly (P = .04) in the 24- to 48-hour period after the eye examination compared with apnea events before the eye examination. These results were based on 39 infants who were not receiving ventilator support. There was a significant difference in the frequency of oxygen desaturation events between infants with and without apnea (0–24 hours after examination, P < .002; 25–48 hours after examination, P < .001). There were no significant differences in heart rate, cyanosis, gastric residuals, or seizures after the eye examinations.
The ROP examinations may be associated with increased apnea, a clinically significant problem. Nursing implications include careful monitoring of infants during and after ROP eye examinations, discharge teaching for caregivers, and continued research on nursing interventions to prevent adverse physiologic events.
Department of Biostatistics (Dr Roberson), Arkansas Children's Hospital (Drs Jeffs and Green), College of Nursing (Drs Mitchell and Green), University of Arkansas for Medical Sciences, Little Rock.
Correspondence: Anita J. Mitchell, PhD, APN, College of Nursing, University of Arkansas for Medical Sciences, 4301 W Markham, Slot 529, Little Rock, AR 72205 (AMitchell@uams.edu).
This study was supported by UAMS College of Nursing Tailored Biobehavioral Interventions Research Center (TBIRC). The TBIRC is funded by a grant (P20 NR009006-01) through the National Institute of Nursing Research (NINR).