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A Survey of Neonatal Nurses on Mydriatic Regimens Used in Neonatal Retinopathy of Prematurity Eye Examinations
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.
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
Keywordsretinopathy - neonate - mydriatic - phenylephrine - cyclopentolate - tropicamide - adverse drug event
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.
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).
Received: 06 December 2020
Accepted: 01 February 2021
Article published online:
30 March 2021
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