Examination of the premature infant

Mydriatics slow gastric emptying in preterm infants

OBJECTIVE

Preterm infants are more likely to have episodes of abdominal distention, emesis, and gastric residuals 24 hours after their first screening examination for retinopathy of prematurity (ROP) than on the day preceding the examination. Because these feeding problems reflect abnormalities in motor function, the purpose of this study was to compare antral and duodenal motor activity and gastric emptying in preterm infants before and after the instillation of mydriatics.

STUDY DESIGN

Using a low compliance continuous perfusion manometric system, we recorded antral and duodenal fasting motor activity in 11 preterm infants before and after the instillation of mydriatics for their first screening examination for ROP. Gastric emptying was compared before and after the eye examination.

RESULTS

Although the number of antral motor contractions remained relatively constant throughout the study, duodenal motor contractions decreased nearly fourfold after the instillation of mydriatics versus that seen before (P <.01). Gastric emptying was significantly delayed after the completion of the eye examination compared with that seen before the examination (P <.05).

CONCLUSION

Current doses of mydriatics inhibit duodenal motor activity and delay gastric emptying, and these gastrointestinal effects of mydriatics may underlie the feeding difficulties seen in preterm infants on the day of screening examinations for ROP.

Retrolental fibroplasia. Experience over two decades in one institution

We examined 1,849 consecutively admitted premature infants weighing 2000 gm or less at birth for retrolental fibroplasia (RLF). Proliferative RLF was diagnosed frequently in low birth weight infants who were more likely to survive with modern neonatal intensive care. Cicatricial RLF was more likely to result from proliferative RLF and to be more severe in lower birth weight infants, but most affected eyes retained useful vision. Comparison of cases diagnosed over the 20 years of this study suggest that cicatricial RLF in recent years is less likely to result in severe visual disability. Improving survival rates for lower birth weight infants mandate continued surveillance for RLF and study of improved oxygen monitoring techniques.

A speculum for small infants

A new speculum suited to the examination of small infants is described. Its light weight design and reduced dimensions make it particularly useful for peripheral fundus examination in premature infants.

Treatment of retrolental fibroplasia

Retrolental fibroplasia (RLF), a proliferative vascular retinopathy found almost exclusively in premature infants, continues to occur despite careful attention to oxygen administration. Much has been learned about the etiology and mechanisms of RLF over the past 30 years, and it is hoped that technological and biological research will ultimately lead to its prevention. No treatment is of proven value for the proliferative stages of RLF, although photocoagulation and cryotherapy directed at destruction of neovascularization are under study. Surgical treatment may be of value in controlling associated problems, particularly retinal detachments.