International Classification Of Retinopathy Of Prematurity Research Articles

Evaluation of an Artificial Intelligence System for Retinopathy of Prematurity Screening in Nepal and Mongolia.

To evaluate the performance of a deep learning (DL) algorithm for retinopathy of prematurity (ROP) screening in Nepal and Mongolia. Retrospective analysis of prospectively collected clinical data. Clinical information and fundus images were obtained from infants in 2 ROP screening programs in Nepal and Mongolia. Fundus images were obtained using the Forus 3nethra neo (Forus Health) in Nepal and the RetCam Portable (Natus Medical, Inc.) in Mongolia. The overall severity of ROP was determined from the medical record using the International Classification of ROP (ICROP). The presence of plus disease was determined independently in each image using a reference standard diagnosis. The Imaging and Informatics for ROP (i-ROP) DL algorithm was trained on images from the RetCam to classify plus disease and to assign a vascular severity score (VSS) from 1 through9. Area under the receiver operating characteristic curve and area under the precision-recall curve for the presence of plus disease or type 1 ROP and association between VSS and ICROP disease category. The prevalence of type 1 ROP was found to be higher in Mongolia (14.0%) than in Nepal (2.2%; P<0.001) in these data sets. In Mongolia (RetCam images), the area under the receiver operating characteristic curve for examination-level plus disease detection was 0.968, and the area under the precision-recall curve was 0.823. In Nepal (Forus images), these values were 0.999 and 0.993, respectively. The ROP VSS was associated with ICROP classification in both datasets (P < 0.001). At the population level, the median VSS was found to be higher in Mongolia (2.7; interquartile range [IQR], 1.3-5.4]) as compared with Nepal (1.9; IQR, 1.2-3.4; P < 0.001). These data provide preliminary evidence of the effectiveness of the i-ROP DL algorithm for ROP screening in neonatal populations in Nepal and Mongolia using multiple camera systems and are useful for consideration in future clinical implementation of artificial intelligence-based ROP screening in low- and middle-income countries.

Role of the haematological phenotype as a predictive biomarker of retinopathy of prematurity development

AbstractPurpose: To evaluate haematological parameters as possible biomarkers of the development of retinopathy of prematurity (ROP).Methods: Multicenter, observational, and prospective study of preterm infants (PTI) from eight NICU, born in Portugal with gestational age (GA) &lt; 32 weeks or birth weight (BW) &lt;1500 g. ROP staging performed according to the International Classification of ROP (ICROP). Sociodemographic, clinical and laboratory data were collected from the first week of life. Complete blood count (CBC) was determined according to standardized methods. According to the maximum stage of ROP, PTI were divided into four groups: without ROP, ROP stage 1 (ROP‐1), ROP stage 2 (ROP‐2) and ROP stage 3 (ROP‐3). Statistical analysis was performed with the SPSS program with significant value for p &lt; 0.05.Results: 455 PTI were included, GA average of 29.5 ± 2.3 weeks, BW average of 1165.7 ± 313.9 grams and 50.5% were female. In this study 37.8% of the PTI developed ROP: 20% had ROP‐1, 9.4% ROP‐2 and 8.4% ROP‐3. 4.6% of PTI received treatment: laser was performed in 12 PTI (2.6%), anti‐VEGF in 7 PTI (1.5%), anti‐VEGF and laser in 1 PTI (0.2%), and anti‐VEGF, laser, and surgery in 1 PTI (0.2%). ROP‐3 was significantly associated with lower GA (p = &lt;0.001), BW (p &lt; 0.001), erythrocytes (p &lt; 0.001), haemoglobin (p &lt; 0.001), haematocrit (p &lt; 0.001), lymphocyte (p = 0.047) and lymphocyte to monocyte ratio (LMR) (p = 0.018) compared with the other groups. Neutrophils (p = 0.039) and neutrophil to lymphocyte ratio (NLR) (p &lt; 0.001) were higher in ROP‐3. For PTI who did not develop ROP were observed, in relation with the other groups: higher mean corpuscular haemoglobin concentration (MCHC) (p &lt; 0.001), platelets (p = 0.029) and plateletcrit (PCT) (p = 0.007) and lower red cell distribution width (RDW) (p = 0.015) and erythroblast (p &lt; 0.001).Conclusions: This study shows that the increase in neutrophils, NLR, and RDW and the decrease in lymphocytes, LMR, erythrocytes, and platelets may constitute early and low‐cost predictive biomarkers of ROP development.

