To the Editor.
—Through our association with a major children's hospital's neonatal intensive care unit, we perform several hundred retinopathy of prematurity (ROP) examinations every year. Stimulating the oculocardiac reflex by scleral depression in susceptible neonates1 in a relatively uncontrolled environment can lead to some untoward consequences, as evidenced by a recent incident at this institution.
Report of a Case.
—A 12-week-old female infant (gestation, 26 weeks by dates; birth weight, 930 g) was brought in for an outpatient screening ROP examination. The infant had suffered from apnea of prematurity soon after birth, but her condition had been stable, and she was without significant apnea for six weeks before this examination. During the examination of the right eye, the infant cried constantly with good respiratory movement. However, when we performed scleral depression in the left eye the patient became silent as she became cyanotic and flaccid. Stimulation and
Bates JH, Burnstine RA. Consequences of Retinopathy of Prematurity Examinations. Arch Ophthalmol. 1987;105(5):618-619. doi:10.1001/archopht.1987.01060050036026