A new approach to neonatal medical management that could transform the prevention of retinopathy of prematurity: Theoretical considerations

Abstract

Retinopathy of prematurity (ROP) is a disease of the immature retina and is the leading global cause of blindness in children. Two postnatal phases of the disease are distinguished, the first phase is thought to be caused by hyperoxia. One of the most relevant ROP risk factor in routine clinical practice is blood transfusion which leads to the introduction into the neonatal circulation of ‘non-physiological’ adult haemoglobin (HbA) rather than the physiological foetal haemoglobin (HbF). Due to their different affinities for oxygen, HbA will release into retina more oxygen than HbF. It can be expected that this much greater influx of oxygen from HbA may be sensed by the relevant retinal receptors as hyperoxia. Based on the above considerations, I propose that the introduction of non-physiological HbA from adult donors during blood transfusion for anaemia is of key importance in the development and progression of ROP. This hypothesis predicts that there is an HbA limit, beyond which the sequence of events described in the pathogenesis of ROP is triggered.To prevent ROP, I propose launching a new medical field: neonatal transfusion medicine. This system would involve the collection and preparation of umbilical cord blood from the placenta of healthy newborns (containing almost 100% HbF), which would then be administered to premature newborns (who are at risk of ROP) instead of adult blood.