Update on risk factors and future perspectives for preterm infants

Abstract

Abstract Purpose To give an update on risk factors for retinopathy of prematurity with special focus on postnatal growth and growth factors Methods The relationship between birth weight, serum levels of IGF‐I as well as postnatal longitudinal growth and ROP will be presented. Preventive measures will be discussed. Results Birth weight data on 451 infants demonstrated initially a significant difference in BW between different ROP stages but when taking gestational age and sex into account the significance was eliminated. Recently, a new diagnostic tool based on weekly neonatal measurements of body weight and serum insulin‐like growth factor 1 (IGF‐I) levels, was shown to be predictive for ROP development. The algorithm “Weight IGF‐I Neonatal ROP” (WINROP™) predicted early (mean 10 weeks) all infants who later developed proliferative ROP requiring treatment. The WINROP algorithm was then taken one step further using only serial weight measurements (n=700), excluding blood sampling for measuring IGF‐I. With this approach WINROP predicted all infants who later developed proliferative ROP requiring treatment (100% sensitivity) and correctly identified 75% of those who did not develop proliferative ROP, and thus would not need any ophthalmologic screening. We have also shown a close relationship between postnatal growth, severe ROP and poor brain development. Conclusion For decades, neonatal intensive care has focused on survival of the most immature babies. Time has come to find methods to ameliorate the nutrition for the children born very preterm. It is known that IGF‐I is essential for growth and development of the immature vasculature of the eye. Intervention with substitution of IGF‐I to the very preterm babies to raise IGF‐I up to normal intrauterine levels might be beneficial. Commercial interest