Incidence Of Severe Retinopathy Of Prematurity Research Articles

Nutritional interventions to prevent retinopathy of prematurity.

Very preterm infants are at high risk of growth failure. Poor weight gain is a prominent risk factor for retinopathy of prematurity (ROP) and optimizing nutrition could potentially promote growth and reduce ROP. Most infants at risk of ROP need parenteral nutrition initially and studies of enhanced parenteral provision of lipids and amino acids have suggested a beneficial effect on ROP. Higher amino acid intake was associated with lower incidence of hyperglycemia, a risk factor for ROP. For very preterm infants, providing unpasteurized fortified raw maternal breast milk appears to have a dose-dependent preventive effect on ROP. These infants become deficient in arachidonic acid (ArA)and docosahexaenoic acid(DHA) after birth when the maternal supply is lost. Earlier studies have investigated the impact of omega-3 fatty acids on ROP with mixed results. In a recent study, early enteral supplementation of ArA 100 mg/kg/d and DHA 50 mg/kg/d until term equivalent age reduced the incidence of severe ROP by 50%. IMPACT: Previous reviews of nutritional interventions to prevent morbidities in preterm infants have mainly addressed bronchopulmonary dysplasia, brain lesions and neurodevelopmental outcome. This review focusses on ROP. Neonatal enteral supplementation with arachidonic acid and docosahexaenoic acid, at levels similar to the fetal accretion rate, has been found to reduce severe ROP by 50% in randomized controlled trials.

The impact after 20 years of an early detection program for severe retinopathy of prematurity in a Latin American city.

To evaluate the effects of long-standing early detection program in the incidence and trends of severe retinopathy of prematurity (ROP) in Cali, Colombia. This was a retrospective cohort study of infants included in an ROP prevention, early detection, and prompt treatment program, from January 01, 2002, to December 31, 2021 (20 years). Infants with gestational age (GA) <37 weeks or birth weight (BW) <2000 g and those with known ROP risk factors were screened. The incidence of severe ROP was calculated, and the average annual percent change (AAPC) was estimated through a joinpoint model. 16,580 infants were screened, with an average GA and BW of 31.4 ± 2.8 weeks and 1526.5 ± 56.7 g, respectively. The incidence of severe ROP was 2.69% (446 cases, 95% confidence interval [95%CI]: 2.45%; 2.95%), with an average annual decrease of - 14% (AAPC, 95%CI: -16.3%; -11.6%) from 13.6% in 2002 to 0.7% in 2021. In infants with GA <32 weeks, the incidence was 5.21%. A significant reduction in the risk of ROP was observed with increasing GA and BW (P < 0.05). Among the cases with severe ROP, 6.5% (29/446) had a GA ≥32 weeks with a maximum of 37 weeks; only 0.4% (2/446) of the detected infants had a BW >2000 g. Awareness and screening as part of the early detection program to prevent ROP has shown a significant decline in the incidence of severe ROP over time. Screening infants with GA <32 weeks or BW <2000 g and preterm infants (<37 weeks) with risk factors may be a feasible decision for resource optimization.

Early Hyperglycemia Is Associated with Increased Incidence of Severe Retinopathy of Prematurity in Extremely Low Birth Weight Infants.

