Eye-drop advice 'scaremongering'

By Hana Garrett-Walker

Coroner's call for weaker medicine for premature babies unwarranted, medical professionals say.

Experts have challenged a suggestion that eye drops could be linked to bowel disease in pre-term infants. Photo / Getty Images
Experts have challenged a suggestion that eye drops could be linked to bowel disease in pre-term infants. Photo / Getty Images

A coroner has recommended weaker-strength eye drops be made available after a premature baby died of septicaemia linked to an illness in her bowel shortly after having laser eye surgery.

But experts say there is no established link between the bowel disease and the eye drops and it would be scaremongering to say parents had any cause to be concerned about the use of eye drops on premature babies.

Hannah Charlotte Hope Smith was 65 days old when she died at Wellington Hospital on July 21 last year.

The tissue of her bowel began to deteriorate 12 hours after laser eye surgery for damage to her retinas, caused by being born prematurely at 26 weeks.

A coroner's finding focused on dilating eye drops used during the eye surgery and its connection to her deteriorating bowel, known as necrotising enterocolitis.

Auckland University ophthalmology lecturer Andrea Vincent said it was a weak link between the necrotising enterocolitis and the eye drops.

"I think the cause of necrotising enterocolitis is not clearly known, it is clearly known that the risk factor is being premature, not getting enough oxygen and infection and feeding early, and the eye drops really are just a red herring."

She could find very few pieces of literature which connected the two, and had never heard of it before.

"If [eye drops] were going to make it worse, it would surely make it worse on the eyes than the bowel, which is a long, long way away," she said.

Associate professor of ophthalmology at Otago University, Gordon Sanderson, said eye drops would have to be "seriously" strong to have an effect on a baby, and that sort of strength was not used.

He said the benefits of the eye drops far outweighed any risks and parents should not be concerned.

"I think it would be scaremongering to say otherwise."

In the coroner's report Dr Helen Millar, a neonatal paediatrician, also said that as far as clinicians were aware there was not a well-established connection between laser eye surgery and a deteriorating bowel.

Dr Miller said it was possible that the necrotising enterocolitis was coincidental to the eye surgery but said, in case there was a link, the neonatal intensive care unit at Wellington Hospital was now using only the smallest dose of eye drop necessary.

Independent expert Dr Peter Wellings told the coroner there had been anecdotal cases reported in medical literature of necrotising enterocolitis following the administration of dilating eye drops, but "such reports have been rare".

Dr Wellings said "there are not very firm connections one way or another" and he would be hesitant to draw a link between the eye drops and the deteriorating bowel in this case.

However, he recommended to Coroner Garry Evans that it would probably be wise to use a weaker strength if the drops needed to be used twice within hours of each other.

Coroner Evans agreed and recommended to the Ministry of Health that it considered making lower strength eye drops - which were not currently in New Zealand - available.

The Ministry of Health said Medsafe would write to eye medicine suppliers and ask they submit an application for low-dose products.


What is necrotising enterocolitis?
A medical condition where parts of the bowel tissue begin to die. Commonly known as NEC.

When does it occur?
It is primarily seen in premature babies who weigh less than 1500 grams, and typically occurs in the first two weeks of life.

What causes it?
The exact cause of NEC is not known, but it is thought that the intestinal tissues of premature babies are weakened by too little blood flow or oxygen and that when feeds are started the added stress of food moving through the gut allows bacteria that are normally found in the intestine to invade and damage the wall of the intestinal tissues.

What are the signs and symptoms of NEC?
Poor feed tolerance, feeds stay in stomach for too long, stomach becomes tender, bowel sounds not heard with the stethoscope, bile stained vomit, red mottle stomach.

How is it treated?
Stop feeding; placement of a naso-gastric tube and gentle suction attached to the end to remove air from the stomach; antibiotics, depending how severe the case is. If the bowel perforates surgery could be required to insert a drain or remove the section of affected bowel.

Source: Capital and Coast District Health Board


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