Am J Perinatol 2003; 20(5): 219-226
DOI: 10.1055/s-2003-42340
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Cryotherapy for Threshold Retinopathy: Perioperative Management in a Single Center

K. Allegaert1 , M. Van de Velde2 , I. Casteels3 , G. Naulaers1 , C. Vanhole1 , H. Devlieger1
  • 1Department of Pediatrics, Neonatal Intensive Care Unit, University Hospitals, Gasthuisberg, KU Leuven, Belgium
  • 2Department of Anesthesiology, University Hospitals, Gasthuisberg, KU Leuven, Belgium
  • 3Department of Ophthalmology, University Hospitals, Gasthuisberg, KU Leuven, Belgium
Further Information

Publication History

Publication Date:
18 September 2003 (online)

ABSTRACT

Perioperative management and complications during and after surgery were reviewed in a population of premature infants who received cryotherapy because of threshold retinopathy by retrospective analysis of medical, anaesthetic, and ophthalmologic files. Infants (n = 31) who received cryotherapy between January 1, 1996 and January 1, 2001 and were treated during the neonatal period in the unit were included in the study. Cryotherapy was performed under general anesthesia on the neonatal ward. Neonatal and preoperative characteristics of this cohort point to a vulnerable group of infants with a preoperative weight of 1622 g (1519 to 1862 g), bronchopulmonary dysplasia criteria applying in 29 of 31 patients and methylxanthins prescribed in 26 of 31 patients. No single cryotherapy session had to be interrupted because of systemic complications. Still marked cardiorespiratory instability was documented until 36 hours postoperative in 8 patients. Performing surgical procedures on the neonatal ward is a feasible option. Perioperative management in infants who received cryotherapy is used as an illustration of this approach.

References

  • 1 Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinotherapy of prematurity: preliminary results.  Arch Ophthalmol . 1988;  106 471-477
  • 2 Schulenburg W E, Bloom P A. Current problems in the management of ROP.  Acta Ophthalmol Scand . 1995;  73 (suppl 214) 14-16
  • 3 Hussain N, Clive J, Bhandari V. Current incidence of retinopathy of prematurity, 1989-1997.  Pediatrics . 1999;  104 E26
  • 4 Anand K J, Hickey P R. Pain and its effects in the human neonate and fetus.  N Engl J Med . 1987;  317 1321-1329
  • 5 Haigh P M, Chiswick M L, O'Donoghue E P. Retinopathy of prematurity: systemic complications associated with different anaesthetic techniques at treatment.  Br J Ophthalmol . 1997;  81 283-287
  • 6 Gregory G A, Steward D J. Life-threatening perioperative apnea in the ex-premie.  Anesthesiology . 1983;  59 495-498
  • 7 Finer N N, Woo B C, Hayashi A, Hayes B. Neonatal surgery: intensive care unit versus oprating room.  J Pediatr Surg . 1993;  28 645-649
  • 8 The International Neonatal Network. The CRIB (Clinical Risk Index for Babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units.  Lancet . 1993;  342 193-198
  • 9 Cornips E, Van Calenbergh F, Plets C, Devlieger H, Casaer P. Use of external drainage for posthemorrhagic hydrocephalus in very low birth weight premature infants.  Childs Nerv Syst . 1997;  13 369-374
  • 10 Somaschini M, Locatelli G, Salvoni L, Bellan C, Colombo A. Impact of new treatments for respiratory failure on outcome of infants with congenital diaphragmatic hernia.  Eur J Pediatr . 1999;  158 780-784
  • 11 Frawley G, Bayley G, Chondros P. Laparotomy for necrotizing enterocolitis: intensive care nursery compared with operating theatre.  J Paediatr Child Health . 1999;  35 291-295
  • 12 Sullivan T J, Clarke M P, Tuli R, Devenyi R, Harvey P. General anesthesia with endotracheal intubation for cryotherapy for retinopathy of prematurity.  Eur J Ophthalmol . 1995;  5 187-191
  • 13 Lonnqvist P A. Successful use of laryngeal mask airway in low-weight expremature infants with bronchopulmonary dysplasia undergoing cryotherapy for retinopathy of the premature.  Anesthesiology . 1995;  83 422-424
  • 14 Pinsker M C, Sanborn G E. Is general anesthesia required?.  <~>[letter]. Anesthesiology . 1996;  84 1529-1530
  • 15 Brown G C, Tasman W S, Naidoff M, Schaffer D B, Quinn G, Bhutani V K. Systemic complications associated with retinal cryoablation for retinopathy of prematurity.  Ophthalmology . 1990;  97 855-858
  • 16 Louon A, Lithander J, Reddy V G, Gupta A. Sedation with nasal ketamine and midazolam for cryotherapy in retinopathy of prematurity.  Br J Ophthalmol . 1993;  77 529-530
    >