Preterm infants have a higher rate of hypoglycemia and hyperglycemia, both of which have been associated with increased neonatal morbidities. The aim of this study was to evaluate the incidence of abnormal glucose homeostasis during the first 72 hours of life and study its association with major morbidities in infants admitted to our neonatal intensive care unit (NICU). This was a retrospective single-center study. We extracted demographic, maternal, and patient information and blood glucose levels for the first 72 hours of life for all infants with birth weight ≤1,000 g admitted to the NICU from January 2017 to December 2019. Continuous data were presented as mean ± standard deviation or as median with interquartile range. Categorical data were presented as frequency and percentage. Student's t-tests and Mann-Whitney U test were used to analyze continuous data and chi-squared test or Fisher's exact test were used to analyze categorical data. Logistic regression analysis was performed to study the relation between hyperglycemia and various morbidities after controlling for gestational age (GA). Statistical significance was set at p < 0.05. Of the 235 infants included in the study, 49% were hypoglycemic at admission to the NICU. Infants that were small for GA and those with history of maternal β-blocker use had a higher incidence of hypoglycemia. Hypoglycemia at admission was not associated with increased mortality or any major morbidities. Seventy-three percent infants who were hypoglycemic or euglycemic at birth developed iatrogenic hyperglycemia during the first 72 hours of life. The incidence of retinopathy of prematurity (ROP) and severe ROP was higher in infants with hyperglycemia on univariate analysis. However, on multivariate analysis, after adjusting for GA, no difference was noted in the incidence of ROP between the two groups. Multivariate analysis could not be performed for severe ROP due to inadequate sample size. Hyperglycemia in the initial 3 days of life is associated with an increased incidence of severe ROP in preterm infants. Neonatologists should aim to maintain euglycemia in these infants to decrease the risk of adverse outcomes. · Preterm infants have a high rate of both hypoglycemia and hyperglycemia.. · Majority of infants who were euglycemic or hypoglycemic at birth develop iatrogenic hyperglycemia.. · Hyperglycemia in the initial 3 days of life is associated with an increased incidence of severe ROP in preterm infants..

Impact of postnatal steroids on peripheral avascular retina and severity of retinopathy of prematurity.

We investigated the role of postnatal steroids on the severity of retinopathy of prematurity (ROP) and its impact on peripheral avascular retina (PAR). A retrospective cohort study of infants born at ≤32 weeks gestation and/or birth weight ≤1500 g. Demographics, the dose and duration of steroid treatment, and age when full retinal vascularization occurred were collected. The primary outcomes were the severity of ROP and time to full vascularization of the retina. A total of 1695 patients were enrolled, 67% of whom received steroid therapy. Their birth weight was 1142 ± 396 g and gestational age was 28.6 ± 2.7 weeks. The total hydrocortisone-equivalent dose prescribed was 28.5 ± 74.3 mg/kg. The total days of steroid treatment were 8.9 ± 35.1 days. After correction for major demographic differences, infants who received a higher cumulative dose of steroids for a longer duration had a significantly increased incidence of severe ROP and PAR (P < 0.001). For each day of steroid treatment, there was a 3.2% increase in the hazard of the severe form of ROP (95% CI: 1.022-1.043) along with 5.7% delay in achieving full retinal vascularization (95% CI: 1.04-1.08) (P < 0.001). Cumulative dose and duration of postnatal steroid use were independently associated with the severity of ROP and PAR. Thus, postnatal steroids should be used very prudently. We report ROP outcomes in a large cohort of infants from two major healthcare systems where we have studied the impact of postnatal steroids on the severity of ROP, growth, and development of retinal vessels. After correcting our data for three major outcome measures, we show that high-dose postnatal steroids used for a prolonged duration of time are independently associated with severe ROP and delay in retinal vascularization. Postnatal steroids impact the visual outcomes of VLBW infants significantly, so their clinical use needs to be moderated.

BORN study: a multicenter randomized trial investigating cord blood red blood cell transfusions to reduce the severity of retinopathy of prematurity in extremely low gestational age neonates

