Changing Spectrum of Retinopathy of Prematurity (ROP) and Variations Among Siblings of Multiple Gestation

Objective  

To assess the changing spectrum of ROP, and to compare the siblings of multiple gestations with regard to incidence and severity of ROP.     

The Role of Hemoglobin Variant Replacement in Retinopathy of Prematurity

Objective  

To conduct tests of relationships between different factors that could influence the course of retinopathy of prematurity (ROP) and ROP, particularly the role of hemoglobin variant replacement in adult blood transfusions.     

Duration of anaemia during the first week of life is an independent risk factor for retinopathy of prematurity

Aim

This study evaluated the correlation between retinopathy of prematurity (ROP), anaemia and blood transfusions in extremely preterm infants.

Methods

We included 227 infants born below 28 weeks of gestation at King Edward Memorial Hospital, Perth, Australia, from 2014–2016. Birth characteristics and risk factors for ROP were retrieved, and anaemia and severe anaemia were defined as a haemoglobins of <110 g/L and <80 g/L, respectively. Logistic regression was used for the analysis.

Results

Retinopathy of prematurity treatment was needed in 11% of cases and the mean number of blood transfusions (p < 0.01), and mean number of weeks of anaemia (p < 0.001) and of severe anaemia (p < 0.05), had positive associations with ROP cases warranting treatment. In the multivariate logistic regression analysis, the best‐fit model of risk factors included anaemic days during first week of life, with an odds ratio (OR) of 1.46% and 95% confidence interval (CI) of 1.16–1.83 (p < 0.05), sepsis during the first 4 weeks of life (OR 3.14, 95% CI 1.10–9.00, p < 0.05) and days of ventilation (OR 1.03, 95% CI 1.01–1.06, p < 0.05).

Conclusion

The duration of anaemia during the first week of life was an independent risk factor for ROP warranting treatment and preventing early anaemia may decrease this risk.     

Retinopathy of Prematurity in a Rural Neonatal Intensive Care Unit in South India—A Prospective Study

Objective  

To report the incidence, spectrum and treatment outcome of Retinopathy of Prematurity (ROP) in a rural neonatal nursery.     

Severe retinopathy of prematurity in big babies in India: History repeating itself?

Objective  

To describe the characteristics of babies with severe retinopathy of prematurity (ROP) attending a tertiary referral eye hospital in South India.     

Treatment of Retinopathy of Prematurity with topical ketorolac tromethamine: a preliminary study

Background  

Retinopathy of Prematurity (ROP) is a common retinal neovascular disorder of premature infants. It is of variable severity, usually heals with mild or no sequelae, but may progress to blindness from retinal detachments or severe retinal scar formation. This is a preliminary report of the effectiveness and safety of a new and original use of topical ketorolac in preterm newborn to prevent the progression of ROP to the more severe forms of this disease.     

Risk Factors for Severe Retinopathy of Prematurity in Preterm Low Birth Weight Neonates

Objective  

To evaluate the risk factors predisposing to severe retinopathy of prematurity (ROP) in a level III neonatal unit. This retrospective study was conducted in a tertiary care neonatal and ophthalmic center.     

Retinopathy of prematurity and risk factors: a prospective cohort study

Background  

Increased survival of extremely low birth infants due to advances in antenatal and neonatal care has resulted in a population of infants at high risk of developing retinopathy of prematurity (ROP). Therapeutic interventions include the use of antenatal and postnatal steroids however, their effects on the severity of ROP is in dispute. In addition, it has not been investigated whether severe ROP is due to therapeutic interventions or due to the severity of illness. The aim of the present study was to assess the association between the incidence of severe retinopathy of prematurity (greater than stage 2 – International classification of ROP) and mechanical ventilation, oxygen therapy, gestational age, antenatal and postnatal steroids in extremely low birth weight infants.     

Role of Hematological Parameters in Predicting Retinopathy of Prematurity (ROP) in Preterm Neonates

Objectives

To study the role of hematological parameters in predicting retinopathy of prematurity (ROP) in preterm neonates.

