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Priya B, Sahu V, Padhi P, Kumar A. Exploring the Relationship Between Early Postnatal Weight Gain and the Severity of Retinopathy of Prematurity: Insights From a Tertiary Care Facility in Central India. Cureus 2025; 17:e81262. [PMID: 40291178 PMCID: PMC12032441 DOI: 10.7759/cureus.81262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2025] [Indexed: 04/30/2025] Open
Abstract
Purpose The primary aim of this study is to ascertain whether early postnatal weight gain serves as an independent predictor for the severity of retinopathy of prematurity (ROP) in preterm infants. Method In this prospective observational study, 50 preterm infants (<34 weeks GA at birth or <2000 gm BW) in the Neonatal Care Unit were screened for ROP from June 2021 to June 2022. All infants were assessed weekly for postnatal weight gain during the first six weeks of life and the results were correlated with the severity of ROP. Result Out of 50 preterm infants, 25 (50%) developed ROP, and 25 (50%) had no ROP. Type 1 ROP was identified in two (8%) preterm infants. The mean gestational age and birth weight for the ROP group were 29.98 ± 1.80 weeks (SEM 95% CI) and 1161.32 ± 340.55 gm (SEM 95% CI), which were lower than those of the No ROP group, which had 31.94 ± 1.71 weeks (SEM 95% CI) and 1359.80 ± 313.52 gm (SEM 95% CI), respectively. The change in weight (grams) between the ROP and No ROP groups was statistically significant each week, except for the first week. However, for the first six weeks, no statistical correlation was found between Type 1 ROP and Type 2 ROP regarding weight change. Conclusion This study posits that postnatal weight gain, particularly evident in the fourth week, may be a pivotal factor in predicting the onset and severity of ROP in preterm infants. Further research and analysis are required to validate these findings and enhance our understanding of the relationship between postnatal growth patterns and ROP development.
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Affiliation(s)
- Bhanu Priya
- Ophthalmology, Centre for Sight, New Delhi, IND
| | - Vijaya Sahu
- Ophthalmology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Phalguni Padhi
- Neonatology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Aseem Kumar
- Ophthalmology, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Aulakh S, Houtman AC, Rathod D, Biswas S, McLoone E, Shafiq AE, Nassar MM, Connor AJ, Hillier RJ. The Royal College of Paediatrics and Child Health Retinopathy of Prematurity Screening Guidelines (2022): a series of treated infants falling outside the updated criteria. Eye (Lond) 2024; 38:2557-2560. [PMID: 38658679 PMCID: PMC11384725 DOI: 10.1038/s41433-024-03076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/12/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND/OBJECTIVES Screening for retinopathy of prematurity (ROP) is a core healthcare intervention in premature babies to avoid preventable sight loss. A variety of screening criteria are in place globally for this purpose. The Royal College of Paediatrics and Child Health recently updated the United Kingdom ROP screening guidelines (March 2022). A key change was the reduction in the gestational age (GA) to warrant retinal screening (from 32 to 31 weeks). SUBJECTS/METHODS In the course of informal national surveillance during guideline development (2017-2022) and soon after, babies under our care falling outside the updated screening criteria who underwent treatment for ROP were identified. A retrospective case review was carried out. RESULTS Six babies were identified as having undergone screening and treatment, prior to implementation of the new guidance. Screening and treatment would have been forfeited as per the March 2022 guidelines. All six had numerous systemic risk factors for developing ROP. Specifically, all had documented poor postnatal weight gain. CONCLUSIONS We present this case series to bring forth an urgent discussion amongst key stakeholders as to whether the new guidance, as it stands, is safe and fit for purpose.
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Affiliation(s)
| | - Anne Cees Houtman
- Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Dinesh Rathod
- Swansea Bay University Health Board, Port Talbot, UK
| | - Susmito Biswas
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Eibhlin McLoone
- Royal Victoria Hospital, Belfast Trust and Social Care Trust, Belfast, UK
| | - Ayad E Shafiq
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Mahmoud M Nassar
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Alan J Connor
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
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Cagliari PZ, Hoeller VRF, Kanzler ÉLR, Carraro MCM, Corrêa ZGD, Blazius G, Marghetti PG, Lenz GB, Mastroeni SSDBS, Mastroeni MF. Oral DHA supplementation and retinopathy of prematurity: the Joinville DHA Clinical Trial. Br J Nutr 2024; 132:341-350. [PMID: 38826072 DOI: 10.1017/s0007114524001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants. The condition is associated with DHA deficiency. This study aimed to investigate the effect of DHA supplementation on the occurrence of ROP in infants receiving oral oil drops. It is part of the Joinville DHA study, a non-parallel-group cohort study conducted from March 2020 to January 2023 at a public maternity hospital in Brazil. Infants born before 33 weeks of gestational age or with a birth weight ≤ 1500 g were recruited. Among 155 infants, 81 did not receive and 74 received DHA supplementation until complete vascularisation of the peripheral retina. There was a higher incidence of infants with ROP in the unsupplemented group (58·6 %) compared with the DHA group (41·4 %), but this difference was NS (P = 0·22). Unadjusted logistic regression analysis showed that patent ductus arteriosus and neonatal corticosteroids were significantly (P < 0·05) associated with ROP in both groups. In the DHA group, surfactant use was also associated with ROP (P = 0·003). After adjusting for important covariates, patent ductus arteriosus and neonatal corticosteroids continued to be significant for infants in the unsupplemented group (OR = 3·99; P = 0·022 and OR = 5·64; P = 0·019, respectively). In the DHA group, only surfactant use continued to be associated with ROP (OR = 4·84; P = 0·015). In summary, DHA supplementation was not associated with ROP. Further studies are necessary to better understand the relationship between DHA supplementation, ROP and associated comorbidities.
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Affiliation(s)
- Patrícia Zanotelli Cagliari
- Postgraduate Program in Health and Environment, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Darcy Vargas Maternity Hospital, Joinville, SC89.202-190, Brazil
- Medicine Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
| | | | | | | | | | - Gleici Blazius
- Nursing Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
| | | | - Gabriela Bruns Lenz
- Medicine Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
| | - Silmara Salete de Barros Silva Mastroeni
- Postgraduate Program in Health and Environment, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Medicine Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Nursing Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Nutrition Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
| | - Marco Fabio Mastroeni
- Postgraduate Program in Health and Environment, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Medicine Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Nursing Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Nutrition Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
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Schoephoerster J, Roston S, Lunos S, Ramel SE, Anderson J, Georgieff MK, Ingolfsland EC. Identification of clinical factors associated with timing and duration of spontaneous regression of retinopathy of prematurity not requiring treatment. J Perinatol 2023; 43:702-708. [PMID: 36973383 DOI: 10.1038/s41372-023-01649-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Identify clinical factors that delay or prolong spontaneous regression of retinopathy of prematurity (ROP). STUDY DESIGN Secondary analysis of three prospective studies with 76 infants with ROP not requiring treatment, born ≤30 weeks postmenstrual age (PMA) and ≤1500 grams. Outcomes were PMA at greatest severity of ROP (PMA MSROP), at which regression began, at time of complete vascularization (PMA CV), and regression duration. Pearson's correlation coefficients, t-tests, or analyses of variance were calculated. RESULTS Increased positive bacterial cultures, hyperglycemia, transfusion volume of platelets and red blood cells and severity of ROP were associated with later PMA MSROP. Positive bacterial cultures, maternal chorioamnionitis, and less iron deficiency were associated with later PMA CV and prolonged regression duration. Slower length gain was associated with later PMA CV. P < 0.05 for all. CONCLUSIONS Preterm infants with inflammatory exposures or linear growth impairment may require longer surveillance for ROP resolution and complete vascularization.
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Affiliation(s)
| | - Sydney Roston
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Sara E Ramel
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, USA
| | - Jill Anderson
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Michael K Georgieff
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, USA
| | - Ellen C Ingolfsland
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, USA.
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5
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Prasad M, Ingolfsland EC, Christiansen SP. Modifiable Risk Factors and Preventative Strategies for Severe Retinopathy of Prematurity. Life (Basel) 2023; 13:life13051075. [PMID: 37240719 DOI: 10.3390/life13051075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/28/2023] Open
Abstract
Severe ROP is characterized by the development of retinal fibrovascular proliferation that may progress to retinal detachment. The purpose of this report is to review five of the most common and well-studied perinatal and neonatal modifiable risk factors for the development of severe ROP. Hyperoxemia, hypoxia, and associated prolonged respiratory support are linked to the development of severe ROP. While there is a well-established association between clinical maternal chorioamnionitis and severe ROP, there is greater variability between histologic chorioamnionitis and severe ROP. Neonatal sepsis, including both bacterial and fungal subtypes, are independent predictors of severe ROP in preterm infants. Although there is limited evidence related to platelet transfusions, the risk of severe ROP increases with the number and volume of red blood cell transfusions. Poor postnatal weight gain within the first six weeks of life is also strongly tied to the development of severe ROP. We also discuss preventative strategies that may reduce the risk of severe ROP. Limited evidence-based studies exist regarding the protective effects of caffeine, human milk, and vitamins A and E.
