Retinopathy of prematurity. Diagnosis, severity, and natural history

This article presents data gathered in a prospective clinical trial of constant monitoring of oxygen therapy on the diagnosis, severity (as coded by a severity index [SI]) and natural history of retinopathy of prematurity (ROP) in 214 surviving infants with birthweights less than or equal to 1300 g. ROP developed in 119 (55.6%) infants and, of these, cicatricial ROP developed in nine (7.6%). The disease was diagnosed at 8-9 weeks on the average in infants with birthweights less than 900 g and 4-5 weeks in infants 900 to 1300 g. Those infants in whom the disease regressed, ROP lasted approximately 15 weeks. The severity of the disease, as defined by the SI, was strongly correlated with the birthweight of the infant and weakly correlated with the total duration of oxygen therapy.     

Surveillance for retinopathy of prematurity in a Danish country. Epidemiological experience over 20 years

PURPOSE: An updated analysis of the trends in a Danish county regarding retinopathy of prematurity (ROP), outlining its natural history over the years 1982-2001. METHODS: Epidemiological data are given of the 132 infants in the county with birth years 1998-2001 prospectively under surveillance for ROP. The customary national screening limits of gestational age (GA) and birthweight (BW) of 32 weeks/1750 g were generally adhered to. The findings are compared to five previous consecutive reports of a similar set-up, now making a total of 1123 who have been under surveillance. RESULTS: With focus on the 20 years' newborns at a higher risk for ROP in the county (GA/BW both under the above limits; n=591) the continuous improvement up to 1998--as reflected by ROP frequency, its severity, and risk levels according to GA/BW--appears to have been interrupted. Compared to the previous 4-year period, the percentage acquiring ROP in 1998-2001 increased from 10 to 31%, and four recent cases qualified for retinal ablation therapy, compared with zero in the previous 4-year period. However, there were no advanced stages (of at least ROP 3) in infants above 30 weeks/1500 g at delivery. CONCLUSIONS: (a) Using the ROP also as a neonatal treatment quality parameter, the present trend (progress stopped) should be followed attentively. So far, we have no clues regarding therapy-related or other causality. (b) Despite the suggested worsening, a lowering of the ophthalmic GA and BW screening limits now seems justifiable. With a view also to the high-risk Copenhagen data and the national childhood visual impairment register, a reduction of the values to 31 weeks/1500 g should be considered.     

Retinopathy of prematurity. Clinical findings in a Danish County 1982-87

The study includes all infants in a Danish county born 1982-87 considered at risk of acquiring retinopathy of prematurity (n = 411; 178 girls, 233 boys). 325 had birthweight (BW) less than or equal to 1750 g and/or gestational age (GA) less than or equal to 34 weeks. The remaining referrals were on account of functional immaturity/significant oxygen treatment (n = 86). With a median onset age of 6.5 weeks (range 5-9 weeks) ROP was recorded in 63 infants. A negative correlation (r = -0.34) between GA and ROP onset age suggested a later onset in the very immature infant. ROP appeared in 60% of those born at GA less than or equal to 28 weeks (n = 30) and in 50% of survivals with BW less than or equal to 1000 g (n = 20). With BW and GA beyond the limits of 32 weeks and 1750 g only 5 cases of ROP were observed. Out of the 14 infants with at least stage 3 ROP 6 became blind in both eyes after few months (GA at delivery 25-31 weeks/BW 920-1595 g). All considered, 57 of the 63 with ROP showed spontaneous regression, however, leaving myopia of prematurity in 8 subjects.     

Retinopathy of prematurity in infants with birth weight>or=1250 grams-incidence, severity, and screening guideline cost-analysis.