BackgroundExtremely low gestational age neonates (ELGANs, i.e., neonates born before 28 weeks of gestation) are at high risk of developing retinopathy of prematurity (ROP), with potential long-life visual impairment. Due to concomitant anemia, ELGANs need repeated red blood cell (RBC) transfusions. These produce a progressive replacement of fetal hemoglobin (HbF) by adult hemoglobin (HbA). Furthermore, a close association exists between low levels of HbF and severe ROP, suggesting that a perturbation of the HbF-mediated oxygen release may derange retinal angiogenesis and promote ROP.Methods/designBORN (umBilical blOod to tRansfuse preterm Neonates) is a multicenter double-blinded randomized controlled trial in ELGANs, to assess the effect of allogeneic cord blood RBC transfusions (CB-RBCs) on severe ROP development. Recruitment, consent, and randomization take place at 10 neonatology intensive care units (NICUs) of 8 Italian tertiary hospitals. ELGANs with gestational age at birth comprised between 24+0 and 27+6 weeks are randomly allocated into two groups: (1) standard RBC transfusions (adult-RBCs) (control arm) and (2) CB-RBCs (intervention arm). In case of transfusion need, enrolled patients receive transfusions according to the allocation arm, unless an ABO/RhD CB-RBC is unavailable. Nine Italian public CB banks cooperate to make available a suitable amount of CB-RBC units for all participating NICUs. The primary outcome is the incidence of severe ROP (stage 3 or higher) at discharge or 40 weeks of postmenstrual age, which occurs first.DiscussionBORN is a groundbreaking trial, pioneering a new transfusion approach dedicated to ELGANs at high risk for severe ROP. In previous non-randomized trials, this transfusion approach was proven feasible and able to prevent the HbF decrease in patients requiring multiple transfusions. Should the BORN trial confirm the efficacy of CB-RBCs in reducing ROP severity, this transfusion strategy would become the preferential blood product to be used in severely preterm neonates.Trial registrationClinicalTrials.gov NCT05100212. Registered on October 29, 2021

Effect of Optimizing Oxygen Saturation Targets on the Incidence of Retinopathy of Prematurity in a Quaternary NICU

Introduction: Retinopathy of prematurity (ROP) is a multifactorial disease and a preventable cause of blindness in childhood. Hyperoxia and hypoxia can cause retinal neovascularization resulting in retinal detachment and blindness if left untreated. Besides oxygen treatment, other reasons for ROP development are well known. We prospectively adopt various strategies to keep oxygen saturation (SpO₂) within targets^, between 91 and 95% for those on supplemental oxygen. By adapting this, we postulated that the incidence of severe ROP might be reduced. Methods: 2018–2019 provided pre-intervention and 2020 post-intervention data for the project. For all babies (≤32 weeks, ≤1,500 g with FiO₂ >0.21), target SpO₂ between 91 and 95% was measured as a percentage of time spent within and outside target SpO₂ during 1–4 weeks of life. Results: 112 and 60 preterm neonates were screened for ROP during the pre- and post-intervention phase. Twenty neonates (18.3%) during pre-intervention and 16 (26.7%) in the post-intervention phase developed severe ROP requiring treatment. Despite a statistically significant increase of 10 percent points in time spent within target SpO₂ (91–95%) in the post-intervention phase (p < 0.05), the incidence of severe ROP did not decline. Using a multivariate model, odds of ROP development decreased with gestational age (25%) while increasing with PDA requiring treatment (4.33 times) and glucose ≥10 mg/dL (4.15 times), considering one variable at a time, keeping others constant. Conclusion: Our QI project showed successful attainment of maximum time; the SpO₂ remained within targets during supplemental oxygen; however, the incidence of severe ROP had not declined. Factors other than SpO₂ might be responsible for a high incidence of ROP in our neonatal intensive care unit.

Effect of Enteral Long-Chain Polyunsaturated Fatty Acids on Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

