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Am J Perinatol 2022; 39(16): 1779-1785
DOI: 10.1055/s-0041-1726316
Original Article

A Survey of Neonatal Nurses on Mydriatic Regimens Used in Neonatal Retinopathy of Prematurity Eye Examinations

Lisa Kremer 
1   School of Pharmacy, University of Otago, Dunedin, Aotearoa, New Zealand
2   Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, Aotearoa, New Zealand
,
David Reith
3   Deans Department, Dunedin School of Medicine, University of Otago, Dunedin, Aotearoa, New Zealand
,
Natalie J. Medlicott
1   School of Pharmacy, University of Otago, Dunedin, Aotearoa, New Zealand
,
Mary J. Sime
4   Ophthalmology Department, Dunedin Hospital, Dunedin, Aotearoa, New Zealand
,
Liza Edmonds
2   Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, Aotearoa, New Zealand
5   Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, Aotearoa, New Zealand
,
Roland Broadbent
2   Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, Aotearoa, New Zealand
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Abstract

Objective This study was aimed to determine mydriatic regimen(s) used in neonatal units in Aotearoa, New Zealand (NZ), and Australia and to estimate the frequency of adverse drug events following mydriatic administration in preterm neonates.

Study Design A cross-sectional survey was sent to neonatal nursing staff listed in the Australian and New Zealand Neonatal Network contact list. Participants were asked to state what mydriatic regimen they use, and to estimate the frequency of adverse drug events when eye drops were administered for retinopathy of prematurity eye examinations (ROPEE).

Results Thirteen different mydriatic regimens were identified; phenylephrine 2.5% and cyclopentolate 0.5% (1 standard drop of each) was the most commonly used regimen. Two of the regimens exceeded adult doses and five regimens included a mydriatic that is equivalent to an adult dose. Following mydriatic instillation, the three most common adverse effects were apnea, tachycardia, and periorbital pallor.

Conclusion Low-concentration single-microdrop regimens are currently in use and resulting in successful ROPEE, yet doses exceeding adult doses are in use throughout Aotearoa, NZ, and Australian units. We know from this dataset that neonates are experiencing unwanted and potentially preventable, adverse effects associated with mydriatics, and every effort should be made to minimize this risk.

Key Points

  • Thirteen different regimens are in use in Aotearoa, NZ, and Australia.

  • Three regimens use doses in excess of adult doses.

  • Phenylephrine 2.5% and cyclopentolate 0.5% (one standard drop of each) is the most common regimen

Keywords

retinopathy - neonate - mydriatic - phenylephrine - cyclopentolate - tropicamide - adverse drug event

Authors' Contributions

L.K., R.B., D.R., and N.J.M. designed the survey questions. L.K. performed the survey and the analysis of the results. L.K. and D.R. planned the structure of the article. R.B., D.R., L.E., M.J.S., and N.J.M. provided comments, supervision, and support throughout.


Note

Participant information was presented at the beginning of the survey, and participation in the survey was considered to be consent. Ethical approval for the study was obtained from the Human Ethics Committee University of Otago, Aotearoa, New Zealand (reference number: D17/053).


Supplementary Material



Publication History

Received: 06 December 2020

Accepted: 01 February 2021

Article published online:
30 March 2021

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