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Prolonged Mydriatic Effect of Tolazoline in the Premature Infant

Oded Preis, MD; Lindsay Noonan, RN
Am J Dis Child. 1987;141(5):476. doi:10.1001/archpedi.1987.04460050018009.
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Sir.—Tolazoline has been widely advocated for use in hypoxic infants refractory to mechanical ventilation. Among the many side effects attributed to tolazoline, mydriasis has been described in adults but not yet in the newborn. We present two premature infants with a prolonged mydriatic effect from tolazoline.

Patient Reports.—Patient 1.—A 1690-g female infant was born to a 25-year-old, para 0 woman at 34 weeks' gestation by normal spontaneous vaginal delivery. The Apgar scores were 6 and 8 at five and ten minutes, respectively. The infant presented with mild respiratory distress complicated by a right-sided tension pneumothorax on the third day. A chest tube was inserted. A tolazoline hydrochloride drip was started, and pancuronium bromide was given once for muscle relaxation. Within five hours, her pupils were dilated and unresponsive to light; this state persisted for 48 hours. The infant remained on a respirator and received oxygen supplementation for


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