Respiratory Complications in Infants with Retinopathy of Prematurity (ROP) Requiring Laser Photocoagulation

Abstract

Objective The objective of this paper was to describe peri-procedural events and complications of infants requiring laser photocoagulation for retinopathy of prematurity (ROP) in a level IV neonatal intensive care unit.

Study Design A retrospective chart review was performed of neonates requiring ROP exams from January 2017 to August 2020. Baseline maternal and neonatal characteristics, ROP exam findings, and associated treatment were analyzed. Group characteristics were compared based on the need for laser photocoagulation. Subgroup analysis of the laser group including respiratory outcomes, cardiorespiratory index (CRI) scores, and pain scores was also performed.

Results Neonatal and maternal characteristics in the laser (n = 27) and non-laser (n = 172) groups were assessed. Of the 81.5% (22/27) that required re-intubation for laser, 36% (8/22) had >1 intubation and 18% (4/22) had >1 extubation attempt. The average duration of intubation following laser was 2.46 ± 7.13 days, with 40% (9/22) needing peri-extubation steroids and 18% (4/22) racemic epinephrine to facilitate extubation. Mean total respiratory support time post-laser was 8.65 ± 15.23 days. Mean neonatal pain, agitation, and sedation scores after laser were zero immediately after the procedure, 0.09 ± 0.33 at 12 hours, 0.11 ± 0.47 at 24 hours, and 0.11 ± 0.51 at 48 hours. The mean CRI scores were 1 ± 0 immediately after the procedure, 1.17 ± 0.4 at 12 hours, 1.41 ± 0.20 at 24 hours, and 1 ± 0 at 48 hours.

Conclusion Nearly all infants undergoing laser photocoagulation for ROP in our cohort required intubation and continued respiratory support. Despite stability during the procedure, complications from intubation were common.

Key Points

• Routine intubation for laser is associated with complications.

• Need for post-procedural respiratory support is common.

• Avoiding intubation may mitigate these neonatal complications.

Keywords

infant - newborn - preterm infant - retinopathy of prematurity - laser photocoagulation - respiratory complications

Publikationsverlauf

Eingereicht: 20. August 2021

Angenommen: 31. Oktober 2021

Artikel online veröffentlicht:
10. Dezember 2021

• References

• 1 Hellström A, Smith LE, Dammann O. Retinopathy of prematurity. Lancet 2013; 382 (9902): 1445-1457
• 2 Freitas AM, Mörschbächer R, Thorell MR, Rhoden EL. Incidence and risk factors for retinopathy of prematurity: a retrospective cohort study. Int J Retina Vitreous 2018; 4 (20) 20
• 3 Seiberth V, Linderkamp O. Risk factors in retinopathy of prematurity: a multivariate statistical analysis. Ophthalmologica 2000; 214 (02) 131-135
• 4 Jensen AK, Ying G-S, Huang J, Quinn GE, Binenbaum G. Postnatal serum insulin-like growth factor-1 and retinopathy of prematurity. Retina 2017; 37 (05) 867-872
• 5 Wang S-D, Zhang G-M. Shenzhen Screening for Retinopathy of Prematurity Cooperative Group. Laser therapy versus intravitreal injection of anti-VEGF agents in monotherapy of ROP: a meta-analysis. Int J Ophthalmol 2020; 13 (05) 806-815
• 6 Klein KS, Aucott S, Donohue P, Repka M. Anesthetic and airway management during laser treatment for retinopathy of prematurity: a survey of US ophthalmologists and neonatologists. J AAPOS 2013; 17 (02) 221-222
• 7 Örge FH, Lee TJ, Walsh M, Gordon K. Comparison of fentanyl and morphine in laser surgery for retinopathy of prematurity. J AAPOS 2013; 17 (02) 135-139
• 8 Ulgey A, Güneş I, Bayram A. et al. Decreasing the need for mechanical ventilation after surgery for retinopathy of prematurity: sedoanalgesia vs. general anesthesia. Turk J Med Sci 2015; 45 (06) 1292-1299
• 9 Piersigilli F, Di Pede A, Catena G. et al. Propofol and fentanyl sedation for laser treatment of retinopathy of prematurity to avoid intubation. J Matern Fetal Neonatal Med 2019; 32 (03) 517-521
• 10 Jiang JB, Strauss R, Luo XQ. et al. Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study. BMJ Open 2017; 7 (01) e013344
• 11 Lyon F, Dabbs T, O'Meara M. Ketamine sedation during the treatment of retinopathy of prematurity. Eye (Lond) 2008; 22 (05) 684-686
• 12 Kirwan C, O'Keefe M, Prendergast M, Twomey A, Murphy J. Morphine analgesia as an alternative to general anaesthesia during laser treatment of retinopathy of prematurity. Acta Ophthalmol Scand 2007; 85 (06) 644-647
• 13 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
• 14 Gregory KE, Deforge CE, Natale KM, Phillips M, Van Marter LJ. Necrotizing enterocolitis in the premature infant: neonatal nursing assessment, disease pathogenesis, and clinical presentation. Adv Neonatal Care 2011; 11 (03) 155-164 , quiz 165–166
• 15 Murat I, Constant I, Maud'huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatr Anaesth 2004; 14 (02) 158-166
• 16 Woodhead DD, Lambert DK, Molloy DA. et al. Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity. J Perinatol 2007; 27 (04) 209-213
• 17 Haigh PM, Chiswick ML, O'Donoghue EP. Retinopathy of prematurity: systemic complications associated with different anaesthetic techniques at treatment. Br J Ophthalmol 1997; 81 (04) 283-287