Background: Long-chain polyunsaturated fatty acids (LCPUFA) are critical for the maturation of the brain and retina. Retinopathy of prematurity (ROP) is a preventable cause of blindness in preterm infants. LCPUFA have anti-inflammatory, antioxidant, and antiangiogenesis effects. Supplementation of enteral LCPUFA might mitigate the incidence of ROP in these infants. Available limited randomized studies showed promising results. We aimed to assess the effect of enteral supplementation of LCPUFA on ROP in preterm infants. Methods: We followed PRISMA guidelines and searched MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Embase, and Cochrane Registry from 1990 to 2021 for the studies that examined the effects of enteral LCPUFA and ROP in preterm infants. We included the studies that satisfied the predefined inclusion criteria. RevMan 5.3 software derived the forest plot of pooled relative risk. We assessed the quality of all the included studies using GRADE recommendations. Results: Nine studies were eligible for the meta-analysis involving 2,482 infants. Of the nine RCTs, six studies provided LCPUFA (DHA/AA) as a separate intervention in different concentrations, and three studies provided formula milk enriched with LCPUFA. In addition, five studies recruited infants below 32 weeks of gestational age. Supplementation of LCPUFA did not reduce the incidence of severe ROP (RR 0.71, 95% CI: 0.50–1.01, 5 studies, 1,822 infants) with very low CoE or any ROP (RR 0.95, 95% CI: 0.73–1.12, 6 studies, 1,177 infants) with very low CoE or ROP requiring treatment (RR 0.92, 95% CI: 0.62–1.38, 4 studies, 1,395 infants) with very low CoE. Regarding safety outcomes, enteral LCPUFA did not increase the risk of necrotizing enterocolitis or mortality. Discussion/Conclusion: Supplementation of enteral LCPUFA to preterm infants did not reduce ROP incidence; however, there was a trend toward benefit in mitigating severe form of ROP. More well-designed, large, randomized controlled studies are warranted.

Ten-Year Trend of Retinopathy of Prematurity Among Extremely Preterm Infants in One Neonatal Intensive Care Unit in China.

Background: Extremely preterm (EP) infants are at the highest risk of retinopathy of prematurity (ROP). With more EP infants survived in China, recent data of ROP is lacking. The aim of the study is to report the trend of incidence of ROP among EP infants in a large neonatal intensive care unit in China over the past 10-year period, in relation with the overall survival rate and the change of oxygen saturation targets.Methods: This retrospective cohort study enrolled all EP infants born before 28 weeks' gestation and admitted to one of the largest tertiary neonatal intensive care units in China from 2010 to 2019. Data were compared between two time periods according to different oxygen saturation targets: 2010–2014 (P1) with low saturation target and 2015–2019 (P2) with higher target.Results: Of 630 EP infants admitted during the 10 years, 447 (71.0%) infants survived to discharge. The survival rate increased significantly from 61.6% in P1 to 75.8% in P2 (P < 0.05). Of the 472 infants who had ROP data, 318 (67.4%) developed ROP of any stage, 67 (14.2%) developed severe ROP, and 44 (9.3%) received treatment. The incidence of any ROP increased significantly from 51.7% in P1 to 74.3% in P2 (P < 0.05). The incidence of severe ROP increased from 11.0% in P1 to 15.6% in P2, and ROP treatment increased from 6.9% in P1 to 10.4% in P2, but neither reached statistical significance (both P > 0.05).Conclusions: We observed an increasing trend in the incidence of ROP across the 10-year period in one of the largest neonatal care units in China. The increased survival rate and the use of high-target oxygen saturation in the later period may partly explain this trend. Further investigations are needed to improve the care practices and to reduce the incidence of severe ROP.

Incidence of retinopathy of prematurity treatment in extremely preterm infants in China.

Retinopathy of prematurity (ROP) continues to be a major cause of visual impairment and blindness in premature infants and children. To investigate the incidence of severe ROP receiving treatment in extremely preterm (EP) infants in China over time. The risk factors for ROP treatment were also assessed. This was a multicentre retrospective study and a subanalysis of baseline data from the "Outcomes of EP infants in China 2010-2019" study. This study was conducted in 68 tertiary neonatal care centres from 31 provinces of China. Infants with a gestational age of 230 -276 weeks and admitted to a neonatal unit within the first 72h of life between 2010 and 2019 were enrolled. Incidence of ROP was analysed in infants who survived to 32weeks postmenstrual age and screened for ROP. Multivariable modified Poisson regression models were used to identify risk factors for ROP treatment. Among 7295 eligible infants, 4701 (64.5%) survived to 32weeks postmenstrual age and met ROP screening criteria. Of the 3756 infants who screened and with ROP data, 2320 (61.8%) developed ROP of any stage. The overall incidence of ROP treatment was 12.6%, decreasing from 45.5% at 23weeks to 8.3% at 27weeks. During the 10-year period, the incidence of ROP treatment did not change, although the incidence of any ROP increased over time. Independent risk factors associated with ROP treatment included lower gestational age, small for gestational age, multiple birth, severe intraventricular haemorrhage, patent ductus arteriosus and supplemental oxygen duration. The incidence of EP infants receiving ROP treatment showed no change during this 10-year period in China. Prevention of prematurity and foetal growth restriction, judicious use of oxygen and reducing comorbidities are promising factors that may reduce the incidence of ROP needing treatment in these high-risk infants.

