Mitchell Anita J, Green Angela, Jeffs Debra A, Roberson Paula K
Department of Biostatistics, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Adv Neonatal Care. 2011 Aug;11(4):291-7. doi: 10.1097/ANC.0b013e318225a332.
Preterm infants weighing less than 1500 g routinely undergo a series of eye examinations to screen for retinopathy of prematurity (ROP). While these examinations are important for the prevention of blindness, infants may suffer adverse physiologic events during and after the examination. The procedure includes administration of mydriatic eye drops that may be absorbed systemically and physical manipulation of the eye that is accompanied by stress and pain. The purpose of the study was to monitor changes in infant health status and adverse physiologic events in the 2 days after ROP eye screening.
The study used 50 preterm infants with a mean gestational age of 32 weeks, undergoing their first ROP examination in a NICU located in a university medical center.
This pilot study used a prospective, descriptive design.
Physiologic changes and illness events were recorded before and for 2 days after the eye examination, using tools that tracked parameters of respiratory, cardiovascular, gastrointestinal, and neurological status. Data were collected directly from daily audits of medical records. McNemar's test for comparing paired proportions and the signed rank test were used for comparing significance of physiologic changes before and after the ROP eye examination.
Apnea events increased significantly (P = .04) in the 24- to 48-hour period after the eye examination compared with apnea events before the eye examination. These results were based on 39 infants who were not receiving ventilator support. There was a significant difference in the frequency of oxygen desaturation events between infants with and without apnea (0-24 hours after examination, P < .002; 25-48 hours after examination, P < .001). There were no significant differences in heart rate, cyanosis, gastric residuals, or seizures after the eye examinations.
The ROP examinations may be associated with increased apnea, a clinically significant problem. Nursing implications include careful monitoring of infants during and after ROP eye examinations, discharge teaching for caregivers, and continued research on nursing interventions to prevent adverse physiologic events.
体重不足1500克的早产儿通常要接受一系列眼部检查，以筛查早产儿视网膜病变（ROP）。虽然这些检查对于预防失明很重要，但婴儿在检查期间及检查后可能会出现不良生理事件。该检查程序包括使用可能被全身吸收的散瞳眼药水以及对眼睛进行伴有压力和疼痛的物理操作。本研究的目的是监测ROP眼部筛查后2天内婴儿健康状况的变化及不良生理事件。
本研究采用了50名平均胎龄为32周的早产儿，他们在一所大学医学中心的新生儿重症监护病房（NICU）接受首次ROP检查。
这项初步研究采用前瞻性描述性设计。
使用追踪呼吸、心血管、胃肠道和神经状态参数的工具，在眼部检查前及检查后2天记录生理变化和疾病事件。数据直接从病历的每日审核中收集。使用McNemar检验比较配对比例，使用符号秩检验比较ROP眼部检查前后生理变化的显著性。
与眼部检查前的呼吸暂停事件相比，眼部检查后24至48小时内呼吸暂停事件显著增加（P = 0.04）。这些结果基于39名未接受呼吸机支持的婴儿。有无呼吸暂停的婴儿在氧饱和度下降事件频率上存在显著差异（检查后0 - 24小时，P < 0.002；检查后25 - 48小时，P < 0.001）。眼部检查后心率、发绀、胃残余量或惊厥方面无显著差异。
ROP检查可能与呼吸暂停增加有关，这是一个具有临床意义的问题。护理方面的影响包括在ROP眼部检查期间及检查后仔细监测婴儿、对护理人员进行出院指导，以及继续研究预防不良生理事件的护理干预措施。
