Abstract
Objective The objective of this paper was to describe peri-procedural events and complications
of infants requiring laser photocoagulation for retinopathy of prematurity (ROP) in
a level IV neonatal intensive care unit.
Study Design A retrospective chart review was performed of neonates requiring ROP exams from January
2017 to August 2020. Baseline maternal and neonatal characteristics, ROP exam findings,
and associated treatment were analyzed. Group characteristics were compared based
on the need for laser photocoagulation. Subgroup analysis of the laser group including
respiratory outcomes, cardiorespiratory index (CRI) scores, and pain scores was also
performed.
Results Neonatal and maternal characteristics in the laser (n = 27) and non-laser (n = 172) groups were assessed. Of the 81.5% (22/27) that required re-intubation for
laser, 36% (8/22) had >1 intubation and 18% (4/22) had >1 extubation attempt. The
average duration of intubation following laser was 2.46 ± 7.13 days, with 40% (9/22)
needing peri-extubation steroids and 18% (4/22) racemic epinephrine to facilitate
extubation. Mean total respiratory support time post-laser was 8.65 ± 15.23 days.
Mean neonatal pain, agitation, and sedation scores after laser were zero immediately
after the procedure, 0.09 ± 0.33 at 12 hours, 0.11 ± 0.47 at 24 hours, and 0.11 ± 0.51
at 48 hours. The mean CRI scores were 1 ± 0 immediately after the procedure, 1.17 ± 0.4
at 12 hours, 1.41 ± 0.20 at 24 hours, and 1 ± 0 at 48 hours.
Conclusion Nearly all infants undergoing laser photocoagulation for ROP in our cohort required
intubation and continued respiratory support. Despite stability during the procedure,
complications from intubation were common.
Key Points
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Routine intubation for laser is associated with complications.
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Need for post-procedural respiratory support is common.
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Avoiding intubation may mitigate these neonatal complications.
Keywords
infant - newborn - preterm infant - retinopathy of prematurity - laser photocoagulation
- respiratory complications