Lipid supplement reduced ROP in premature infants

Hellström A, Nilsson AK, Wackernagel D, Pivodic A, Vanpee M, Sjöbom U, et al. Effect of Enteral Lipid Supplement on Severe Retinopathy of Prematurity: A Randomized Clinical Trial. JAMA Pediatr 2021:e205653. https://doi.org/10.1001/jamapediatrics.2020.5653 Among premature infants, what is the therapeutic benefit of supplemental arachidonic acid (AA) and docosahexaenoic acid (DHA), compared with no supplementation, in reducing the incidence of retinopathy of prematurity (ROP)? Randomized control trial. 3 centers in Sweden. Infants born <28 weeks' gestational age. AA:DHA vs none. Primary outcome: incidence of severe ROP (stage 3 and/or type 1 ROP). The treatment group demonstrated less ROP, 16 of 101 (15.8%) in the AA:DHA group vs 35 of 105 (33.3%) in the non-treatment group, absolute risk reduction 17.5% (6.0%-29.0%), number needed to treat 5.7 (3.5-16.6). There were no differences between the groups in bronchopulmonary dysplasia, intraventricular hemorrhage, sepsis, or death rates. AA:DHA reduced ROP development without increasing major morbidities.

Stable incidence but regional differences in retinopathy of prematurity in Norway from 2009 to 2017.

To explore the changes over time and regional differences in the incidence of retinopathy of prematurity (ROP) in a national cohort of infants born <28weeks' gestational age (GA). A population-based study of infants with GA <28weeks in Norway from 2009 to 2017. Prospectively collected data on clinical variables and outcomes were obtained from the Norwegian Neonatal Network. Of 1499 live-born infants transferred to a neonatal intensive care unit, 1156 were discharged alive. Four-hundred and fifty-eight infants (39.6%) had ROP, 152 (13.1%) had severe ROP, and 110 (9.5%) were treated for ROP. Eleven hundred infants (95.2%) had complete data sets. In a model comprising region of primary care, GA [odds ratios (OR): 0.65; 95% CI: 0.55-0.77], growth velocity (OR: 1.10; 95% CI: 1.00-2.00), medically treated patent ductus arteriosus (OR: 1.80; 95% CI: 1.19-2.72), weeks of supplemental oxygen (OR: 1.07; 95% CI: 1.03 to 1.11) and region of primary care (OR: 4.95; 95% CI: 3.05-8.04 for the pair of regions with the highest estimated OR) were significantly associated with severe ROP. Additionally, institutional differences for severe ROP were found, with ORs from 0.41 (95% CI: 0.05-3.23) to 5.36 (95% CI: 3.05-9.43) using the largest institution as reference. Incidences were stable over time after adjusting for GA. A larger proportion was treated with anti-vascular endothelial growth factor after 2011. The incidence of severe ROP was stable between 2009 and 2017 in Norway. Regional and institutional differences need to be explored in future studies.

Retinopathy of Prematurity among Syrian Refugees: Incidence and Severity.