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Affiliation(s)
- Minali Prasad
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Ellen C Ingolfsland
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Stephen P Christiansen
- Departments of Ophthalmology and Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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6
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Anvekar A, Athikarisamy S, Rao S, Gill A, Nathan E, Doherty D, Lam G. Time to regain birth weight - a marker to predict the severity of retinopathy of prematurity? BMC Pediatr 2021; 21:540. [PMID: 34856950 PMCID: PMC8638437 DOI: 10.1186/s12887-021-03027-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor weight gain in the first few weeks of life has been studied as a predictor of retinopathy of prematurity (ROP). Our aim was to assess whether time taken to regain birthweight (BW) be used as an additional marker to identify infants with type 1 ROP. METHODS In this retrospective study, preterm infants (< 27 weeks gestational age at birth) born during the period from 1/1/2010-31/12/2015 at a tertiary neonatal intensive care unit in Australia were included. Twenty-seven preterm infants with Type 1 ROP were identified. Controls (No ROP or ROP other than type 1) were matched with cases on gestational age at birth and BW (1:4 ratio). Data were collected from the database and medical records. RESULTS The median (IQR) gestational age for Type 1 ROP and control groups were 24 (24-26) and 25 (24-26) weeks respectively and median (IQR) BW for Type 1 ROP and control groups were 675 (635-810) and 773 (666-884) grams respectively. Preterm infants with Type 1 ROP were more likely to be small for gestational age (SGA) (18.5% vs 3.7%, p = 0.015) and had increased weeks on oxygen therapy (median 11.9 vs 9.1, p = 0.028). Time to regain BW was longer in preterm infants with type 1 ROP than controls but did not reach statistical significance (median 9 vs 7 days, OR 1.08, 95% CI 1.00-1.17, p = 0.059) adjusted for SGA and duration of oxygen therapy. The area under the curve from the time to regain BW model with adjustment for SGA and duration of oxygen therapy was 0.73 (95% CI 0.62-0.83). CONCLUSION We hypothesize that time to regain BW has potential to aid prediction of Type 1 ROP and this warrants further investigation in a larger prospective study.
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Affiliation(s)
- Ajay Anvekar
- Department of Neonatal Paediatrics, Fiona Stanley hospital, Perth, Australia.
| | - Sam Athikarisamy
- Department of Neonatal Paediatrics, Perth Children's Hospital, Perth, Australia.,Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia.,Department of Paediatrics, University of Western Australia, Perth, Australia
| | - Shripada Rao
- Department of Neonatal Paediatrics, Perth Children's Hospital, Perth, Australia.,Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia.,Department of Paediatrics, University of Western Australia, Perth, Australia
| | - Andy Gill
- Department of Neonatal Paediatrics, Perth Children's Hospital, Perth, Australia.,Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia.,Department of Paediatrics, University of Western Australia, Perth, Australia
| | - Elizabeth Nathan
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia.,Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia
| | - Dorota Doherty
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia.,Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia
| | - Geoffrey Lam
- Department of Ophthalmology, Perth Children's Hospital, Perth, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
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7
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Chaves-Samaniego MJ, Chaves-Samaniego MC, Muñoz Hoyos A, García Serrano JL. Nuevas evidencias sobre el efecto protector de la ganancia de peso en la retinopatía del prematuro. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpedi.2020.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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New evidence on the protector effect of weight gain in retinopathy of prematurity. An Pediatr (Barc) 2021; 95:78-85. [PMID: 34172428 DOI: 10.1016/j.anpede.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Retinopathy of prematurity (ROP) is characterised by insufficient vascular development in the retina, and requires early treatment to avoid visual disability in severe cases. ROP is currently the second leading cause of preventable child blindness in the world. PATIENTS AND METHODS This was an observational, retrospective, case-control study including 233 preterm infants examined between 1999 and 2019. RESULTS Postnatal weight gain in the first 4 weeks of life, birth weight, gestational age, mechanical ventilation, transfusion, presence of sepsis, persistence of arterial ductus, necrotising enterocolitis, intraventricular haemorrhage, or periventricular leukomalacia were found to be significantly different between the ROP groups requiring and not requiring treatment. The mean postnatal weight gain in the ROP group not requiring treatment was 12.75 ± 5.99 g/day, whereas it was 9.50 ± 5.45 g/day in the ROP group requiring treatment. The risk of developing ROP that required treatment decreased with an increase in weight gain. The risk reduction was 2.76%-8.35% in preterm infants gaining 10 g/day, and 7.17%-12.76% in infants gaining 20 g/day. CONCLUSIONS The risk of developing ROP requiring treatment decreased with increasing weight gain in the first 4 weeks of life. This was applicable in infants with postnatal weight gain ≥14 g/day. However, gestational age, birth weight, time of mechanical ventilation, and comorbidity should be taken into account when evaluating the risk of ROP requiring treatment.
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9
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Cabañas Poy MJ, Montoro Ronsano JB, Castillo Salinas F, Martín Begué N, Clemente Bautista S, Gorgas Torner MQ. Association between postnatal weight gain and need for treatment in retinopathy of prematurity. J Matern Fetal Neonatal Med 2021; 35:8027-8031. [PMID: 34157934 DOI: 10.1080/14767058.2021.1940937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the association between gestational age (GA) and weight at birth and the development of retinopathy of prematurity (ROP), and in particular the link between postnatal weight gain during the first 6 weeks and need for ROP treatment. MATERIAL AND METHODS Retrospective observational study of premature infants who underwent ophthalmoscopy at Hospital Universitari Vall d'Hebron in Barcelona, Spain, between June 2017 and December 2018. We collected data on obstetric and birth characteristics, comorbidities, GA and weight at birth, and weekly weight for the first 6 weeks. RESULTS Ninety patients with a mean ± SD GA of 26.87 ± 1.90 weeks and a mean birth weight of 884.29 ± 227.40 g were studied. The mean weight at 6 weeks was 1656.89 ± 478.51 g, which corresponds to a gain of 776.17 ± 298.12 g. Thirty-seven patients (41.1%) were diagnosed with ROP and nine (10%) needed treatment. Significant predictors of the need for treatment in patients with ROP were GA (p = .018) and weight at 6 weeks (p = .021). Birth weight was not significant (p = .361). CONCLUSIONS GA and weight gain during the first 6 weeks of life are significantly associated with the need for treatment in infants with ROP. Sex and birth weight were not significant predictors. Postnatal weight gain at 6 weeks is predictive of the need for ROP treatment.
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Affiliation(s)
| | | | | | - Nieves Martín Begué
- Unidad de Oftalmología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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10
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Bin Amro A, Alnuaimi R, Chan T, Alali A. Different retinopathy of prematurity severity and outcomes in triplets: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20944306. [PMID: 33101683 PMCID: PMC7550963 DOI: 10.1177/2050313x20944306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 06/29/2020] [Indexed: 12/01/2022] Open
Abstract
In this case report, we discuss the presentation of retinopathy of prematurity in
triplets born at 25 + 3 weeks gestational age of whom each had a different birth
weight, weight gain and treatment requirements. Triplet A weighed 800 g and his
retinopathy of prematurity had resolved with no intervention. Triplet B weighed
630 g at birth and he required bilateral intravitreal ranibizumab injection at
32 + 6 weeks. Triplet C weighed 520 g and required bilateral intravitreal
ranibizumab injection at 36 weeks, but after 5 weeks he had recurrence which was
treated with bilateral diode laser. Triplet C had the poorest weight gain. The
main differences between the triplets are the birth weight and the weight gain.
Furthermore, refraction was performed at 10 months; triplet A had a hyperopia of
+1.25 spherical equivalent in both eyes, triplet B had mild myopia of −0.25
spherical equivalent and triplet C had a myopia of −3.00 spherical equivalent in
the right eye and −2.75 spherical equivalent in the left eye.
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Affiliation(s)
- Ashwaq Bin Amro
- Ophthalmology Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Rawdha Alnuaimi
- Ophthalmology Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Tin Chan
- Ophthalmology Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Abeer Alali
- Ophthalmology Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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11
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Chaves-Samaniego MJ, García Castejón M, Chaves-Samaniego MC, Solans Perez Larraya A, Ortega Molina JM, Muñoz Hoyos A, García-Serrano JL. Risk Calculator for Retinopathy of Prematurity Requiring Treatment. Front Pediatr 2020; 8:529639. [PMID: 33042928 PMCID: PMC7530187 DOI: 10.3389/fped.2020.529639] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 08/13/2020] [Indexed: 11/13/2022] Open
Abstract
Importance: Vascular delay that occurs early in the development of retinopathy of prematurity (ROP) is a risk factor that can be compensated by ensuring a good rate of retinal vascularization to avoid ROP that requires treatment. Background: The objective of the present study was to determine the association between ROP that requires treatment and risk factors such as the extent of the temporal avascular area of the retina and the number of days of mechanical ventilation (MV). Design: Observational retrospective case-control study. Participants: Two hundred and twenty-eight premature newborns included in the screening protocol for retinopathy of prematurity. Methods: Subjects underwent retinal examination in the 4 and 6th postnatal weeks. Main Outcome Measures: The temporal avascular area was measured in disc diameters (DD), while the MV time was measured in days of treatment. Results: Patients with a longer MV time had a higher risk of treatment (R 2: 24.7, p < 0.0001; increase in risk of 8.1% for each additional day), as did those who showed greater avascular area (R 2: 24.7, p < 0.0001; increase in risk of 111% for each additional DD). An online calculator system and a table are presented for calculating the risk of ROP requiring treatment as a function of these two risk factors. Conclusions and Relevance: The temporal avascular area of the retina and MV time must be taken into account in the first examination of the newborn to predict the need for ROP treatment.
