Concerning the article by s. Belda et Al.: screening for retinopathy of prematurity: is it painful?

Abstract

Therefore, we consider that it is as important to relieve the pain as to prevent systemic effects of mydriatics in low-weight infants [3] . The main prophylactic measures are [4] : (1) To use in neonates only the minimum effective concentration of drugs: 2% ophthalmic phenylephrine solution and 0.5% ophthalmic cyclopentolate solution. (2) To reduce systemic absorption of drugs by applying pressure to the lacrimal sac during and for 2 min after instillation. Without lacrimal sac occlusion, approximately 80% of each drop may pass through the nasolacrimal system and be available for rapid systemic absorption by the nasal mucosa. To perform this correctly, two persons are needed: one for applying pressure to the lacrimal sac and the other for instilling the drops. (3) Not to repeat the doses. Usually it is enough to instill one drop of each drug in the eye at least 10 min prior funduscopic procedures, especially if lacrimal sac occlusion is complete. This procedure can be exceptionally repeated 15 min later, but a third dose should never be given. Dear Sir, We read with interest the article by Belda et al. ‘Screening for retinopathy of prematurity: Is it painful?’ [Biol Neonate 2004; 86: 195–200]. We agree with its content but we have a few concerns about some of the information presented in the above referenced article [1] and about practical recommendations that have not been included for neonatologists and nurses taking care of the preterm infants. The objective of the study was to evaluate the ophthalmologic examination side effects in preterm neonates with specially focusing on the occurrence of pain. Gastrointestinal side effects (vomiting and gastric aspirates), minimum oxygen saturation, apneas, and the need for respiratory assistance or intensive care unit admission within 24 h after the examination were assessed. These late clinical side effects are probably not due to pain but to the instillation of mydriatics, as the same authors refer to in the Discussion. These changes on physiologic variables may be life-threatening and can produce, although rarely, a cardiorespiratory arrest [2] . Published online: November 15, 2005