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Abutrabi IH, Ayed A, Malak MZ, Batran A. Knowledge, Attitudes, and Practices Toward Retinopathy of Prematurity Among Neonatal Intensive Care Nurses: A Cross-sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241249431. [PMID: 38716812 PMCID: PMC11080752 DOI: 10.1177/00469580241249431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024]
Abstract
It is important to study the awareness of retinopathy of prematurity (ROP) among neonatal care nurses in hospitals. Unfortunately, there is a lack of studies conducted among nurses on this subject in Palestine. Thus, this study purposed to assess the knowledge, attitudes, and practices toward ROP among neonatal intensive care nurses in Palestine. A cross-sectional was used to conduct this study. A convenience sampling method was utilized to recruit 289 neonate intensive care nurses working in private and governmental hospitals. The findings showed that around 48.0% of the nurses had low knowledge about preventing ROP. Most of the nurses (78%) reported a neutral attitude toward preventing ROP. Moreover, overall nurses' practices regarding ROP were fair (57.1%). There was a difference in practices regarding ROP according to the health sector (P < .05), in which the private sector had better practices compared to the governmental sector. Additionally, there was a significant difference in knowledge regarding ROP according to educational level (P < .05). Also, a significant difference was found in knowledge and practices regarding ROP according to nurses' experience. Attitudes and practices were the main significant predictors of knowledge (B = 0.153, P < .05; B = 0.172, P < .05, respectively). Knowledge and practices were the main predictors of attitudes (B = 0.126, P < .05; B = 469, P < .001), respectively. Knowledge, attitudes, and experience in neonate intensive care nurses were the main significant predictors of practices (B = 0.135, P < .05; B = 0.449, P < .001; B = 0.224, P < .05, respectively). It is necessary to develop an educational program and competency-based training programs for neonate intensive care nurses about ROP and implement preventive strategies.
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Affiliation(s)
| | | | | | - Ahmad Batran
- Palestine Ahliya University, Bethlehem, Palestine
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Almeida AC, Borrego LM, Brízido M, de Figueiredo MB, Teixeira F, Coelho C, Teixeira S. DIGIROP efficacy for detecting treatment-requiring retinopathy of prematurity in a Portuguese cohort. Eye (Lond) 2022; 36:463-469. [PMID: 33712731 PMCID: PMC8807590 DOI: 10.1038/s41433-021-01455-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND/OBJECTIVES To determine the efficacy of the DIGIROP model in detecting treatment-requiring retinopathy of prematurity (TR-ROP) in a Portuguese cohort. SUBJECTS/METHODS Multicentre, retrospective cohort study of all consecutive preterm infants who underwent ROP screening from April 2012 to May 2019 in two neonatal units. Gestational age (GA), birth weight (BW) and sex were inserted in the DIGIROP platform. The optimal cut-off point to achieve 100% sensitivity was calculated. Area under the receiver operating characteristic curve (AUC) was calculated. RESULTS Of the 431 infants who underwent ROP screening, 257 were eligible for DIGIROP analysis and 174 infants were excluded for having a GA outside the range 24-30 weeks imposed by the DIGIROP algorithm. Median GA was 29 weeks (range 24-30) and BW was 1060 g (range 408-2080). Twenty-tree infants (8.9%) developed TR-ROP. The highest risk obtained for TR-ROP was 0.5404 (95% CI 0.4343-0.6616) with a median achieved risk of 0.0938 (range 0.0016-0.5404). The optimal cut-off point to achieve 100% sensitivity on TR-ROP was 0.0016. The number of infants receiving ROP examinations would have been reduced from 257 to 187 infants (-27.2%) if the model was applied. CONCLUSIONS In our cohort, of 257 infants, the optimal cut-off point to achieve 100% sensitivity for TR-ROP was 0.0016 with moderate accuracy in the AUC (0.70). The number of infants requiring screening would have decreased 27.2% if the model was applied. It is essential that algorithms continue to be tested in different populations, especially in cohorts that include both younger and older GA infants.
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Affiliation(s)
- Ana C Almeida
- Hospital Beatriz Ângelo, Loures, Portugal.
- Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
- CHRC, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
- LUZ Saúde, Hospital da Luz de Lisboa, Lisbon, Portugal.
| | - Luís Miguel Borrego
- CHRC, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- LUZ Saúde, Hospital da Luz de Lisboa, Lisbon, Portugal
| | | | | | - Filipa Teixeira
- Hospital Santa Maria, Centro Hospitalar de Lisboa Norte, EPE, Lisbon, Portugal
| | - Constança Coelho
- Institute of Environmental Health (ISAMB), Lisbon Medical School, University of Lisbon, Lisbon, Portugal
| | - Susana Teixeira
- LUZ Saúde, Hospital da Luz de Lisboa, Lisbon, Portugal
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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Karunatilake M, Daspal S, Mugarab Samedi V, Rubab S. Screening for Retinopathy of Prematurity Through Utilization a Pediatric Retinal Camera at Jim Pattison Children's Hospital: A Vision for Improved Care. Glob Pediatr Health 2021; 8:2333794X211039642. [PMID: 34616858 PMCID: PMC8488407 DOI: 10.1177/2333794x211039642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022] Open
Abstract
Retinopathy of Prematurity (ROP) is a vascular proliferative disorder of preterm infants,
with increased disease severity and incidence occurring with lower gestational age and
birth weight. An alternate approach to ROP screening with wide-field digital retinal
imaging helps with the early detection of ROP, especially during the pandemic.
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Affiliation(s)
- Malshi Karunatilake
- University of Saskatchewan, Saskatoon, SK, Canada.,Royal University Hospital Children's Services, Saskatoon, SK, Canada
| | - Sibasis Daspal
- University of Saskatchewan, Saskatoon, SK, Canada.,Royal University Hospital Children's Services, Saskatoon, SK, Canada
| | - Veronica Mugarab Samedi
- University of Saskatchewan, Saskatoon, SK, Canada.,Royal University Hospital Children's Services, Saskatoon, SK, Canada
| | - Shehla Rubab
- University of Saskatchewan, Saskatoon, SK, Canada.,Royal University Hospital Children's Services, Saskatoon, SK, Canada
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Systemic adverse events after screening of retinopathy of prematurity with mydriatic. PLoS One 2021; 16:e0256878. [PMID: 34499693 PMCID: PMC8428556 DOI: 10.1371/journal.pone.0256878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate systemic adverse events after screening for retinopathy of prematurity (ROP) performed with mydriatic. Methods This was a retrospective case series study. Medical records of consecutive patients who underwent screening for ROP with 0.5% phenylephrine and 0.5% tropicamide eyedrops were retrospectively reviewed. The score of abdominal distention (0–5), volume of milk sucked and volume of stool, along with systemic details (pulse and respiration rates, blood pressure and number of periods of apnea) were collected at 1 week and 1 day before ROP examination, and at 1 day after examination. Results were compared between the days before and after examination. Correlation between body weight at the time of examination and the score of abdominal distention was examined. The numbers of infants with abdominal and/or systemic adverse events were compared between pre- and post-examination periods. Results Eighty-six infants met the inclusion criteria. The score of abdominal distention increased from 2.0 at 1 day before examination to 2.3 at 1 day after examination (p = 0.005), and the number of infants who had worsened abdominal distension increased after examination (p = 0.01). Infants with lower body weight had a higher score of abdominal distention (p < 0.0001, r = −0.57). The number of infants with reduced milk consumption increased after examination (p = 0.0001), as did the number of infants with decreased pulse rate (p = 0.0008). Conclusions Screening for ROP with mydriatic may have adverse effects on systemic conditions. Infants should be carefully monitored after ROP screening with mydriatic.
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Lundgren P, Jacobson L, Hård AL, Al-Hawasi A, Larsson E, Gränse L, Saric M, Sunnqvist B, Tornqvist K, Wallin A, Holmstrom GE, Smith LLE, Morsing E, Hellström A. High rate and large intercentre variability in retreatment of retinopathy of prematurity in infants born <24 gestational weeks. BMJ Open Ophthalmol 2021; 6:e000695. [PMID: 33981857 PMCID: PMC8070879 DOI: 10.1136/bmjophth-2020-000695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 11/08/2022] Open
Abstract
Objective Prematurity is a major risk factor for retinopathy of prematurity (ROP). We aimed to elucidate ROP prevalence, treatment and retreatment in infants born before 24 gestational age (GA) weeks in a Swedish cohort. Methods and analysis Infants with completed ROP screening, born at <24 GA weeks, 2007–2018 in Sweden were included. Data of GA, birth weight (BW), sex, neonatal morbidities, maximal ROP stage, aggressive posterior ROP (APROP), ROP treatments, treatment modality and treatment centre were retrieved. Results In total, 399 infants, with a mean GA of 23.2 weeks (range 21.9–23.9) and a mean BW of 567 g (range 340–874), were included. ROP was detected in 365 (91.5%) infants, 173 (43.4%) were treated for ROP and 68 of 173 (39.3%) were treated more than once. As the first treatment, 142 (82.0%) received laser and 29 (16.1%) received intravitreal injection of antivascular endothelial growth factor (anti-VEGF). Retreatment was performed after first laser in 46 of 142 (32.4%) and in 20 of 29 (69.0%) after first anti-VEGF treatment. Retreatment rate was not associated with GA, BW or sex but with APROP, treatment method (anti-VEGF) and treatment centre where the laser was performed (p<0.001). Twenty eyes progressed to retinal detachment, and two infants developed unilateral endophthalmitis after anti-VEGF treatment. Conclusion Infants, born at <24 weeks’ GA, had high rates of treatment-warranting ROP and retreatments. Treatment centre highly influenced the retreatment rate after laser indicating that laser treatment could be improved in some settings.