PURPOSE: To determine the incidence and severity of retinopathy of prematurity (ROP) in infants with birth weight (BW) 1250 to 1800 g, to examine the influence of systemic conditions on the development of ROP in this population, and to evaluate the cost-effectiveness of various screening guidelines. METHODS: We reviewed records from 259 consecutive infants with BW 1250 to 1800 g who were screened for ROP over a 3-year period. Extracted data included presence and severity of ROP, and the following potential risk factors (RF) for ROP development: sepsis, meningitis, necrotizing enterocolitis, intraventricular hemorrhage greater than stage I, pneumothorax, direct bilirubin>2 mg/dl, central line placement, antibiotic treatment>14 days, greater than seven red blood cell (RBC) transfusions, and mechanical ventilation>96 hours. RESULTS: The overall incidence of ROP in this population was 4.2%. Two infants had stage 3 ROP, one with plus disease. Infants with stage 3 ROP had significantly lower BW (1299 versus 1484 g, P=0.013) and gestational age (GA) (28 versus 31 weeks, P=0.002) than those with no ROP. No infant with BW>1500 g developed treatable ROP. Conditions that best predicted ROP development in the 1501 to 1800 g BW group were sepsis, ventilation >96 hours, antibiotic use >14 days, RBC transfusions greater than seven units, and central line placement (P=0.001, P=0.001, P=0.012, P=0.014 and P=0.035, respectively). All infants with BW>1500 g who developed ROP had greater than or equal to two of these RF. CONCLUSIONS: All cases of high-risk ROP would have been identified by current screening guidelines. Modified screening criteria of infants with (1) BW相似文献   

Lower oxygen saturation alarm limits decrease the severity of retinopathy of prematurity.

PURPOSE: To determine whether lowering oxygen saturation alarm limits for infants at risk for retinopathy of prematurity (ROP) reduces its incidence and/or severity. METHODS: Oximetry alarm limits were lowered to 85% and 93% for all infants with a birth weight 1250 g or less and/or gestational age 28 weeks or less, and maintained until 32 weeks' postmenstrual age or until oxygen saturations were consistently greater than 93% in room air. The new policy was effective for infants born on or after June 1, 2003. ROP data were prospectively collected, and we compared the rate and severity of ROP in the year after the oximeter alarm policy change to the rates in the immediately preceding 3 years. RESULTS: In the year after the oximeter alarm limit policy change, 4 of 72 infants developed prethreshold ROP compared with 44 of 251 infants in the previous 3-year epoch (17.5% vs 5.6%, p=0.01). Similarly, only 6 of 144 eyes developed prethreshold ROP in the year after the policy change, compared with 84 of 502 in the previous 3 years (16.7% vs 4.2%, p=0.001). CONCLUSIONS: A simple change in oximeter alarm parameters in the first weeks of life for infants with a birth weight 1250 g or less may decrease the incidence of prethreshold ROP.     

Retinopathy of prematurity in surfactant treated infants.

Seventy six babies of less than 1500 g birth weight who had surfactant replacement therapy for severe respiratory distress syndrome were studied to assess the presence and stage of subsequent retinopathy of prematurity (ROP). A control group of 90 babies, matched for birth weight and gestational age, who did not have surfactant therapy were also studied. Threshold ROP or greater was found in 1.7% of the surfactant group and 7.8% of the controls. For the babies of less than 1000 g birth weight 4.0% of the surfactant babies and 16.3% of the controls reached threshold disease or greater. It is concluded that surfactant therapy is not associated with an increased incidence or severity of severe ROP in this preterm population.     

Retinopathy of prematurity: review of a four-year period.

For a four-year period the development of retinopathy of prematurity (ROP) was determined among neonates considered at risk of acquiring this condition. Fifty-six out of 249 premature infants developed some degree of ROP. Comparison of these infants with a group of 56 controls, admitted to hospital in the same period and matched for sex, birth weight, and gestational age, showed significant differences for sepsis, blood transfusions, and the period of oxygen monitoring in relation to the period of oxygen administration. The most consistent factor associated with the development of ROP was gestational age at the time of birth, though no gestational age group was entirely devoid of ROP. This suggests that screening for ROP should not be restricted to high-risk premature infants only.     