PURPOSE:The aim of this study is to compare the incidence and severity of retinopathy of prematurity (ROP) in premature newborns of Syrian refugees and those of Turkish origin.METHODS:This retrospective, the single-center study included 1545 premature infants assigned to two groups based on maternal origin. Group 1 comprised 1366 premature infants of Turkish origin, and Group II comprised 179 premature infants born to Syrian refugees. All the premature infants were screened for ROP by the same ophthalmologist who is experienced in the screening and treatment of ROP. All data including gestational age (GA), birth weight (BW), the presence of ROP, and severe ROP collected from 2014 to 2017 were recorded for each group. The outcomes were compared between the two groups.RESULTS:The mean GA at birth was 30.6 ± 2 weeks and was significantly lower in Group II (P = 0.03). The overall incidence of ROP was similar in both groups. The incidence of severe ROP in Group II was nearly seven times higher than in Group I (1.5% and 10%, respectively). The incidence of severe ROP seen in Group II evaluated according to different ranges of GA and BW was higher than in Group I.CONCLUSION:The higher incidence of severe ROP in the premature newborns of Syrian refugees could play an important role in identifying ongoing health problems of refugees.

Risk factors for retinopathy of prematurity in a district in South India: A prospective cohort study.

PURPOSE:The purpose of this study was to determine the incidence, severity, and associated risk factors of retinopathy of prematurity (ROP) in a district in South India.METHODS:This was a prospective, observational, cohort study involving babies at risk of ROP conducted in five Neonatal Intensive Care Units in a district in Tamil Nadu, South India. All babies with gestational age at birth of ≤36 weeks and a birth weight (BW) of ≤1900 g with a follow-up period of at least 6 months were enrolled for the study. Neonatal and maternal risk factors were assessed and univariate and multivariate logistic regression analysis performed to examine the predictors of ROP.RESULTS:A total of 325 infants were screened. ROP was identified in 210 eyes of 106 (32.6%) babies with severe ROP (stage ≥3 ROP) occurring in 14 (13.2%) babies. Low BW (LBW) was the only significant risk factor for ROP on multivariate logistic regression analysis. The mean BW was 1285 and 1452 g for babies with and without ROP, respectively. Treatment was indicated in 22 eyes of 14 (13.2%) infants.CONCLUSIONS:The incidence of ROP was fairly high and strongly associated with LBW. A relatively low incidence of severe ROP was, however, observed. More effort is, therefore, required towards the prevention of preterm births while the present gains in neonatal care should be sustained to reduce the incidence of ROP and thus childhood blindness in the country.

Parenteral Fish-Oil Lipid Emulsions in the Prevention of Severe Retinopathy of Prematurity: A Systematic Review and Meta-Analysis.

Objective Omega-3 fatty acids are vital for brain and retinal maturation. It is not clear if early use of ω-3 fatty acids in the form of fish-oil lipid emulsions (FLEs) prevents retinopathy of prematurity (ROP) in preterm infants. The aim of this meta-analysis is to evaluate whether early administration of parenteral FLEs reduces ROP requiring laser therapy or severe ROP ≥stage 3 in preterm infants. Methods A literature search was performed to identify studies comparing parenteral FLEs with soybean-based lipid emulsions (SLEs) in preventing ROP. The main outcome was incidence of severe ROP or ROP requiring laser therapy. Results Studies met the inclusion criteria (four RCTs and two observational studies). The pooled relative risk of ROP requiring laser therapy or severe ROP ≥ stage 3 in FLEs group was 0.47 [95% CI: 0.24-0.90] and 0.40 [95% CI: 0.22-0.76] in RCTs and observational studies, respectively. FLEs also reduced cholestasis; however, other secondary outcomes of bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), sepsis, intraventricular hemorrhage (IVH), and mortality were similar. Conclusion The use of FLEs may reduce the incidence of severe ROP or need for laser therapy in preterm infants. A large multicenter RCT is required to confirm this.

Sight-Threatening Retinopathy of Prematurity: Changing Trends in Treatment.