Variability in Plus Disease Diagnosis using Single and Serial Images

To assess changes in retinopathy of prematurity (ROP) diagnosis in single and serial retinal images. Cohort study. Cases of ROP recruited from the Imaging and Informatics in Retinopathy of Prematurity (i-ROP) consortium evaluated by 7 graders. Seven ophthalmologists reviewed both single and 3 consecutive serial retinal images from 15 cases with ROP, and severity was assigned as plus, preplus, or none. Imaging data were acquired during routine ROP screening from 2011 to 2015, and a reference standard diagnosis was established for each image. A secondary analysis was performed using the i-ROP deep learning system to assign a vascular severity score (VSS) to each image, ranging from 1 to 9, with 9 being the most severe disease. This score has been previously demonstrated to correlate with the International Classification of ROP. Mean plus disease severity was calculated by averaging 14 labels per image in serial and single images to decrease noise. Grading severity of ROP as defined by plus, preplus, or no ROP. Assessment of serial retinal images changed the grading severity for > 50% of the graders, although there was wide variability. Cohen's kappa ranged from 0.29 to 1.0, which showed a wide range of agreement from slight to perfect by each grader. Changes in the grading of serial retinal images were noted more commonly in cases of preplus disease. The mean severity in cases with a diagnosis of plus disease and no disease did not change between single and serial images. The ROP VSS demonstrated good correlation with the range of expert classifications of plus disease and overall agreement with the mode class (P= 0.001). The VSS correlated with mean plus disease severity by expert diagnosis (correlation coefficient, 0.89). The more aggressive graders tended to be influenced by serial images to increase the severity of their grading. The VSS also demonstrated agreement with disease progression across serial images, which progressed to preplus and plus disease. Clinicians demonstrated variability in ROP diagnosis when presented with both single and serial images. The use of deep learning as a quantitative assessment of plus disease has the potential to standardize ROP diagnosis and treatment.

The new edition of the international classification of retinopathy of premature. Part 1

Retinopathy of prematurity (ROP) is still one of the main causes of blindness and low vision from early childhood in developed countries and therefore remains the focus of attention of researchers and clinicians. The International Classification of Retinopathy of Prematurity (ICROP) was initially adopted in 1984, expanded in 1987, amended in 2005, and revised in 2021. Part 1 of this article discusses the new edition of the ICROP3. The reasons for updating the ICROP3 and the composition of the International Committee, which was specially organized for this purpose, are indicated. The new and third edition retains the current definitions (zone, stage, and extent of the disease). The main updates in ICROP3 include the improved classification of indicators, two of which, in the authors opinion, are most significant for the acute stages of the disease. The definition of posterior zone II region and the recognition that retinal vascular changes in ROP represent a continuous spectrum from normal to preplus- and plus disease, with images demonstrating this range. In conclusion, the new edition of the ICROP3 requires a deep reading and discussion between domestic experts and must be introduced to clinical practices and the educational process. The next article will continue the discussion on the remaining additions/updates to ICROP3.

Pattern and risk factors of retinopathy of prematurity in tertiary care centre

Retinopathy of prematurity is one of the commonest cause of blindness in sick neonates exposed to excessive oxygen following NICU admissions. The present study was thus conducted to assess the pattern and risk factors associated with incidence of retinopathy of prematurity.A retrospective record based study was conducted at tertiary care centre between 1st July 2017 to 30thMay 2020 were screened for ROP. Baseline characteristics and risk factors for ROP were assessed. The zone and stage of ROP were categorized as per the International classification of ROP along with iris neovascularisation and plus disease as per the revised international classification of retinopathy of prematurity (ICROP) preplus disease criteria. Data was entered in excel sheet and analysed using SPSS software version 20.Majority of neonates belonged to gestational age of 28 to 31 weeks (58.8%) and 51.2% neonates had birthweight of 1.5 to 2 kg. Male preponderance was observed with male: female ratio of 1.75:1. Amongst the various risk factors, the occurrence of ROP was highly significantly associated with gestational age and birthweight (p&amp;#60;0.01). Subgroup analysis revealed that aggressive posterior ROP (APROP) contributed significantly to Type I ROP in 11.1% (3) cases. And the observed difference in gestational age and birthweight between APROP and other cases of ROP were statistically highly significant (p&amp;#60;0.01).Early and timely screening of ROP for all high risk neonates especially low birth weight and neonates with small gestational age should be mandatory as these are the most significant risk factors associated with ROP in present study.

Predicting ROP Severity by Artificial Intelligence: Pragmatic Versus Knowledge-Based Approach.