Retinopathy of prematurity: Prevalence and treatment over a 20 year period at Pennsylvania Hospital

This paper presents the results of a 20 year survey of ROP among ⩽ 2000 g BW infants cared for at Pennsylvania Hospital. It relates changes in perinatal care and nutrition, survival rates, and serial serum E levels with incidence and severity of ROP. It includes our protocol for monitoring E nutrition so as to optimize its effectiveness at physiologic serum levels for prophylaxis for ROP. Also presented are the promising results of our experience with vitamin E at pharmacologic serum levels as a treatment for severe ROP (defined as in the Cryo ROP Trial). These indicate the need for a multicenter trial to assess the effect of pharmacologic Vitamin E therapy as an alternative or supplement to therapy of severe ROP with laser or cryo surgery. Research support was provided by Hoffmann LaRoche Inc, Nutley N.J., USA and by Pennsylvania Hospital Research Support Fund.     

Retinopathy of prematurity in a controlled trial of prophylactic surfactant treatment.

AIMS: To investigate the incidence of acute and cicatricial retinopathy of prematurity (ROP) in a cohort of premature neonates entered into a randomised, multicentre trial of prophylactic exogenous surfactant for respiratory distress syndrome (RDS) compared with controls receiving surfactant only if severe RDS developed. METHODS: The incidence of acute and cicatricial ROP was assessed in 304 neonates born at less than 30 weeks' gestation in a geographically defined population of approximately three million. RESULTS: There was a trend towards improved survival in the group receiving prophylactic surfactant with 102/151 (67.5%) surviving compared with 82/141 controls (58.2%, p = 0.12). The prophylactic surfactant group would be expected to have an increased risk of ROP due to improved survival, particularly of the most premature infants. However, there was no statistically significant difference in the incidence of acute ROP between the two groups and the incidence of cicatricial ROP was lower in the group receiving prophylactic surfactant (4/100 survivors, 4.0%) compared with neonates receiving rescue surfactant as required (6/81, 7.4%). This difference did not reach statistical significance (p = 0.35). CONCLUSION: The trend for a lower incidence of cicatricial ROP in those neonates treated with prophylactic surfactant compared with the rescue surfactant group, despite improved survival, suggests that the use of prophylactic surfactant also had a beneficial effect on the development of cicatricial ROP.     

Retinopathy of prematurity. The association of a persistent hyaloid artery

In a review of 160 cases of retinopathy of prematurity (ROP), 14 patients were found to have an associated persistent hyaloid vascular system. The following four different manifestations of a persistent hyaloid system were identified: hyaloid artery anastomosed to peripheral neovascularization (1 case); hyaloid artery present with attached retina (3 cases); fibrous-appearing stalk with detached retina (3 cases); and massive persistent hyaloid vascular system (7 cases). In some cases, the hyaloid artery was only an associated finding and unrelated to ROP. In other cases, the hyaloid artery appeared to be an integral component of the retrolental membrane. Recognition of a massive persistent hyaloid artery has important prognostic value because the vessels are adherent to the retina and the retrolental membrane complicating surgical repair. The role of the associated hyaloid artery in ROP is described.     

马来西亚一个三级保健医院早产儿视网膜病变的筛查

目的:本研究旨在确定马来西亚一个三级保健医院早产儿视网膜病变的发病率及发病趋势。方法:回顾分析在2003-2005年之间出生并进行ROP筛查的婴儿,记录每个患儿ROP的最严重分期。结果:我们对188名婴儿进行了筛查,平均出生体重1105.3±300.6g,平均妊娠期为29.2 ±2.6wk。这些婴儿整体的ROP发病率为29.18 % (55/188)。出生体重在750g及以下的婴儿发病率为76.2%。3a以来,低体重儿的数量及重型ROP病例数量呈现一个增长的趋势(P<0.05)。出生体重与婴儿受检数量之间存在负相关关系(P=0.000)。结论:随着低体重和小月分婴儿比例的增加,患ROP的患儿比例随之增加。     

