I can see clearly now: Survey results from neonatal staff on mydriatic use in retinopathy or prematurity screening

Aims: Very preterm infants require mydriatic eye drops in preparation for retinopathy of prematurity examination. Mydriatic dosing needs to provide adequate pupil dilation for the examination and yet, avoid adverse effects. Although the relative frequency of mydriatic administration is high, there is no established or preferred mydriatic regimen in the Australia and New Zealand. The aim of surveying neonatal health care professionals is to establish the variation in mydriatic regimens and to estimate the frequency of common to rare adverse drug events after mydriatic administration. Methods: A questionnaire was emailed to selected nursing and management staff at Neonatal Intensive Care Units (NICU) listed in the Directory of NICU within Australia and New Zealand, 2017, the target survey participant being staff who administer the mydriatic eye drops during the retinopathy of prematurity eye examination. Results: Forty six neonatal staff from all major regions in Australia and New Zealand participated in the survey. The majority of participants were nursing staff who administered the mydriatics. Just over half of the staff prepare their own phenylephrine and cyclopentolate eye drops and approximately a quarter used either Cyclomydril® or a combination of phenylephrine and tropicamide. In-house compounded phenylephrine, cyclopentolate and tropicamide eye drops were diluted in the majority of cases. Staff that used the proprietary product Cyclomydril® used it undiluted (90%). Fifty four percent of staff reported that they administered one set of drops, compared to 41% gave two sets of drops and 5% administered 3 drops. No staff member reported administering more than 3 drops. The majority of staff administered a standard drop from the end of a minim or syringe (78%). A microdrop needle and an IV cannula (with the needle removed) were used to administer a microdrop in the remainder (22%). Neonatal staff reported seeing hypertension, tachycardia, bradycardia, apnoea, feed intolerance, abdominal distension, necrotising enterocolitis, death, seizure and skin blanching after mydriatic administration. Conclusions: There is a wide variety of mydriatic combinations used in Australia and New Zealand and a range in frequency of adverse drug events seen after mydriatic administration