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Affiliation(s)
- Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lena Jacobson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Lena Hård
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Abbas Al-Hawasi
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Eva Larsson
- Institution of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Lotta Gränse
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marie Saric
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
| | | | - Kristina Tornqvist
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Gerd E Holmstrom
- Institution of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Lois LE Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eva Morsing
- Department of Pediatrics, Clinical Sciences Lund, Skåne University Hospital Lund, Lund, Sweden
| | - Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kremer LJ, Reith DM, Medlicott N, Broadbent R. Systematic review of mydriatics used for screening of retinopathy in premature infants. BMJ Paediatr Open 2019; 3:e000448. [PMID: 31206081 PMCID: PMC6542421 DOI: 10.1136/bmjpo-2019-000448] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Routine retinopathy of prematurity eye examinations are an important part of neonatal care, and mydriatic medicines are essential in dilating the pupil for the eye examination. There are concerns about the level of evidence for efficacy and safety of these mydriatic medicines. OBJECTIVE This review evaluates both efficacy and safety evidence of mydriatics used during the retinopathy of prematurity eye examination. METHOD Systematic literature review. RESULTS There is limited evidence guiding clinical practice for safety and efficacy of mydriatics. The majority of publications are underpowered and with an unclear to high level of bias. There are a wide variety of mydriatic regimens evaluated for efficacy and safety, and multiple regimens are associated with case reports. CONCLUSIONS Current international guideline seems unnecessarily high, especially when the reviewed literature suggest that lower doses are effective, albiet from underpowered studies. The lowest effective combination regimen appears to be phenylephrine 1% and cyclopentolate 0.2% (1 drop). Microdrop administration of this regimen would further increase the safety profile, however, efficacy needs to be assessed.
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Affiliation(s)
- Lisa Jean Kremer
- School of Pharmacy, University of Otago, Dunedin, Otago, New Zealand.,Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - David M Reith
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Natalie Medlicott
- School of Pharmacy, University of Otago, Dunedin, Otago, New Zealand
| | - Roland Broadbent
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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Jiang JB, Strauss R, Luo XQ, Nie C, Wang YL, Zhang JW, Zhang ZW. Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study. BMJ Open 2017; 7:e013344. [PMID: 28119385 PMCID: PMC5278276 DOI: 10.1136/bmjopen-2016-013344] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Laser photocoagulation surgery is a routine treatment for threshold retinopathy of prematurity (ROP). However, little is known about which anaesthesia protocols provide efficient pain control while minimising exposure risk to vulnerable infants. In this study, therefore, we assessed the efficacy and tolerability of multiple anaesthesia techniques used on premature infants during laser therapy. DESIGN AND MAIN OUTCOME MEASURES Anaesthesia modalities consisted of topical eye drops anaesthesia, general anaesthesia and intravenous fentanyl sedation with mechanical ventilation. Laser treatment efficacy and detailed operative information were retrospectively and consecutively analysed. Cardiorespiratory stability was assessed and compared. The Neonatal Pain Agitation and Sedation Scale (N-PASS) was used to evaluate tolerability in infants that underwent intravenous fentanyl sedation. RESULTS 97 cases of prematurity were included in this study. In 94/97 (96.9%) cases, vascular proliferation regressed. In the topical anaesthesia groups, the ophthalmologist needed 12-16 min more to complete the treatment. During the 3 postoperative days, topical anaesthesia demonstrated the greatest instability; 4/31 (12.90%) infants in this group suffered from life threatening events requiring resuscitation. The only instability observed in general anaesthesia and fentanyl sedation was attributed to difficulty in extubating within 24 hours after surgery. During laser therapy, the N-PASS score increased to 1.8 in the fentanyl sedation group. CONCLUSIONS Topical anaesthesia was associated with more cardiorespiratory instability during ROP laser treatment. While general anaesthesia and fentanyl sedation had similar postoperative cardiorespiratory results, the latter demonstrated acceptable pain stress control. However, the difficulty of weaning off mechanical ventilation in some cases after surgery needs to be addressed in future studies.
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Affiliation(s)
- Jing-bo Jiang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Randy Strauss
- Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Xian-qiong Luo
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Chuan Nie
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Yan-li Wang
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Jia-wen Zhang
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Zhi-wei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
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