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Affiliation(s)
- Maria J. Chaves-Samaniego
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
- Department of Ophthalmology, San Cecilio University Hospital, Granada, Spain
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12
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Wongnophirun A, Khuwuthyakorn V, Tantiprabha W, Wiwatwongwana A. Association between severe retinopathy of prematurity and postnatal weight gain in very low-birthweight infants at Chiang Mai University Hospital, Thailand. Paediatr Int Child Health 2020; 40:85-91. [PMID: 31272307 DOI: 10.1080/20469047.2019.1631588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Poor postnatal weight gain has been associated with low serum IGF-1, a key factor in the pathogenesis of retinopathy of prematurity (ROP).Aim: To investigate an association between relative weight gain (RWG) and severe ROP in very low-birthweight (VLBW) Thai infants.Methods: The medical records of VLBW infants who were admitted to the neonatal intensive care unit in Chiang Mai University Hospital from June 2014 to December 2016 and screened for ROP were reviewed. RWG and total calorie intake (TCI) in the 2nd, 4rth and 6th week of age were calculated and those with no ROP/mild ROP and severe ROP requiring laser treatment were compared.Results: The study included 139 VLBW infants, 24 (17.3%) of whom had ROP requiring laser treatment. Infants with severe ROP requiring laser treatment had a lower median birthweight (840 vs 1,195 g, p < 0.001) and median gestational age (GA) (27 vs 30 wk, p < 0.001) than those with no ROP/mild ROP. When RWG and TCI were compared, the infants with severe ROP requiring laser treatment had a lower RWG at the 2nd (p < 0.01) and 4th weeks of age (p < 0.05) and had a lower TCI at the 2nd week of age (p < 0.001) than those with no ROP/mild ROP. Multivariate logistic analysis demonstrated that GA <29.5 w (p < 0.01), hypotension (p < 0.05), RWG <2.9 g/kg/d (p < 0.05) and TCI <98.5 kcal/kg/day (p < 0.001) at the 2nd week of age were independent risk factors for severe ROP requiring laser treatment.Conclusions: Poor weight gain and low calorie intake at the 2nd week of age were associated with severe ROP requiring laser treatment in VLBW infants. Monitoring weight gain and calorie intake during this period are essential and may improve the outcome of ROP.Abbreviations: BPD, bronchopulmonary dysplasia; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PDA, patent ductus arteriosus; PRC, packed red cells; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity; RWG, relative weight gain; SGA, small for gestational age; TCI, total calorie intake; VLBW, very low birthweight.
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Affiliation(s)
- Ananya Wongnophirun
- Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Varangthip Khuwuthyakorn
- Division of Neonatology, Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Watcharee Tantiprabha
- Division of Neonatology, Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atchareeya Wiwatwongwana
- ROP Unit, Division of Paediatric Ophthalmology and Strabismus, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
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Abstract
Infants meeting retinopathy of prematurity (ROP) screening guidelines based on birth weight and gestational age undergo serial examinations by ophthalmologists for detection and treatment. However, less than 10% require treatment, and less than half develop ROP. Slow postnatal weight gain is highly predictive of ROP, and investigators have incorporated weight gain measures to develop more specific criteria for ROP screening. Such clinical prediction model use involves a large development study, validation studies specific to the target populations, and ongoing impact surveillance, with adjustment as necessary. Of the many weight gain inclusive prediction models intended to improve the precision of ROP screening, the Postnatal Growth and ROP (G-ROP) modified screening criteria were developed using the largest dataset and may provide the most robust model for clinical use. A recently completed G-ROP validation study will evaluate the generalizability of these modified criteria prior to clinical use.
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Affiliation(s)
- Lisa Lin
- Divison of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Gil Binenbaum
- Richard Shafrtiz Chair of Ophthalmology Research, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, United States.
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Kim JY, Park YZ, Seok MJ, Song SY, Sung TJ. Risk Factors for Retinopathy of Prematurity Requiring Laser Treatment in Preterm Infants Born Before 28 Weeks of Gestation. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Li Y, Shah M, Miller MR, Lee DSC, Sharan S. Impact of Early Postnatal Weight Gain on Retinopathy of Prematurity in Very Preterm Infants in Southwestern Ontario. J Pediatr Ophthalmol Strabismus 2019; 56:168-172. [PMID: 31116864 DOI: 10.3928/01913913-20190208-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/18/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To examine the relationship between post-natal growth and development of retinopathy of prematurity (ROP) among preterm infants in southwestern Ontario. METHODS The medical records of 431 preterm infants, born between January 1, 2008, and June 1, 2015, with a gestational age (GA) of less than 31 weeks or birth weight (BW) of less than 1,250 g were reviewed. Information collected included pregnancy and birth history, neonatal characteristics, ROP status, comorbidities, and postnatal weight measurements at specified intervals. Infants diagnosed as having ROP and no ROP were compared. RESULTS Low weight velocity from day 7 to day 28 (P < .001), high weight velocity from birth to first day of full enteral feeding (FEF) (P < .001), long duration from birth to FEF (P < .001), and long duration from FEF to discharge/transfer (P < .001) were associated with ROP. After controlling for GA and BW, the durations, birth to FEF, and FEF to discharge/transfer remained significant (P < .05). In a multivariable logistic regression analysis adjusting for GA, bronchopulmonary dysplasia, and surgical ligation for patent ductus arteriosus, the only independent risk factor of ROP was duration from FEF to discharge/transfer (P < .05). CONCLUSIONS Low weight velocity from day 7 to day 28 may be a useful predictor for the development of ROP but is dependent on GA and BW. A delay to reach FEF, which is associated with comorbidities of ROP, appears to be a risk factor for ROP that is independent of GA and BW. [J Pediatr Ophthalmol Strabismus. 2019;56(3):168-172.].
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Venincasa VD, Bugg V, Dvorak J, Ding K, Bhatti F, Siatkowski RM. Temporal Profile of Retinopathy of Prematurity in Extremely Premature Compared to Premature Infants. J Pediatr Ophthalmol Strabismus 2019; 56:116-123. [PMID: 30889266 DOI: 10.3928/01913913-20190205-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 01/07/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the time course of retinopathy of prematurity (ROP) in premature (≥ 28 to 34 weeks' gestational age) and extremely premature (< 28 weeks' gestational age) infants. METHODS This study was a retrospective single-center chart review that included 582 eyes (122 premature, 464 extremely premature) of 299 infants (65 premature, 234 extremely premature) diagnosed as having ROP who were born between January 1, 2010, and December 31, 2015. Data collected were analyzed with shared frailty models, chi-square, and Fisher's exact tests. RESULTS Extremely premature infants were diagnosed as having ROP earlier than premature infants at 33.6 weeks (95% CI [confidence interval]: 33.4 to 33.9) versus 36.0 weeks (95% CI: 34.7 to 36.4, P < .0001). The time from diagnosis to spontaneous regression was more than 4 weeks longer for extremely premature infants than premature infants with stage 1 ROP (82.0 vs 50.0 days, P < .0001), and more than 6 weeks longer for extremely premature infants than premature infants with stage 2 ROP (99 vs 55 days, P < .0001). Extremely premature infants had more bilateral ROP (96.6% vs 87.1%, P < .01) and were three times more likely to require treatment than premature infants (29.7% vs 9.9%, P < .0001). On average, infants who required treatment weighed 137 grams less at birth (P < .0001) and gained 37.7 grams less per week than infants who underwent spontaneous regression (P < .0001). CONCLUSIONS Extremely premature infants developed ROP earlier, had more bilateral ROP, took longer to achieve spontaneous regression, and required treatment more often than premature infants. Infants who required treatment had a lower birth weight and rate of weight gain than infants who underwent spontaneous regression. [J Pediatr Ophthalmol Strabismus. 2019;56(2):116-123.].
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Ahmed IS, Badeeb AA. The Alexandria retinopathy of prematurity model (Alex-ROP): postnatal weight gain screening algorithm application in a developing country. Int J Ophthalmol 2019; 12:296-301. [PMID: 30809488 DOI: 10.18240/ijo.2019.02.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/29/2018] [Indexed: 01/22/2023] Open
Abstract
AIM To suggest a novel retinopathy of prematurity (ROP) screening model in developing countries incorporating postnatal weight gain ratios (PWGR) to traditional parameters to maintain sensitivity and improve specificity in detecting ROP. METHODS Analysis of weekly PWGR of infants from one tertiary referral center during six months to determine the age at which the PWGR with the highest predictability for ROP development which was referred to as the postnatal net weight gain ratio (NWGR). NWGR was added to conventional criteria to describe a new model (The Alex-ROP model). RESULTS Of 560 infants were included. NWGR 28d after birth was the most predictive factor for the development of ROP. A new model Alex-ROP recommending screening infants with gestational age (GA) ≤33wk or birth weight ≤1500 g and NWGR at 28d after birth <0.3 was suggested. A second screening model referred to as High-grade Alex-ROP (Hg Alex-ROP) model to detect worse grade ROP (Both type 1 and type 2) recommending a cutoff point of NWGR <0.15 between birth and 28th day. CONCLUSION Both Alex-ROP and Hg Alex-ROP models are easy to apply to improve the specificity of ROP screening in developing countries while maintaining high sensitivity.
