Abstract
Introduction: Acute necrotising enterocolitis is a multifactorial disease leading to an alteration of microcirculation eventually resulting in infectious necrosis of the intestinal wall. It principally affects new-borns and prematurely born infants and is the most frequent gastrointestinal emergency in this age group.Material and methods: We report a case of necrotising enterocolitis occurring after ocular instillation of tropicamide and phenylephrine in a prematurely born infant. We searched in the international pharmacovigilance database (Vigibase®) for other cases.Results: A 2-month-old female infant, born after 25 weeks and 5 days of amenorrhea received ocular instillation of tropicamide and phenylephrine and intravitreal injection of bevacizumab for treatment of premature retinopathy. While the patient did not show any abdominal significant digestive symptom until then, she presented a bloated abdomen. The next day, her clinical state improved but each of the three following administrations of tropicamide and phenylephrine led to reoccurring of digestive symptoms and rectal bleeding. Diagnosis of necrotizing enterocolitis justified the initiation of antibiotics. Five days after the last administration of the eye drops, the patient recovered. In Vigibase®, we found 12 other case reports of necrotising enterocolitis with tropicamide or phenylephrine eye drops which were associated in 6 cases and were the only suspected drugs in 3 cases. All concerned newborns or infants and 9 of them were premature. Discussion/Conclusion: After reaching the general blood circulation, a slowdown of intestinal peristalsis is expected with these drugs because of the anticholinergic properties of tropicamide associated with a decrease in mesenteric perfusion due to the vasoconstrictive action of phenylephrine [1,2]. Vigilance is required following the administration of these drugs especially in premature newborns and infants, whose often need to undergo eyeground in case of premature retinopathy and have an increased risk of systemic leakage of eye drops.References:[1] Barber, H.E. et al. Br. J. Pharmacol. 1975; 55:335–41.[2] Ward, P. W. et al. BMJ Case Rep. 2014; 2014.