Retinopathy of prematurity in a tertiary center in south of Brazil

AIM: To investigate the incidence of retinopathy of prematurity(ROP) in the southern Brazil, the rate of treatment and outcomes in all premature infants born at Hospital de Clinicas de Porto Alegre, Brazil, from October 2002 to October 2006. · METHODS: A prospective cohort study was conducted on 323 premature children born at Hospital de Clinicas de Porto Alegre, Brazil, from October 2002 to October 2006 with birth weight equal to or less than 1 500g or a gestational age at birth of 32 weeks or less. All of the newborns were examined by indirect binocular ophthalmoscopy with the 28 diopters lens after pupil's dilation and a lid speculum after the sixth week of life with examinations repeated depending on the disease classification. The main clinical outcome was the occurrence of ROP at any stage. · RESULTS: ROP occurred in 82 infants with an incidence rate of 25.7%. Threshold disease occurred in only 17 of the patients (5.3%), all of them had the disease affecting posterior Zone II needing laser treatment. None of the treated children had Zone I or aggressive posterior disease despite that three of the treated children needed a second laser session. One patient of the re-treated group needed scleral buckling with an equatorial silicon band after progression to stage 4 of ROP. · CONCLUSION: The incidence of retinopathy and the threshold disease in this study was similar to the international results reported. This study showed a high survival rate (70.1%), high incidence of retinopathy, and high laser treatment necessity among newborns under 28 weeks of gestational age or under 1 000g of birth weight. This study drove attention about the no identification of any Zone I posterior disease in this cohort of patients.     

Retinopathy of prematurity. A randomized, prospective trial of transcutaneous oxygen monitoring

To determine whether the use of continuous transcutaneous oxygen monitoring (tcPO2) could reduce the incidence of retinopathy of prematurity (ROP) in pre-term infants receiving oxygen therapy, a randomized, prospective trial of constant monitoring using the transcutaneous oxygen monitor versus intermittent monitoring of oxygen was performed on a population of premature infants at very high risk for the development of ROP. Two hundred ninety-six infants were randomly assigned to either a constantly monitored (CM) or standard care (SC) group. CM infants had tcPO2 monitored continuously as long as they required supplemental oxygen, whereas SC infants had tcPO2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. One hundred one of 148 infants in the CM group and 113 of 148 in the SC group survived. The overall incidence of ROP was 51% in the CM group and 59% in the SC group (no significant difference). In infants over 1000 g birthweight, as the weight increased there was increasing risk of developing ROP in the SC group. The odds ratio for the ROPsc:ROPcm reached 7.6 in infants between 1200 and 1300 g in infants with Apgar scores greater than or equal to 8 at 5 minutes. The incidence of cicatricial ROP was similar in both groups: four in the CM and five in the SC group.     

Retinopathy of prematurity in a South Australian neonatal intensive care unit

Purpose: To establish the incidence and severity of retinopathy of prematurity (ROP) in an Australian population of premature infants, and define risk factors for this population.
Methods: A survey of neonates born weighing less than 1501 g and/or with gestational age below 33 weeks, was undertaken at a neonatal intensive care unit in South Australia.
Results: ROP was diagnosed in 16.0% of the 94 neonates who were screened until retinal vascularisation was complete. Threshold disease occurred in 4.2%. Logistic regression identified three significant risk factors for the development of ROP: days of mechanical ventilation, multiple birth and female sex.
Conclusions: The incidence of ROP was relatively low when compared with figures recently published for two large populations studied in the United States and England. This difference was due to a lower incidence of mild forms of the disease. Days of mechanical ventilation, multiple birth and female sex were independently predictive of the occurrence of ROP. As small numbers of infants with ROP are managed at individual Australian centres each year, a national ROP register is recommended to facilitate the study of the disease in this country.