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Affiliation(s)
- Islam Sh Ahmed
- Department of Ophthalmology, Faculty of Medicine, Alexandria Main University Hospital, Alexandria 21121, Egypt
| | - Adham Ao Badeeb
- Department of Pediatrics and Neonatology, Faculty of Medicine, Alexandria University maternity Hospital, Alexandria 21121, Egypt
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Kardaras D, Papageorgiou E, Gaitana K, Grivea I, Dimitriou VA, Androudi S, Gounaris A, Tsironi EE. The Association Between Retinopathy of Prematurity and Ocular Growth. ACTA ACUST UNITED AC 2019; 60:98-106. [DOI: 10.1167/iovs.18-24776] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Dimitrios Kardaras
- Department of Ophthalmology, Medical School, University of Thessaly, Larissa, Greece
| | - Eleni Papageorgiou
- Department of Ophthalmology, Medical School, University of Thessaly, Larissa, Greece
| | - Katerina Gaitana
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Ioanna Grivea
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | | | - Sofia Androudi
- Department of Ophthalmology, Medical School, University of Thessaly, Larissa, Greece
| | - Antonios Gounaris
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Evangelia E. Tsironi
- Department of Ophthalmology, Medical School, University of Thessaly, Larissa, Greece
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Chaves-Samaniego MJ, Gómez Cabrera C, Chaves-Samaniego MC, Escudero Gómez J, García Campos JM, Muñoz Hoyos A, García Serrano JL. Multicenter validation study of the WINROP algorithm as a method for detecting retinopathy of prematurity. J Matern Fetal Neonatal Med 2018; 33:1302-1306. [DOI: 10.1080/14767058.2018.1517325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- María J. Chaves-Samaniego
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
- Department of Ophthalmology, San Cecilio University Hospital, Granada, Spain
| | | | | | - Julia Escudero Gómez
- Department of Paediatric Ophthalmology, Regional University Hospital of Málaga, Málaga, Spain
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Lucio KCDV, Bentlin MR, Augusto ACDL, Corrente JE, Toscano TBC, Dib RE, Jorge EC. The ROPScore as a Screening Algorithm for Predicting Retinopathy of Prematurity in a Brazilian Population. Clinics (Sao Paulo) 2018; 73:e377. [PMID: 30066729 PMCID: PMC6055020 DOI: 10.6061/clinics/2018/e377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/05/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate the accuracy of the ROPScore algorithm as a predictor of retinopathy of prematurity (ROP). METHODS A prospective cohort of 220 preterm infants with a birth weight ≤1500 g and/or gestational age ≤32 weeks was included. The ROPScore was determined in the sixth week of life in 181 infants who then survived until a corrected gestational age of 45 weeks. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the algorithm were analyzed. RESULTS ROP was found in 17.6% of the preterm infants. The sensitivity of this test for any stage of ROP was 87.5%, while that for severe ROP was 95.4% (21/22 cases). The PPV and NPV were 59.6% and 97%, respectively, for any stage of ROP and 44.7% and 99.25%, respectively, for severe ROP. The ROPScore could therefore hypothetically reduce the number of ophthalmologic examinations required to detect ROP by 71.8%. CONCLUSION The ROPScore is a useful screening tool for ROP and may optimize examinations and especially the identification of severe ROP.
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Affiliation(s)
| | - Maria Regina Bentlin
- Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP, BR
| | | | | | | | - Regina El Dib
- Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP, BR
| | - Eliane Chaves Jorge
- Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP, BR
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Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol 2018; 63:618-637. [PMID: 29679617 DOI: 10.1016/j.survophthal.2018.04.002] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 01/09/2023]
Abstract
Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease that affects premature infants. Despite improvements in neonatal care and management guidelines, ROP remains a leading cause of childhood blindness worldwide. Current screening guidelines are primarily based on two risk factors: birth weight and gestational age; however, many investigators have suggested other risk factors, including maternal factors, prenatal and perinatal factors, demographics, medical interventions, comorbidities of prematurity, nutrition, and genetic factors. We review the existing literature addressing various possible ROP risk factors. Although there have been contradictory reports, and the risk may vary between different populations, understanding ROP risk factors is essential to develop predictive models, to gain insights into pathophysiology of retinal vascular diseases and diseases of prematurity, and to determine future directions in management of and research in ROP.
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Affiliation(s)
- Sang Jin Kim
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Alexander D Port
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Ryan Swan
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA; Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA.
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Abstract
Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease affecting the retina of premature infants. The clinical spectrum of ROP varies from spontaneous regression to bilateral retinal detachment and total blindness. Between these two extremes lies the form of ROP, which is amenable to treatment with laser photocoagulation, anti-vascular endothelial growth factor drugs or surgery. Increasing rates of preterm births coupled with better survival rates but lack of uniform quality of neonatal care and delays in diagnosis have led to increasing ROP blindness. Atypical forms of Aggressive Posterior ROP are seen in heavier birth weight babies in developing countries. Prevention of ROP by following stringent protocols for supplemental oxygen, prevention of sepsis, timely screening and laser treatment by a concerted and collaborative effort of neonatologists and ophthalmologists are required to fight the blindness from ROP.
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Abstract
PURPOSE Low serum IGF-1 has been associated with development of severe ROP, but no U.S. studies have been reported. We sought to determine the relationship between postnatal serum IGF-1 levels and severe ROP in a racially diverse U.S. cohort. METHODS Prospective cohort study of 74 infants with birth weight <1,251 g and a known ROP outcome at 3 Philadelphia hospitals. Weekly postnatal filter paper blood spot IGF-1 assays were measured through 42 weeks postmenstrual age. RESULTS The cohort included 20 white, 45 black, 2 Asian, and 9 other infants; median gestational age was 27.6 weeks (range 23-33 weeks), and median birth weight was 975 g (range 490-1,250 g). During postmenstrual age Weeks 28 to 33, mean IGF-1 was 20.0 ng/mL (standard error 0.52) for no ROP (n = 46), 18.0 (0.49) for Stage 1 or 2 (n = 23), and 17.0 (0.70) for Stage 3 (n = 5, 2 lasered) (P = 0.003). Adjustment for birth weight and gestational age showed similar results. CONCLUSION The presence and timing of an association between low postnatal serum IGF and ROP in a racially diverse U.S. sample were found to be consistent with those of European cohorts. This association provides the pathophysiological basis for growth-based predictive models, which could improve efficiency of ROP screening.
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Binenbaum G, Ying GS, Tomlinson LA. Validation of the Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOP ROP) Model. JAMA Ophthalmol 2017; 135:871-877. [PMID: 28715553 DOI: 10.1001/jamaophthalmol.2017.2295] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOP ROP) model uses birth weight (BW), gestational age at birth (GA), and weight gain rate to predict the risk of severe retinopathy of prematurity (ROP). In a model development study, it predicted all infants requiring treatment, while greatly reducing the number of examinations compared with current screening guidelines. Objective To validate the CHOP ROP model in a multicenter cohort that is large enough to obtain a precise estimate of the model's sensitivity for treatment-requiring ROP. Design, Setting, and Participants This investigation was a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study. The setting was 30 hospitals in the United States and Canada between January 1, 2006, and June 30, 2012. The dates of analysis were September 28 to October 5, 2015. Participants were premature infants at risk for ROP with a known ROP outcome. Main Outcomes and Measures Sensitivity for Early Treatment of Retinopathy of Prematurity type 1 ROP and potential reduction in the number of infants requiring examinations. In the primary analysis, the CHOP ROP model was applied weekly to predict the risk of ROP. If the risk was above a cut-point level (high risk), examinations were indicated, while low-risk infants received no examinations. In a secondary analysis, low-risk infants received fewer examinations rather than no examinations. Results Participants included 7483 premature infants at risk for ROP with a known ROP outcome. Their median BW was 1070 g (range, 310-3000 g), and their median GA was 28 weeks (range, 22-35 weeks). Among them, 3575 (47.8%) were female, and their race/ethnicity was 3615 white (48.3%), 2310 black (30.9%), 233 Asian (3.1%), 93 Pacific Islander (1.2%), and 40 American Indian/Alaskan native (0.5%). The original CHOP ROP model correctly predicted 452 of 459 infants who developed type 1 ROP (sensitivity, 98.5%; 95% CI, 96.9%-99.3%), reducing the number of infants requiring examinations by 34.3% if only high-risk infants received examinations. Lowering the cut point to capture all type 1 ROP cases (sensitivity, 100%; 95% CI, 99.2%-100%) resulted in only 6.8% of infants not requiring examinations. However, if low-risk infants were examined at 37 weeks' postmenstrual age and followed up only if ROP was present at that examination, all type 1 ROP cases would be captured, and the number of examinations performed among infants with GA exceeding 27 weeks would be reduced by 28.4%. Conclusion and Relevance The CHOP ROP model demonstrated high but not 100% sensitivity and may be better used to reduce examination frequency. The model might be used reliably to guide a modified ROP screening schedule and decrease the number of examinations performed.