Method

Two hundred forty eight babies less than 34 wk and/or with a birth weight of less than 2,000 g were evaluated. Peripheral blood smear and complete blood count were done on day one of life. Ophthalmological examination was done as per guidelines and grades of ROP classified and followed up till 40 wk of gestation for complete vascularisation. Cases were matched with similar number of controls (n?=?67) and the sensitivity, specificity and positive predictive value of different parameters were assessed.

Results

The incidence of ROP on screening was found to be 27 %. Sixty seven cases were matched with 67 controls as per birth weight and gestational age. Significant risk factors for ROP included longer duration of ventilation, higher FiO₂, culture proven sepsis and apnea requiring pharmacotherapy. The incidence of Stage I was 10.5 % (n?=?7), Stage II 58.2 % (n?=?39) and Stage III was 31.3 % (n?=?21). The absolute nucleated RBC (ANRBC) count was found to be the only parameter which was significantly higher in babies with ROP (p?<?0.001). The ANRBC was higher with increasing severity of ROP (p?=?0.003). The sensitivity, specificity and positive predictive value of ANRBC with ROP was higher than other parameters.

Conclusions

Increase in ANRBC count correlated with intrauterine hypoxia. Hence, an increase in ANRBC count could be used as a screening tool for the early prediction of ROP in babies.     

Distribution of Retinopathy of Prematurity and Its Risk Factors

Objective

This study was conducted to determine the distribution and risk factors of retinopathy of prematurity (ROP) in premature infants referred to neonates intensive care unit (NICU) of central hospital of Kerman University of Medical Sciences, to obtain primary information on ROP in Kerman, Iran.

Methods

In a cross sectional prospective study, data of premature infants screened for ROP including possible risk factors and eye examination results were recorded during 2006-2008 and analyzed by using logistic regression and chi-square tests.

Findings

Out of 83 premature infants, 24 (29%) had different stages of ROP (CI 95%: 0.19-0.39). The infants’ mean gestational age (GA) and mean birth weight (BW) in ROP group were 30.17±1.8 weeks and 1247.92±237.1 grams (g), respectively. Logistic regression analysis showed a significant relation between GA and BW with ROP (P<0.001). Indication for treatment was set in 6 (25%) infants.

Conclusion

The results of this study illustrate a relatively high prevalence of ROP in this series. GA and BW were independent ROP determinants.     

Retinopathy of prematurity: A systematic review of the literature

OBJECTIVE:

To assist in the diagnosis of retinopathy of prematurity (ROP) to facilitate treatment in a timely manner to help prevent blindness.

DATA SOURCES:

Systematic review using MEDLINE including the following key words, “retinopathy of prematurity”, “retrolental fibroplasia”, “blind”, “blindness”, “vision screening”, “cryotherapy”, “cryosurgery”, “laser” and “ablative therapy”. The bibliographies of the references found using the above techniques were scanned for references missed in the primary search.

DATA SELECTION:

Eight population-based studies examining the incidence and severity of ROP were identified. Other studies of ROP were included because they contributed to an understanding of the natural history, treatment or long term outcome of ROP.

DATA EXTRACTION:

Data was analyzed cumulatively from the population-based studies to determine the incidence of ROP. For the natural history, treatment and schedule of eye examinations, data was reported from individual studies.

DATA SYNTHESIS:

Infants at greatest risk of ROP were 1500 g or less at birth, or 30 weeks gestational age or younger. An inverse relationship existed between the incidence and severity of ROP and birth weight or gestational age. The age of onset of ROP was four to six weeks; however, a few newborns presented with an aggressive form of ROP called ’rush disease’ as early as three weeks of age. For those requiring treatment for ROP, the maximum severity was about 11 weeks of age. Long term follow-up for refractive errors was more effective between six and 12 months and again at four years.

CONCLUSION:

Very premature or very low birth weight infants are at highest risk of ROP. Based upon published information, an optimal screening schedule is recommended and a long term follow-up strategy is provided.     