To study the incidence and treatment of severe retinopathy of prematurity (ROP) in infants younger than 30 weeks' gestational age (GA) in New South Wales and the Australian Capital Territory, Australia, from 2003 to 2008. These data were then compared to data from previously reported epochs (1986 to 1987, 1992 to 1997, and 1998 to 2002). Data were divided into two sub-epochs (2003 to 2005 and 2006 to 2008) to study trends and combined to compare over 22 years. From 2003 to 2008, 2,550 of 3,004 (84.9%) infants survived, 200 (7.8%) were diagnosed as having severe ROP, and 119 (59.5%) required laser therapy. No significant difference in the incidence of severe ROP or treatment rate in infants younger than 27 and 30 weeks' GA from 2003 to 2005 and 2006 to 2008 occurred. Similarly, between 1986 and 2008 there was no difference in the incidence of severe ROP. However, the treatment rate significantly increased during this time. The incidence of severe ROP has been stable since 1986. However, laser treatment significantly increased to include 8 infants with stage 2 ROP from 2003 to 2008.

Validation of the existing modified screening criteria for detection of all cases of Retinopathy of Prematurity in preterm babies – 11 year study from a governorate referral hospital in Oman

PurposeTo study appropriateness of our modified screening criteria for detection of all cases of Retinopathy of Prematurity (ROP) among preterm babies. MethodRetrospective observational cohort study among preterm neonates who underwent ROP screening as per set protocol for 11years at Nizwa Hospital, Al Dhakilya Governorate, Oman. We screened all babies with gestational age ⩽32weeks or BW⩽1500g. Preterm babies >32weeks of GA or BW>1500g with unstable clinical course believed to be at high risk by the attending neonatologist also were screened. ResultsDuring the study period 528 babies were screened for ROP of which 76 babies were excluded due to death, associated congenital ocular malformation and loss for follow-up either due to transfer to other institution or defaulting. Thus 452 babies were included in the final analysis. Incidence of ROP was 46.4% of which 27.9% had mild ROP, 11.3% had severe ROP which regressed and 7.3% had severe ROP who were treated. The incidence of ROP among infants with GA<26wks, 26–28wks, 29–30wks, 31–32wks and above 32weeks was 100.0%, 80.0%, 59.3%, 34.4% and 19.4% respectively.56 babies of this cohort belonged to Extended (modified) criteria group. Among these 12 babies had ROP out of which 9 had mild ROP and 3 had severe ROP. Among cases with severe ROP, two cases regressed spontaneously and one case needed treatment.Multivariate analysis using stepwise regression model showed statistically significant association of GA and BW to development of ROP.We would have missed few babies with ROP if we had followed other criteria. ConclusionOur modified screening criteria seem to be appropriate as no infant with severe ROP was missed during the study period. Incidence of severe ROP among babies in the extended criteria group (5.4%) is low but significant compared to lower gestational age. We plan to formulate a scoring system following all risk factor analysis to enable us to optimize the number of infants screened. Detection of all babies with ROP is important as they need long-term follow-up for the timely detection and management of associated ocular comorbidities.