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Affiliation(s)
- Gil Binenbaum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Gui-Shuang Ying
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Ludwig CA, Greven MA, Moshfeghi DM. Predictors of treatment-warranted retinopathy of prematurity in the SUNDROP cohort: influence of photographic features. Graefes Arch Clin Exp Ophthalmol 2017; 255:1935-1946. [DOI: 10.1007/s00417-017-3745-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/07/2017] [Accepted: 07/05/2017] [Indexed: 02/01/2023] Open
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Binenbaum G, Tomlinson LA, G-ROP Study Group. Postnatal Growth and Retinopathy of Prematurity Study: Rationale, Design, and Subject Characteristics. Ophthalmic Epidemiol 2017; 24:36-47. [PMID: 27996334 PMCID: PMC6499901 DOI: 10.1080/09286586.2016.1255765] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Postnatal-growth-based predictive models demonstrate strong potential for improving the low specificity of retinopathy of prematurity (ROP) screening. Prior studies are limited by inadequate sample size. We sought to study a sufficiently large cohort of at-risk infants to enable development of a model with highly precise estimates of sensitivity for severe ROP. METHODS The Postnatal Growth and ROP (G-ROP) Study was a multicenter retrospective cohort study of infants at 30 North American hospitals during 2006-2012. A total of 65 G-ROP-certified abstractors submitted data to a secure, web-based database. Data included ROP examination findings, treatments, complications, daily weight measurements, daily oxygen supplementation, maternal/infant demographics, medical comorbidities, surgical events, and weekly nutrition. Data quality was monitored with system validation rules, data audits, and discrepancy algorithms. RESULTS Of 11,261 screened infants, 8334 were enrolled, and 2927 had insufficient data due to transfer, discharge, or death. Of the enrolled infants, 90% (7483) had a known ROP outcome and were included in the study. Median birth weight was 1070 g (range 310-3000g) and mean gestational age 28 weeks (range 22-35 weeks). Severe ROP (Early Treatment of Retinopathy type 1 or 2) developed in 931 infants (12.5%). CONCLUSION Successful incorporation of a predictive model into ROP screening requires confidence that it will capture cases of severe ROP. This dataset provides power to estimate sensitivity with half-confidence interval width of less than 0.5%, determined by the high number of severe ROP cases. The G-ROP Study represents a large, diverse cohort of at-risk infants undergoing ROP screening. It will facilitate evaluation of growth-based algorithms to improve efficiency of ROP screening.
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Affiliation(s)
- Gil Binenbaum
- The Children’s Hospital of Philadelphia, Philadelphia PA
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA
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Klevebro S, Lundgren P, Hammar U, Smith LE, Bottai M, Domellöf M, Löfqvist C, Hallberg B, Hellström A. Cohort study of growth patterns by gestational age in preterm infants developing morbidity. BMJ Open 2016; 6:e012872. [PMID: 27856479 PMCID: PMC5128893 DOI: 10.1136/bmjopen-2016-012872] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine differences in growth patterns in preterm infants developing major morbidities including retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotising enterocolitis (NEC) and intraventricular haemorrhage (IVH). STUDY DESIGN Cohort study of 2521 infants born at a gestational age (GA) of 23-30 weeks from 11 level III neonatal intensive care units in USA and Canada, and 3 Swedish population-based cohorts. OUTCOMES Birth weight and postnatal weight gain were examined relative to birth GA and ROP, BPD, NEC and IVH development. RESULTS Among infants with a birth GA of 25-30 weeks, birth weight SD score and postnatal weight were lower in those developing ROP and BPD. Infants developing ROP showed lower growth rates during postnatal weeks 7-9 in the 23-24 weeks GA group, during weeks 4-6 in the 25-26 weeks GA group and during weeks 1-5 in the 27-30 weeks GA group. Infants with BPD born at 27-30 weeks GA showed lower growth rates during postnatal weeks 3-5. Infants with NEC had lower growth rates after postnatal week 6 in all GA groups, with no significant differences in birth weight SD score. IVH was not associated with prenatal or postnatal growth. CONCLUSIONS In this cohort study of extremely preterm infants, we found that the postnatal growth pattern was associated with morbidities such as ROP, BPD and NEC as well as with gestational age at birth.
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Affiliation(s)
- S Klevebro
- Clinical Sciences, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - P Lundgren
- Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - U Hammar
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L E Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Domellöf
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - C Löfqvist
- Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - B Hallberg
- Clinical Sciences, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - A Hellström
- Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Shah PK, Prabhu V, Karandikar SS, Ranjan R, Narendran V, Kalpana N. Retinopathy of prematurity: Past, present and future. World J Clin Pediatr 2016; 5:35-46. [PMID: 26862500 PMCID: PMC4737691 DOI: 10.5409/wjcp.v5.i1.35] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/15/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940s and 1950s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.
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Cao JH, Wagner BD, McCourt EA, Cerda A, Sillau S, Palestine A, Enzenauer RW, Mets-Halgrimson RB, Paciuc-Beja M, Gralla J, Braverman RS, Lynch A. The Colorado-retinopathy of prematurity model (CO-ROP): postnatal weight gain screening algorithm. J AAPOS 2016; 20:19-24. [PMID: 26917066 DOI: 10.1016/j.jaapos.2015.10.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/17/2015] [Accepted: 10/17/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe a novel retinopathy of prematurity (ROP) screening model incorporating birth weight, gestational age, and postnatal weight gain that maintains sensitivity but improves specificity in detecting all grades of ROP compared to current 2013 screening guidelines. METHODS The medical records of 499 neonates from a single tertiary referral center who met the 2013 screening guidelines for ROP were retrospectively reviewed. Weekly weights were analyzed using standard logistic regression to determine the age at which the weekly net weight gain best predicted the development of ROP, which was designated as the postnatal weight gain criterion. The 2013 birth weight and gestational age criteria were included in an "and" fashion to form the CO-ROP model. Sensitivities and specificities in detecting high grade (type 1 and 2) and all grades of ROP were calculated. RESULTS The CO-ROP model screens infants with a gestational age at birth of ≤30 weeks and birth weight of ≤1500 g and net weight gain of ≤650 g between birth and 1 month of age. In our cohort, CO-ROP had a sensitivity of 100% (95% CI, 92.1%-100.0%) for high-grade (type 1 and 2) ROP and 96.4% (95% CI, 92.3%-98.7%) for all grades of ROP. It would reduce the number of infants screened by 23.7% compared to 2013 guidelines. Calibrating the model to detect only high-grade ROP would result in a 45.9% reduction in the total number of infants screened. CONCLUSIONS CO-ROP is a simple model that maintains a statistically similar sensitivity in detecting all grades of ROP while significantly reducing the total number of required ROP screenings compared to 2013 guidelines. The study had a small sample size but shows promise for future research and clinical efforts.
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Affiliation(s)
- Jennifer H Cao
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora.
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora
| | - Emily A McCourt
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Ashlee Cerda
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Stefan Sillau
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora
| | - Alan Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Robert W Enzenauer
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | | | - Miguel Paciuc-Beja
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Jane Gralla
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Rebecca S Braverman
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Anne Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
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Wang ZH, Gao PF, Bai H, Li YY. Postnatal weight gain in very low birth weight infants in Beijing and the risk of retinopathy of prematurity. Int J Ophthalmol 2015; 8:1207-10. [PMID: 26682174 DOI: 10.3980/j.issn.2222-3959.2015.06.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/12/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To analyze the low weight gain (WG) from birth to 4 and 6wk of life to predict the development of retinopathy of prematurity (ROP) among very low birth weight (VLBW) preterm babies. METHODS Three hundred and three newborns with VLBW were analyzed. Body weight measurements were recorded weekly. In all patients, the proportion of the WG was defined as the preterm weight measured at the 4(th) and 6(th) weeks of life minus the birth weight (BW) divided by the BW. Other risk factors for ROP were also analyzed. RESULTS Mean gestational age and mean BW of the whole cohort were 29.56±1.44wk and 1270.58±176.18g respectively. WG proportion at 4wk postnatal age (18.89%±13.58%) were significantly lower in infants with ROP (P=0.003). WG proportion at 6wk was not different between ROP and no ROP group (42.48%±20.36% vs 46.43%±15.65% P=0.118). When all the other risk factors significant for ROP were included in the logistic regression poor WG did not arise as an independent risk factor. Area under the ROC curve was 0.591 (95%CI: 0.515-0.666; P=0.016). For ROP, the best discriminative cutoff of 18.06% of the proportional WG at the 4(th) week over the BW, sensitivity and specificity values were 67.3% and 50.0% respectively. CONCLUSION Low WG proportion in the first 4wk of life is maybe an additional predictor of ROP in very low BW infants. Preterm babies with low BW and low WG proportion should be followed closely for ROP.
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Affiliation(s)
- Zong-Hua Wang
- Department of Ophthalmology, Beijing General Hospital of the Chinese PLA, Beijing 100700, China
| | - Peng-Fen Gao
- Department of Ophthalmology, Fuzhou General Hospital of the Chinese PLA, Fuzhou 350025, Fujian Province, China
| | - Hua Bai
- Department of Ophthalmology, Beijing General Hospital of the Chinese PLA, Beijing 100700, China
| | - Yao-Yu Li
- Department of Ophthalmology, Beijing General Hospital of the Chinese PLA, Beijing 100700, China
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Mezer E, Chetrit A, Kalter-Leibovici O, Kinori M, Ben-Zion I, Wygnanski-Jaffe T. Trends in the incidence and causes of severe visual impairment and blindness in children from Israel. J AAPOS 2015; 19:260-5.e1. [PMID: 26059674 DOI: 10.1016/j.jaapos.2015.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/28/2015] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe trends in the incidence and causes of legal childhood blindness in Israel, one of the few countries worldwide that maintain a national registry of the blind. METHODS We performed a historical cohort study of annual reports of the National Registry of the Blind (NRB) between 1999 and 2013. All data regarding demographic information, year of registration and cause of blindness of children 0-18 years of age registered for blind certification were obtained from the annual reports of the NRB. Causes of legal blindness analyzed were optic atrophy, retinitis pigmentosa, retinopathy of prematurity (ROP), albinism, other retinal disorders, cataract, and glaucoma. The main outcome measure was the incidence of new cases of certified legal blindness. RESULTS The incidence of newly registered legally blind children in Israel almost halved from 7.7 per 100,000 in 1999 to 3.1 per 100,000 in 2013. The decline was mainly attributable to a decreased incidence of blindness resulting from retinitis pigmentosa and ROP. The incidence of registered cases due to cerebral visual impairment increased. CONCLUSIONS During the past decade the incidence of severe childhood visual impairment and blindness declined in Israel. A continuous decline in consanguineous marriages among the Jewish and Arab populations in Israel may have contributed to the decrease in the rate of vision loss due to retinitis pigmentosa in children.