Early Aggressive Parenteral Nutrition Induced High Insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3) Levels Can Prevent Risk of Retinopathy of Prematurity

Objective

To evaluate early aggressive vs. conservative nutrition and its effect on Retinopathy of Prematurity (ROP) in <32 weeks of gestation neonates.

Methods

A prospective, randomized, clinical study was conducted in NICU with a total of 75 preterm infants. In the intervention group, infants received early aggressive nutrition immediately after birth, in the control group infants were started on conventional parenteral nutrition (PN). Blood samples were obtained for Insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3) levels before commencement of PN on the first postnatal day, and from week 1 to 6 every week. All the infants were examined for ROP.

Findings

Infants in the early aggressive group had a reduction in the risk of ROP of 5% (2 from 40); the number of infants needed treatment averaged 3.7 (2.7 to 5.2). A total of 11 neonates in the conventional group were detected having ROP (P<0.05). Overall, IGF-I levels were higher in the aggressive PN (APN) vs the conventional PN (CPN). ROP development was higher in the CPN compared to the APN. IGF-1levels were lower in ROP developers compared with non-ROP in the APN group. There was no difference in IGF-I levels in ROP developers versus non-ROP in the CPN group. IGF-1 levels were lower in the CPN group compared with the APN group in the third week in ROP developers. There was a correlation between ROP and IGF-1 levels. Through ROC analysis, IGF-1 was demonstrated as being a sensitive marker for ROP.

Conclusion

IGF-1 levels were higher in the APN group versus the CPN group. This may indicate that IGF-1 levels simply being higher is not enough; rather, that being higher above a cutoff value may prevent ROP.     

Does reducing light exposure decrease the incidence of retinopathy of prematurity in premature infants?

BACKGROUND

Retinopathy of prematurity (ROP) can result in significant morbidity in preterm infants. Light exposure has been suggested to be a contributing factor.

OBJECTIVE:

A systematic review was performed to determine whether reducing light exposure in the neonatal intensive care unit decreased the incidence of ROP in preterm infants.

METHODS:

The literature was reviewed using the methodology for systematic reviews recommended by the Consensus on Resuscitation Science, adapted from the American Heart Association’s International Liaison Committee on Resuscitation.

RESULTS:

Seven articles were reviewed. Six of the articles were neutral to the clinical question and one supported the clinical question. However, the latter study used retrospective controls and was conducted during the evolution of the classification system for ROP. There were no studies that opposed the clinical question.

CONCLUSION:

Decreasing ambient light exposure in neonatal intensive care units is not of benefit in reducing the incidence of ROP.     

Role of Serum Levels of Vascular Endothelial Growth Factor and Its Receptor in Retinopathy of Prematurity

Background:

Retinopathy of prematurity (ROP) is a disorder of developing retina of low birth weight preterm infants which can lead to blindness. One theory attributes the fibrosis seen in ROP to deregulation of vascularization in the retina. Vascular endothelial growth factor (VEGF) is one of the important mediators involved in vascularization.

Objectives:

This study was carried out to assess the role of VEGF and its receptor in retinopathy of prematurity.

Patients and Methods:

Around 200 preterm infants born in SSK hospital were screened at 33 - 34 weeks. These babies were followed up according to the international classification of retinopathy of prematurity (ICROP) criteria. Those infants who developed ROP at 38 - 40 weeks were enrolled in group A while an equal number of infants who did not develop ROP were included in group B. Each group comprised of 30 subjects each. Venous sampling was carried out twice, once at 33 - 34 weeks and then again at 38 - 40 weeks. VEGF and VEGF-R2 were estimated by commercially available ELISA kits.

Results:

There was no statistically significant difference between the levels of VEGF and VEGF-R2 in both groups at first visit as well as the follow up visit. However, the intra-group difference was significant between the first and the final visit in VEGF and VEGF-R2 levels in the cases with ROP. In the control population, the VEGF levels were significantly lower in the follow up visit as compared to the initial visit.

