![aap unequal pupil size in infants aap unequal pupil size in infants](https://image.slidesharecdn.com/ch4emtvitals-110901135745-phpapp01/95/ch4-em-tvitals-19-728.jpg)
![aap unequal pupil size in infants aap unequal pupil size in infants](https://ytimg.googleusercontent.com/vi/p2Q0Fo3rRao/hqdefault.jpg)
Relationships between drug levels and adverse events were assessed.Ĭyclopentolate (range 6-53 ng/ml) was observed in 15 of 18 infants, while phenylephrine was not detected. Blood was collected onto dried blood spot cards, extracted, and analyzed for cyclopentolate and phenylephrine using liquid chromatography and mass spectrometry. The purpose of this study was to analyze the association between adverse events and drug levels found in neonates undergoing ROPEE.Ģ5 infants were randomized into two groups during routine ROP screening: 5 infants for blood collection before mydriatic drops and 20 for blood collection 1 h after eye drops. Preterm infants undergoing Retinopathy of Prematurity Eye Exams (ROPEE) may experience adverse events, possibly from systemic absorption of cyclopentolate. Except for the clinically increased heart rate in infants aged ≥37 weeks at examination, SI was found to be at par with the recommendation of the UK ROP Guidelines of May 2008.
![aap unequal pupil size in infants aap unequal pupil size in infants](https://ytimg.googleusercontent.com/vi/B_fMm_6jpYQ/hqdefault.jpg)
Due to significant increase in SBP, it is recommended to discontinue SIW in preterm infants for ROP screening since it may promote the mydriatic’s systemic absorption. Pupillary dilation did not have significant differences among groups (p=0.24).Ĭonclusion. This increase in SBP exceeded the clinical normal values for <37 weeks old infants. The SIW group exhibited significant increases in SBP (p<0.002) and in MAP (p<0.04) compared to MAI. The use of SI produced lower DBP (p<0.01) and MAP (p<0.003) compared to MAI. The use of SI produced lower DBP (p<0.0106) and MAP (p<0.0027) compared to MAI. The MAI group did not have significant changes relative to its baseline vital signs.
![aap unequal pupil size in infants aap unequal pupil size in infants](https://i.pinimg.com/originals/3e/2c/c3/3e2cc330baad8556b176798a36ce9a3c.jpg)
Sixty preterm infants, 20 to each intervention, were included. After instillations via MAI, SI, and SIW, systolic blood pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate, and oxygen saturation were monitored.
#AAP UNEQUAL PUPIL SIZE IN INFANTS TRIAL#
A randomized, double-blind, clinical trial included preterm infants for ROP screening at a Philippine tertiary hospital. To determine the safety and efficacy of three different mydriatic regimens in premature infants referred for retinopathy of prematurity (ROP) screening using (1) multiple alternate instillations of 0.5% cyclopentolate hydrochloride and 2.5% phenylephrine (MAI), (2) single instillation of 0.5%/0.5% tropicamide + phenylephrine (SI) and (3) single instillation of 0.5%/0.5% tropicamide + phenylephrine with a cotton wick placed in the inferior fornix (SIW) in a Philippine tertiary hospital. The absence of any severe intraprocedural complications may be related to reduced indentation time and stress in the infant facilitated by effective pupil dilation. We have found the combination of phenylephrine 2.5% with cyclopentolate 0.5% to be efficacious and well-tolerated. This is the largest cohort studying the effectiveness and safety of a mydriatic regimen for ROP screening. No retinal bleeding or other intraocular complication occurred. No respiratory or cardiac arrest or any other intraprocedural event requiring cessation of screening was encountered during any of the examinations. A fourth application was successful in the remaining 1.2%. Of 1246 eyes, 1234 (98.8%) achieved successful dilation to enable complete screening.
#AAP UNEQUAL PUPIL SIZE IN INFANTS FULL#
Outcome measures were successful mydriasis (defined as achieving a full screening examination) and any intraprocedural systemic complications (defined as any respiratory, cardiac, or other clinical deterioration severe enough to result in screening abandonment). We report the safety and efficacy of the use of phenylephrine 2.5% and cyclopentolate 0.5% eyedrops instilled 3 times 5 minutes apart in ROP screening.Ī total of 1246 ROP screening eye examinations were carried out by the same pediatric ophthalmologist between February 2011 and May 2013. Retinopathy of prematurity (ROP) is a leading cause of visual loss in infancy that is largely preventable with careful screening.