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Affiliation(s)
- Eedy Mezer
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Angela Chetrit
- Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology & Health Policy Research, Tel Hashomer, Israel
| | - Ofra Kalter-Leibovici
- Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology & Health Policy Research, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Kinori
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Itay Ben-Zion
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Tamara Wygnanski-Jaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
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Kim J, Jin JY, Kim SS. Postnatal weight gain in the first two weeks as a predicting factor of severe retinopathy of prematurity requiring treatment. KOREAN JOURNAL OF PEDIATRICS 2015; 58:52-9. [PMID: 25774196 PMCID: PMC4357772 DOI: 10.3345/kjp.2015.58.2.52] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/26/2014] [Accepted: 11/05/2014] [Indexed: 11/27/2022]
Abstract
Purpose This study aimed to investigate the relative weight gain at 2-week intervals up to 6 weeks after birth to predict retinopathy of prematurity (ROP) requiring treatment among very low birth weight infants. Methods A total of 211 preterm infants with birth weights <1,500 g and gestational age <32 weeks were retrospectively reviewed. The main outcome was the development of ROP requiring treatment. Body weight measurements were recorded daily. Relative weight gains (g/kg/day) were calculated at the second, fourth, and sixth week after birth. Results Of the 211 infants, 89 developed ROP, of which 41 spontaneously regressed and 48 with early treatment of ROP type I required laser treatment. The relative weight gain at 2, 4, and 6 weeks postnatal age was significantly lower in infants with ROP requiring treatment than in infants without ROP or those with spontaneous regression (P<0.001, P=0.005, and P=0.004, respectively). On logistic regression, poor relative weight gain in the first 2 weeks was found to be related to ROP requiring treatment (adjusted odds ratio, 0.809; 95% confidence interval, 0.695-0.941; P=0.006). Relative weight gain at 2 weeks postnatal age was significantly lower in infants with ROP requiring treatment compared to that in ROP requiring no treatment (P=0.012). Conclusion Poor postnatal weight gain in the first 2 weeks of life is an important and independent risk factor for ROP requiring treatment. Postnatal weight gain can predict the development of severe ROP requiring treatment.
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Affiliation(s)
- Jongmoon Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jang Yong Jin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Shin Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Stahl A, Hellstrom A, Smith LEH. Insulin-like growth factor-1 and anti-vascular endothelial growth factor in retinopathy of prematurity: has the time come? Neonatology 2014; 106:254-60. [PMID: 25300950 PMCID: PMC4197141 DOI: 10.1159/000365132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Treatment of retinopathy of prematurity (ROP) is currently evolving. Novel therapeutic options are emerging that have the potential to complement existing therapies and improve treatment outcomes. However, any new therapeutic option must be thoroughly evaluated before existing (and successful) treatment paradigms can be amended. This is particularly so when switching from locally effective therapies like photoablative laser therapy to systemic pharmacological treatments, which may have hitherto unknown widespread side effects. This review compiles the current knowledge of where and when the two most advanced pharmacological treatment options for ROP, insulin-like growth factor-1 supplementation and anti-vascular endothelial growth factor treatment, may have their place in future therapy regimens for ROP. The requirement for clinical studies is emphasized: these are needed to address safety considerations before any of these interventions can achieve the status of standard clinical care in the very vulnerable population of ROP infants.
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Affiliation(s)
- Andreas Stahl
- Eye Center, University of Freiburg, Freiburg, Germany
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Rao KA, Purkayastha J, Hazarika M, Chaitra R, Adith KM. Analysis of prenatal and postnatal risk factors of retinopathy of prematurity in a tertiary care hospital in South India. Indian J Ophthalmol 2014; 61:640-4. [PMID: 24145565 PMCID: PMC3959079 DOI: 10.4103/0301-4738.119347] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Recent advances in neonatology have influenced the incidence and severity of ROP in a dichotomous fashion. AIMS To determine the incidence of ROP and to analyse its risk factors. SETTINGS AND DESIGN Prospective clinical case series. MATERIALS AND METHODS 282 preterm infants with birthweight < 1500 g and/or gestational age ≤ 32 weeks and also those with gestational age > 32 weeks, with birthweight between 1500-2000 g, who were at risk for ROP were selected. Weight gain proportion was measured as weight at 6 weeks minus birthweight divided by birthweight. STATISTICAL ANALYSIS Univariate and multivariate logistic regression. RESULTS Incidence of any ROP was 21.6% while severe ROP was 6.7%. Prenatal factors like multiple gestation (P = 0.510) and antenatal steroids (P = 0.104) were not significantly associated with ROP. On multivariate analysis, postnatal factors like weight at birth < 1250 g (P = 0.01) and gestational age between 31-32 weeks (P = 0.02) were independent risk factors for any ROP, while intraventricular hemorrhage (P = 0.03) was the only independent risk factor for severe ROP. Mean birthweight of infants with severe ROP was 1056 μ 207 g (P = 0.004), which was significantly low. After logistic regression, the mean weight gain proportion at 6 weeks, of those neonates with severe ROP was 30%. CONCLUSIONS Low birthweight and prematurity were the most important risk factors for developing any ROP, while intraventricular hemorrhage was the independent risk factor for developing severe ROP. The mean postnatal weight gain at 6 weeks was not statistically significant in neonates with severe ROP.
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Affiliation(s)
| | | | - Manali Hazarika
- Department of Ophthalmology, Kasturba Medical College and Hospital, Manipal University, Manipal, Karnataka, India
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Lundgren P, Wilde Å, Löfqvist C, Smith LEH, Hård AL, Hellström A. Weight at first detection of retinopathy of prematurity predicts disease severity. Br J Ophthalmol 2014; 98:1565-9. [PMID: 24963022 DOI: 10.1136/bjophthalmol-2014-304905] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether postnatal weight at first detection of retinopathy of prematurity (ROP) can predict preterm infants who will develop severe ROP warranting treatment. DESIGN This modern, population-based cohort included 147 infants born at gestational age (GA) <32 weeks in the Gothenburg region during 2011-2012 and screened for ROP at Sahlgrenska University hospital. GA, birth weight (BW), and weekly postnatal weight from birth until postmenstrual age (PMA) 40 weeks data were retrospectively retrieved. Birth weight SD scores (BWSDS) were calculated. ROP data, including first detected ROP stage, maximal ROP stage, ROP treatment, and PMA at first detected sign of ROP were also retrieved. Weight SDS (WSDS) at first ROP detection was calculated. RESULTS Stepwise multivariate logistic regression analysis revealed that the best fit-model of risk factors for developing severe ROP warranting treatment included; GA (OR=0.28, CI 95% 0.12 to 0.66, p<0.01) and WSDS at first ROP detection (OR=0.22, CI 95% 0.05 to 0.89, p<0.05). CONCLUSIONS Low weight and low WSDS at first ROP detection can be useful predictors for ROP warranting treatment.
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Affiliation(s)
- Pia Lundgren
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Åsa Wilde
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Chatarina Löfqvist
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lois E H Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna-Lena Hård
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellström
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Eriksson L, Lidén U, Löfqvist C, Hellström A. WINROP can modify ROP screening praxis: a validation of WINROP in populations in Sörmland and Västmanland. Br J Ophthalmol 2014; 98:964-6. [PMID: 24568873 DOI: 10.1136/bjophthalmol-2013-304617] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study validates the newly developed WINROP algorithm aimed at detecting retinopathy of prematurity (ROP) requiring treatment at an early stage. The study was conducted at two middle-sized hospitals in Sweden, prospectively and retrospectively. METHODS A total of 104 children participated in this study. Their mean gestational age at birth was 28.7 weeks (range, 23.6-32.1 weeks), and their mean birth weight was 1208 g (range, 477-2340 g). Weekly weight measurements were used in WINROP to calculate the risk of developing ROP. RESULTS 80% of infants (83/104) had no ROP, 15% (16/104) had mild ROP (stage 1 or 2), 5% (5/104) had severe ROP, and 2% (2/104) were treated for ROP. The alarm was registered at an average of 2 weeks postnatal age (range 1-6 weeks). CONCLUSIONS WINROP identified all the infants at risk for developing stage 3 ROP (100% sensitivity) and had a 59% specificity. The alarm was registered several weeks before screening for ROP began. WINROP can be used to complement conventional ROP screening.
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Affiliation(s)
- Laila Eriksson
- Ophthalmology Department, Västmanland Hospital in Västerås, Västerås, Sweden
| | - Ulrika Lidén
- Ophthalmology Department, Mälarsjukhuset in Eskilstuna, Eskilstuna, Sweden
| | - Chatarina Löfqvist
- Sahlgrenska Academy at University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Ann Hellström
- Sahlgrenska Academy at University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden
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Fortes Filho JB, Borges Fortes BG, Tartarella MB, Procianoy RS. Incidence and main risk factors for severe retinopathy of prematurity in infants weighing less than 1000 grams in Brazil. J Trop Pediatr 2013; 59:502-6. [PMID: 23771954 DOI: 10.1093/tropej/fmt036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study evaluated the incidence and risk factors for severe retinopathy of prematurity (ROP) in babies <1000 g at Porto Alegre, Brazil. METHODS Prospective cohort study including premature children with birth weight ≤1000 g was conducted. Main outcome was the occurrence of severe ROP needing treatment. RESULTS A total of 157 infants were included. Severe ROP occurred in 20 infants (12.7%). Nineteen patients were treated by laser photocoagulation. Main risk factors for severe ROP were gestational age (P = 0.029), infant's weight measured at sixth week of life (P < 0.001) and number of days of oxygen therapy under mechanical ventilation (P < 0.001). After logistic regression, infant's weight at sixth week of life and number of days in mechanical ventilation were associated to severe ROP. CONCLUSIONS We reported the incidence of 12.7% of severe ROP among babies born ≤ 1000 g in our institution. Laser photocoagulation was effective to stabilize the disease among 19 treated patients.