Conclusions:

Our study demonstrates that a significant difference is seen in the serum VEGF and VRGF-R2 in the second visit of the infants with ROP demonstrating that VEGF might be responsible for the initiation and aggravation of ROP.     

Quality Improvement Initiative to Improve the Screening Rate of Retinopathy of Prematurity in Outborn Neonatal Intensive Care Graduates

Objective

To improve the screening rate of Retinopathy of prematurity (ROP) in the outborn neonatal intensive care unit, using the quality improvement method.

Methods

40 neonatal nurses, 89 parents from an outborn neonatal intensive care unit of a tertiary-care hospital were included in the study between May 2017 and March 2018. Universal sampling method was used.

Results

In 345 neonates, ROP screening rate increased from 10.7% in the pre-intervention phase to 45.5% and 87.3% in the intervention and post-intervention phase, respectively.

Conclusion

Point of care quality improvement (POCQI) method can be effectively used to improve ROP screening rate in outborn neonates.

     

The influence of early postnatal nutrition on retinopathy of prematurity in extremely low birth weight infants

Background

Retinopathy of prematurity(ROP) is the most common serious ophthalmic disease in preterm infants. Human milk may provide a protective effect for ROP; however, beneficial effects of human milk preclude randomized trials. Therefore, we conducted a retrospective analysis comparing early postnatal nutrition with ROP development.

Objective

Evaluate relationship between early postnatal nutriture and ROP surgery.

Design/methods

Nutrition data was collected for inborn AGA infants, BW 700-1000 g. ROP surgery was the primary outcome variable. A single pediatric ophthalmologist supervised examinations. All infants received triweekly IM vitamin A as chronic lung disease prophylaxis (Tyson: NEJM, 1999).

Results

BW and gestational age were 867 ± 85 g and 26.3 ± 1.2 weeks (n = 77, mean ± 1SD). ROP surgery infants(n = 11) received more parenteral nutrition, 1648 mL, and less human milk, 13.8 mL/kg-day, and vitamin E, 1.4 mg/kg-day, during the second postnatal week. Human milk was a negative predictor for ROP surgery, odds ratio = 0.94. Both groups met vitamin A recommendations; however, 74% was administered via IM injections. Neither group met vitamin E recommendations.

Conclusions

Human milk feeding, parenteral nutrition volume and vitamin E intake were predictors for ROP surgery. IM vitamin A injections provided the majority of vitamin A; vitamin E administration was insufficient. Improving human milk feeding rates and vitamin dosing options may affect ROP surgery rates.     

Blinding Retinopathy of Prematurity in Western India: Characteristics of Children,Reasons for Late Presentation and Impact on Families

Objective

To ascertain why children with end-stage retinopathy of prematurity (ROP) become blind, and to explore the impact of blindness on families.

Design

Mixed quantitative and qualitative methods.

Setting

Tertiary-care eye hospital in India.

Participants

Children with end-stage ROP and their carers.

Intervention

Cases presenting between June 2009 and July 2016 were identified from medical records and data extracted. Carers were contacted for missing information, if required. Data were analyzed to explore where failure had occurred in the process of screening and treatment. A subset of carers were selected for in-depth interviews to explore the impact of having a blind child. Interviews were recorded, transcribed and analyzed using a thematic framework.

Main outcome measures

Parental perceptions.

Results

66 children were included: median age 4.3 y (range 3 mo–6 y), 58% boys. 74% were blind due to ‘screening failure’, which was associated with lower maternal education (P=0.03). Of the 17 case of treatment failure (24.6%), majority (12, 70%) had aggressive posterior ROP. A subset of carers of 18 children (50% boys) were interviewed, mostly mothers. Most reported impoverishment as a result of having a blind child, and many reported lack of access to special education, negative attitudes of others and concerns about the future.

Conclusions

Screening for retinopathy of prematurity needs to be expanded and counselling improved. Access to special education and rehabilitation need to be improved.

     

Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year retrospective review

Background  

The increasing use of serial PET/CT scans in the management of pediatric malignancies raises the important consideration of radiation exposure in children.