Procena riziko faktora kod retinopatije prematuriteta

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants. Our study was conducted in order to determine which risk factors lead to the development of retinopathy of prematurity. This retrospective study included 108 newborns with birth weight (BW) &lt; 1500 g and gestation age (GA) &lt; 33 weeks, over the period of two years, who were treated at the Clinic of Pediatric, University Hospital, Clinic Centre Banja Luka. In all preterm children, the impact of risk factors conditioned preterm birth (gestational age and birth weight), parameters of general health status (respiratory distress syndrome, apnea, perinatal asphyxia, frequent use of blood derivatives, sepsis, hyperbilirubinemia) and parameters of the treatment with oxygen therapy. Out of 108 infants who fit the screening criteria, ROP was detected in 64 (59.2%) infants, 21(19.4%) of which had severe ROP requiring surgical intervention. Severe ROP was expressed in only 7.8% (5/64) of infants with GA &gt; 30 weeks and in 12.5% (8/64) of infants with BW &gt; 1250 g, compared to 25% (16/64) of infants with GA &lt; 30 weeks and 20.3% (13/64) of infants with BW &lt; 1250 g. The incidence of severe ROP was statistically significantly more frequent with progressively smaller birth weight BW &lt; 1250 g (p &lt;0.01) and the lower GA (gestational age) &lt; 30 weeks (p &lt;0.01). Using multiple logistic regression analysis for ROP, a long-term oxygen therapy (OR,15:54CI, 1.99-120.79) and a long duration of mechanical ventilation (OR,9.97; CI,3.06-32.51), there were obtained factors with a strong connection to the development of severe ROP. The following factors have a slightly lower correlation to the development of severe ROP: birth weight &lt; 1250 g, gestation age &lt; 30 weeks, respiratory distress syndrome, apnea, frequent use of blood derivatives and early sepsis. Prematurity and low birth weight are significant risk factors for the development of ROP. Compromised pulmonary function with long-term oxygen therapy and frequent use of blood derivatives are important factors in the development of severe ROP.

Outcome and quality of screening in a nationwide survey on retinopathy of prematurity in The Netherlands

PurposeProvide insight in natural history, screening and treatment policy of retinopathy of prematurity (ROP) in The Netherlands.MethodsA multicentre, prospective, population-based study (NEDROP) included all preterm infants born in 2009 in...

The importance of oxygen control reaffirmed: experience of ROP reduction at a single tertiary care center.

To report the impact of the adoption of a low oxygen saturation policy on retinopathy of prematurity (ROP) incidence at a single tertiary care center. ROP incidence, procedures for ROP, and neonatal outcome among very low birth weight infants were compared before and after the adoption of a low saturation policy, which took place in 2004. The Mann– Whitney test was performed to look for differences. The incidence of severe ROP significantly decreased from 5.3% of live very low birth weight infants between 1999 and 2004 to 1% of live very low birth weight infants between 2005 and 2012 (P = .003). The use of laser therapy for severe ROP between the same periods significantly decreased from 6.4% of live very low birth weight infants between 1999 and 2004 to 0.6% of live very low birth weight infants between 2005 and 2012 (P = .002). There was also a significant reduction of death or bronchopulmonary dysplasia from 33.8% between 1999 and 2004 to 24.2% between 2005 and 2012 (P = .02). Trained personnel and low and tailored oxygen saturation intervals for very low birth weight infants could play a pivotal role in reducing the incidence of severe ROP without increasing mortality.

The incidence and risk factors of severe retinopathy of prematurity in extremely low birth weight infants in Turkey.

BackgroundThe aim of this study was to identify the incidence of severe retinopathy of prematurity (ROP) requiring laser treatment and the overall incidence of ROP in extremely low birth weight (ELBW) infants, and to evaluate the associated risk factors for developing severe ROP in ELBW infants in Turkey.Material/MethodsThis retrospective, case-control, tertiary care-hospital based study included 235 ELBW infants screened for ROP. The incidence of the onset of ROP and severe ROP requiring laser treatment were assessed. The relationship between various clinical risk factors, and the development of severe ROP and onset of ROP were analyzed using univariate analysis and multivariate logistic regression analysis.ResultsThe overall incidence of any stage ROP and severe ROP requiring laser treatment in ELBW infants was 75.5% and 38.7%, respectively. Severe ROP requiring laser treatment in ELBW infants was significantly associated with various independent risk factors, including blood transfusion (P=0.002), gestational age at birth (P<0.001), gestational weight at birth (P=0.001), culture-proven sepsis (P=0.047).ConclusionsThe severity of ROP may increase as weight at birth and gestational age at birth decrease, and in those with culture-proven sepsis as well as in those that receive blood transfusion. Clinicians should be aware of the presence of these risk factors when treating ELBW premature infants. Early detection and prevention of sepsis and reducing the number of blood transfusions may decrease the incidence of severe ROP requiring laser treatment.