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Affiliation(s)
- João Borges Fortes Filho
- Department of Ophthalmology, Medical School, Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, RS 90035-903, Brazil
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Abstract
The immature retinas of preterm neonates are susceptible to insults that disrupt neurovascular growth, leading to retinopathy of prematurity. Suppression of growth factors due to hyperoxia and loss of the maternal-fetal interaction result in an arrest of retinal vascularisation (phase 1). Subsequently, the increasingly metabolically active, yet poorly vascularised, retina becomes hypoxic, stimulating growth factor-induced vasoproliferation (phase 2), which can cause retinal detachment. In very premature infants, controlled oxygen administration reduces but does not eliminate retinopathy of prematurity. Identification and control of factors that contribute to development of retinopathy of prematurity is essential to prevent progression to severe sight-threatening disease and to limit comorbidities with which the disease shares modifiable risk factors. Strategies to prevent retinopathy of prematurity will depend on optimisation of oxygen saturation, nutrition, and normalisation of concentrations of essential factors such as insulin-like growth factor 1 and ω-3 polyunsaturated fatty acids, as well as curbing of the effects of infection and inflammation to promote normal growth and limit suppression of neurovascular development.
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Affiliation(s)
- Ann Hellström
- Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Husain SM, Sinha AK, Bunce C, Arora P, Lopez W, Mun KS, Reddy MA, Adams GGW. Relationships between maternal ethnicity, gestational age, birth weight, weight gain, and severe retinopathy of prematurity. J Pediatr 2013; 163:67-72. [PMID: 23351601 DOI: 10.1016/j.jpeds.2012.12.038] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/14/2012] [Accepted: 12/12/2012] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To develop an algorithm that allows advanced identification of infants requiring treatment for retinopathy of prematurity (ROP). STUDY DESIGN A retrospective observational study was performed at 2 tertiary neonatal units serving a multiethnic population in the UK, using data on 929 infants eligible for ROP screening. The relationships between study variables and the risk of developing ROP requiring treatment were analyzed using multiple logistic regression. RESULTS After applying exclusion criteria, data from 589 infants were analyzed; of these, 57 required laser treatment. The proportion of treated infants was 5.9% of those born to black mothers, 9.39% of those born to white mothers, and 12.8% of those born to Asian mothers (P = .047). Multiple logistic regression showed that gestational age, birth weight, maternal ethnicity, and early weight gain were predictors for the development of ROP requiring treatment, with maternal ethnicity having greater predictive power compared with early weight gain. We developed an algorithm for predicting the development of ROP requiring treatment with sensitivity, specificity, and positive and negative predictive values of 100%, 65.7%, 23.8%, and 100%, respectively. CONCLUSION Gestational age, birth weight, early weight gain, and maternal ethnicity are important predictors for the development of ROP requiring treatment. In a multiethnic population, an algorithm to predict development of ROP requiring treatment should include maternal ethnicity. If confirmed through prospective studies, this algorithm could reduce the number of opthalmologic examinations performed for ROP screening.
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Affiliation(s)
- Shahid M Husain
- Center for Pediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary College, London, United Kingdom.
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Hård AL, Smith LE, Hellström A. Nutrition, insulin-like growth factor-1 and retinopathy of prematurity. Semin Fetal Neonatal Med 2013; 18:136-142. [PMID: 23428885 PMCID: PMC3809333 DOI: 10.1016/j.siny.2013.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Retinopathy of prematurity is a potentially blinding disease starting with impaired retinal vessel growth in the neonatal period. Weeks to months later, peripheral retinal hypoxia induces pathologic neovascularization that may lead to retinal detachment and blindness. Current treatment strategies target late stage disease and it would be advantageous if retinopathy of prematurity could be prevented. Poor general growth after very preterm birth is a universal problem associated with increased risk of retinopathy. Loss of the maternal-fetal interaction results not only in loss of nutrients but also of other factors provided in utero. The importance of nutrition and factors such as insulin-like growth factor-1 and ω-3 long chain fatty acids for proper retinal vascularization has been defined in animal studies. Increasing evidence of the applicability of these findings to human infants is accumulating. This review focuses on factors essential for neonatal growth and possible strategies to improve growth and prevent retinopathy.
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Affiliation(s)
- Anna-Lena Hård
- Section of Pediatric Ophthalmology, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at University of Gothenburg, S-416 85 Göteborg, Sweden
| | - Lois E Smith
- Department of Ophthalmology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
| | - Ann Hellström
- Section of Pediatric Ophthalmology, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at University of Gothenburg, S-416 85 Göteborg, Sweden.
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Abstract
Current ROP screening guidelines represent a simple risk model with two dichotomized factors, birth weight and gestational age at birth. Pioneering work has shown that tracking postnatal weight gain, a surrogate for low insulin-like growth factor 1, may capture the influence of many other ROP risk factors and improve risk prediction. Models including weight gain, such as WINROP, ROPScore, and CHOP ROP, have demonstrated accurate ROP risk assessment and a potentially large reduction in ROP examinations, compared to current guidelines. However, there is a need for larger studies, and generalizability is limited in countries with developing neonatal care systems.
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Affiliation(s)
- Gil Binenbaum
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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VanderVeen DK, Martin CR, Mehendale R, Allred EN, Dammann O, Leviton A. Early nutrition and weight gain in preterm newborns and the risk of retinopathy of prematurity. PLoS One 2013; 8:e64325. [PMID: 23734194 PMCID: PMC3667175 DOI: 10.1371/journal.pone.0064325] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/14/2013] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To identify nutritional and weight gain limitations associated with retinopathy of prematurity (ROP) severity among very preterm newborns. PATIENTS AND METHODS 1180 infants <28 weeks GA at birth with ROP examination results were grouped and analyzed by quartile of weekly total calorie, carbohydrate, protein, and lipid intake, as well as growth velocity between postnatal days 7 and 28 (adjusted for GA and birth weight Z-score). ROP was categorized by development of no, mild ( RESULTS Greater risk for Type 1 ROP (risk/95% confidence intervals) was found for infants with lowest quartile receipt of lipids (2.1/1.1, 3.8), total calories (2.2/1.4, 3.6), and carbohydrates (1.7/1.1, 2.9). Development of zone 1 ROP was associated with lipid or total calorie intake in the lowest quartile, and development of stage 3 ROP was associated with lowest quartile of total calorie intake. Growth velocity in the lowest quartile was associated with increased risk of any ROP, including type 1 ROP. CONCLUSION The risk of developing severe ROP in extremely premature infants might be reduced by improving nutritional support, specifically targeting lipids and total calories, and perhaps by improving weight gain.
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Affiliation(s)
- Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Association between retinal neovascularization and serial weight measurements in murine and human newborns. Eur J Ophthalmol 2013; 23:678-82. [PMID: 23564613 DOI: 10.5301/ejo.5000283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Retinopathy of prematurity (ROP) is a leading cause of preventable blindness throughout the world. Several risk factors have been studied, but most studies remain inconclusive. Evidence is accumulating that one of the strongest predictors of ROP, in addition to oxygen use and low gestational age, is poor weight gain during the first postnatal weeks.
METHODS In a prospective study, we sought to determine the importance of serial weight measurements to help predict neovascularization (NV). In a first stage, a summary of the response in each case is identified and calculated as area under the curve (AUC). In a second stage, these different AUCs are analyzed by nonparametric Mann-Whitney U test. For the murine study, pups were redistributed in smaller and larger litters. On postnatal day (P)7-12, the oxygen-induced retinopathy (OIR) model was applied. Body weight was measured on P7, P14, and P17. Retinal NV was assessed on P17. For the human study, the subjects were part of the control arm of the NIRTURE trial. Ophthalmologists screened for ROP. Birthweight was recorded. Weekly weight measurements were performed for the first 4 weeks.
RESULTS The AUC of serial weight (gain) measurements was significantly lower in murine (14 vs 17 g; p = 0.01) and human (140 g/wk vs 240 g/wk; p = 0.0001) newborns developing retinal NV.
CONCLUSION This prospective study supports previous findings, using a new way of statistical analysis, that early postnatal weight gain is an important indicator in the development of neovascular disease.
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Sun H, Kang W, Cheng X, Chen C, Xiong H, Guo J, Zhou C, Zhang Y, Hellström A, Löfqvist C, Zhu C. The use of the WINROP screening algorithm for the prediction of retinopathy of prematurity in a Chinese population. Neonatology 2013; 104:127-32. [PMID: 23887600 DOI: 10.1159/000351297] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/11/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a gestational age (GA)-related illness that can lead to blindness in premature infants. Timely screening of premature infants could improve visual prognosis. OBJECTIVE To evaluate the WINROP algorithm as a method of predicting severe ROP in a Chinese population. METHODS 590 infants with a GA <32 weeks were entered into an online surveillance system (www.winrop.com) that included ROP evaluations and weekly weight measurements from birth to a corrected GA of 40 weeks. If the rate of weight gain decreased to a certain degree, the algorithm signaled an alarm that the infant was at risk for developing sight-threatening ROP. Each infant was categorized as having no, mild, or severe ROP. RESULTS Among the 590 infants with a GA <32 weeks, an alarm was triggered in 85 infants (14.4%), 50 of which developed severe ROP and were identified in this alarm group. Twenty-seven infants triggered the alarm signal in the first week after birth and 7 infants triggered the alarm at birth. Seven of the infants developed proliferative ROP and the median GA at birth for these infants was 31 weeks. CONCLUSIONS The WINROP system had a sensitivity of 87.5% in a Chinese population for the early identification of infants that developed severe ROP. Postnatal weight gain may help predict ROP in lower birth weight infants.
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Affiliation(s)
- Huiqing Sun
- Department of Pediatrics, Zhengzhou Children's Hospital, Zhengzhou, China
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Abstract
Retinopathy of prematurity (ROP) is a complex disease with a multifactorial pathogenetic cascade that is still only partially understood. Important pathogenetic factors are gestational age at birth and birth weight. Potent postnatal factors are exposure to supplemental oxygen, slow weight gain and expression of angiogenic growth factors. Some of these crucial aspects of ROP pathogenesis will be discussed in this article and put into clinical context. With the introduction of intravitreal anti-VEGF (vascular endothelial growth factor) treatment into ROP therapy, the pathomechanistic role of VEGF in ROP deserves a special focus. Apart from VEGF, other factors will be discussed that may precede VEGF upregulation and thus may represent targets for an earlier and potentially protective intervention. Among these insulin-like growth factor 1 (IGF-1) appears to be most prominent. Finally, factors such as postnatal weight gain will be discussed in light of their potential role as screening parameters and their ability to predict ROP severity.
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Cekmez F, Pirgon O, Aydemir G, Dundar B, Çekmez Y, Karaoglu A, Fidanc K, Tunc T, Aydinoz S, Karademir F, Süleymanoglu S. Correlation between cord blood apelin and IGF-1 levels in retinopathy of prematurity. Biomark Med 2012; 6:821-5. [DOI: 10.2217/bmm.12.82] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We hypothesized that circulating apelin concentrations in preterm babies might be linked with retinopathy of prematurity (ROP), similar to IGF-1 levels. Patients & methods: A total of 97 infants born with a gestational age before 32 weeks in 2007–2009 were screened for ROP at the Gata Haydarpasa Hospital (Turkey). Fourteen of them with classified ROP stage 3–5 comprised our study group. Results: The non-ROP group had higher apelin and IGF-1 levels than ROP neonates at birth. After 4–6 weeks, postnatal ROP subjects had lower apelin and IGF-1 levels than non-ROP controls. At the end of the study, the change in apelin levels was positively correlated with the change in IGF-1 levels (r = 0.852; p = 0.01). Conclusion: We suggested that the pathogenesis of ROP, which is regarded as a neovascular retinal disorder, includes variations in the levels of apelin and IGF-1.
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Affiliation(s)
- Ferhat Cekmez
- GATA Medical Faculty, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Ozgur Pirgon
- GATA Medical Faculty, Department of Biochemistry, Istanbul, Turkey
| | - Gokhan Aydemir
- S Demirel University, Faculty of Medicine, Department of Pediatric Endocrinology & Diabetes, Isparta, Turkey
| | - Bumin Dundar
- GATA Medical Faculty, Department of Biochemistry, Istanbul, Turkey
| | | | - Abdulbaki Karaoglu
- GATA Medical Faculty, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Kürsat Fidanc
- GATA Medical Faculty, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Turan Tunc
- GATA Medical Faculty, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Secil Aydinoz
- GATA Medical Faculty, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Ferhan Karademir
- GATA Medical Faculty, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Selami Süleymanoglu
- GATA Medical Faculty, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
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Wu C, Löfqvist C, Smith LEH, VanderVeen DK, Hellström A. Importance of early postnatal weight gain for normal retinal angiogenesis in very preterm infants: a multicenter study analyzing weight velocity deviations for the prediction of retinopathy of prematurity. ACTA ACUST UNITED AC 2012; 130:992-9. [PMID: 22491391 DOI: 10.1001/archophthalmol.2012.243] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess WINROP (https://winrop.com), an algorithm using postnatal weight measurements, as a tool for the prediction of retinopathy of prematurity (ROP) in a large geographically and racially diverse study population. METHODS WINROP analysis was performed retrospectively on conventionally at-risk infants from 10 neonatal intensive careunits.Weight measurements were entered into WINROP, which signals an alarm for an abnormal weight gain rate. Infants were classified into categories of no alarm (unlikely to develop type 1ROP)and alarm (at risk for developing type 1ROP).Use of WINROP requires that an infant has (1) gestational age less than 32 weeks at birth, (2) weekly weight measurements,(3) physiologic weight gain,and(4)absence of other pathologic retinal vascular disease. RESULTS A total of 1706 infants with a median gestational age of 28 weeks (range, 22-31 weeks) and median birth weight of 1016 g (range, 378-2240 g) were included in the study analysis. An alarm occurred in 1101 infants (64.5%), with a median time from birth to alarm of 3 weeks (range, 0-12 weeks) and from alarm to treatment of 8 weeks (range, 1 day to 22 weeks). The sensitivity of WINROP was 98.6% and the negative predictive value was 99.7%. Two infants with type 1 ROP requiring treatment after 40 weeks' postmenstrual age did not receive an alarm. CONCLUSION The WINROP system is a useful adjunct for ROP screening that identifies high-risk infants early to optimize care and potentially reduce the overall number of diagnostic ROP examinations.
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Affiliation(s)
- Carolyn Wu
- Department of Ophthalmology, Children’s Hospital Boston, 300 Longwood Ave, Fegan 4, Boston, MA 02115, USA.
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Podraza W, Podraza H, Jezierska K, Szwed J, Domek H, Kordek A, Modrzejewska M, Rudnicki J. EEG, brain maturation, and the development of retinopathy of prematurity. J Matern Fetal Neonatal Med 2012; 25:2381-4. [PMID: 22630132 DOI: 10.3109/14767058.2012.696167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The factors that influence the central nervous system (CNS) development can affect either the retina or the brain cortex. Immaturity of the brain cortex reflects immaturity of the retina and vice versa. The immature retina is more vulnerable than the mature retina, and is therefore more likely to develop retinopathy of prematurity (ROP). The aim of this study was to compare electroencephalographic brain maturity with ROP severity. METHODS Twenty-one prematurely born infants were divided into two groups according to the severity of ROP. The first group included 12 infants with ROP stage 3 or more and the second group included nine infants with ROP stage 2 or less. We have proposed an index of CNS maturity (M) as a percentage of interburst interval elongation compared with the norm using video-electroencephalography (vEEG). RESULTS The median M value was 1.07 (range = 0.43-4.44) for infants with severe ROP and -0.1 (range = -1.0 to 1.45) for infants with mild or no ROP (p = 0.000948). CONCLUSIONS The study revealed that CNS maturation delay expressed as M value was higher among infants with severe ROP than among infants with mild or no ROP. EEG examination in prematurely born infants may prove to be a useful tool for predicting ROP development.
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Affiliation(s)
- Wojciech Podraza
- Department of Medical Physics, Pomeranian Medical University, Szczecin, Poland.
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Abstract
Mandatory screening performed by an experience ophthalmologist remains the most important pillar in the management of retinopathy of prematurity (ROP). The current gold standard for treatment of proliferative ROP is still panretinal laser photocoagulation, depending on severity, in combination with vitreoretinal surgery if necessary. The first case series of off-label intravitreal anti-VEGF treatment are encouraging. In addition to intravitreal anti-VEGF therapy, other treatment concepts such as supplementation with IGF-1 or omega-3 fatty acids also represent interesting pharmacological approaches to the management of ROP. However, larger controlled trials are required to validate the benefits and safety of these systemic treatment approaches.
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Cekmez F, Canpolat FE, Çetinkaya M, Pirgon O, Aydinoz S, Ceylan OM, Ipcioglu OM, Sarici SU. IGF-I and visfatin levels in retinopathy of prematurity. J Pediatr Ophthalmol Strabismus 2012; 49:120-4. [PMID: 21634360 DOI: 10.3928/01913913-20110531-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 03/31/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE The authors hypothesized that circulating visfatin concentrations in preterm infants might be linked with retinopathy of prematurity (ROP)-like insulin-like growth factor I (IGF-I) levels. METHODS The study group comprised 88 children born with a gestational age younger than 32 weeks between 2007 and 2009 who were screened and/or treated for ROP. The authors collected fetal cord blood (sample 1) and a blood sample at 4 to 6 weeks postnatal age (sample 2) for laboratory investigations. RESULTS The non-ROP group had higher visfatin-1, visfatin-2, insulin-1, insulin-2, (IGF-I)-1, and (IGF-I)-2 levels than the ROP group (P < .001 for all levels). Change in visfatin was positively correlated with change in IGF-I and change in insulin (P < .001 and P < .001, respectively). Change in IGF-I was positively correlated with change in insulin (P < .001). CONCLUSION Similar to IGF-I levels, determination of visfatin levels can be a predictive marker of ROP, but more studies are needed.
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Affiliation(s)
- Ferhat Cekmez
- Division of Neonatology, Department of Pediatrics, Gulhane Military Medical Academy, Ankara, Turkey.
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