Retinopathy of prematurity (ROP) blindness is largely preventable, with many countries having already established programs for its timely identification. However, ∼93% of infants screened do not develop ROP severe enough to require treatment.1 As reported in this issue of Pediatrics by Coyner et al.2 artificial intelligence (AI) is innovative methodology to optimize the timing of ROP examinations. For example, it can predict whether an eye will not require treatment, reducing the number of examinations needed while also predicting which eyes need closer surveillance. This is an important development because it would make ROP programs more effective and efficient, thus reducing the burden on infants, families, and the health care team.From the earliest descriptions, congestion and tortuosity of the posterior retinal vessels were recognized as prominent features of serious ROP.3 In the first international classification of ROP in 1984,4 the term “plus disease” was included to describe progressive vascular incompetence. Two decades later, after the recommendations of the Early Treatment for Retinopathy of Prematurity trial,5 plus disease became the major driver for treatment. With focus now directed to the timely identification of plus disease, the historical dichotomous categorization of normal versus plus disease was deemed inadequate and led to the introduction of an intermediate level, “preplus disease,” in 20056 and the subsequent critical acknowledgment in the 2021 classification7 that the vascular changes associated with ROP do not progress stepwise but are a continuous spectrum.However, categorizing the plus spectrum is subjective and subject to significant variation.8–10 In the late 1990s, the introduction of digital imaging into the NICU provided the opportunity to objectively measure what had long been seen, and this development spawned several methods of retinal vessel measurement.11,12 Despite revealing great early promise, these methods have yet to be incorporated into routine ROP screening worldwide.AI has recently been used to help interpret the complex images captured to monitor for ROP and other patient-specific risk factors. Coyner et al1 report the use of this technology to explore the spectrum of ROP-related vascular changes, and using deep learning (a type of machine learning that can be used to develop predictive rules), the Oregon team developed i-ROP (an algorithm to detect plus disease),13 from which a vascular severity score (VSS) was derived from zone I (the area closest to the optic disc).13,14 Coyner et al1 have devised a risk model to predict ROP requiring treatment using 2 components: gestational age and VSS. Based on images obtained at 32 to 33 weeks’ postmenstrual age, the model had 100% sensitivity and 80.8% negative predictive value to predict (on average, >1 month in advance of the diagnosis) an eye which would later require treatment. This is an exciting and important development. As a result, instead of a stepwise progression through normal, preplus, and plus disease, VSS permits a sliding scale and detailed analysis of the entire plus spectrum, which hopefully will permit fine tuning of the model in the future.To paraphrase Lord Kelvin (1883), when you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, your knowledge is of a meager and unsatisfactory kind. Herein lies a dilemma: Terms such as AI and deep learning are now in common parlance, so much so that few of us are brave enough to express ignorance. By expressing it (VSS) in numbers, it is not clear that, currently, we fully understand what is being measured or if it has advanced our scientific understanding. Hopefully, this will become apparent in the future. Pragmatically, however, there is no doubt that AI-related techniques, including deep learning–derived VSS, are effective and will likely be important in ROP screening. For this to be incorporated into routine clinical practice, some challenges need to be overcome: a short processing time will be essential preferably within the time span of the NICU ward rounds. In addition, this research is North America based and needs to be validated in other countries in which neonatal care may well be more variable and larger infants develop sight-threatening ROP over a shorter time period. Coyner et al1 have introduced us to a new and exciting era of efficient ROP identification.

Update on International Classification of Retinopathy of Prematurity, 3rd edition (ICROP3)

In 1984, a consensus classification of acute retinopathy of prematurity (ROP) was created by the International Classification of ROP (ICROP). In 2005, this was revisited to incorporate advances. Now, a third edition is required because: (1) There are concerns about subjectivity in critical elements of ROP classification. (2) Innovations in imaging are raising questions about validity of traditional ophthalmoscopic tenets. (3) Major advances in treatment (eg, anti-VEGF agents) are creating new challenges regarding classification of post-treatment regression and reactivation.

Key factors in a rigorous longitudinal image-based assessment of retinopathy of prematurity

To describe a database of longitudinally graded telemedicine retinal images to be used as a comparator for future studies assessing grader recall bias and ability to detect typical progression (e.g. International Classification of Retinopathy of Prematurity (ICROP) stages) as well as incremental changes in retinopathy of prematurity (ROP). Cohort comprised of retinal images from 84 eyes of 42 patients who were sequentially screened for ROP over 6 consecutive weeks in a telemedicine program and then followed to vascular maturation or treatment, and then disease stabilization. De-identified retinal images across the 6 weekly exams (2520 total images) were graded by an ROP expert based on whether ROP had improved, worsened, or stayed the same compared to the prior week’s images, corresponding to an overall clinical “gestalt” score. Subsequently, we examined which parameters might have influenced the examiner’s ability to detect longitudinal change; images were graded by the same ROP expert by image view (central, inferior, nasal, superior, temporal) and by retinal components (vascular tortuosity, vascular dilation, stage, hemorrhage, vessel growth), again determining if each particular retinal component or ROP in each image view had improved, worsened, or stayed the same compared to the prior week’s images. Agreement between gestalt scores and view, component, and component by view scores was assessed using percent agreement, absolute agreement, and Cohen’s weighted kappa statistic to determine if any of the hypothesized image features correlated with the ability to predict ROP disease trajectory in patients. The central view showed substantial agreement with gestalt scores (κ = 0.63), with moderate agreement in the remaining views. Of retinal components, vascular tortuosity showed the most overall agreement with gestalt (κ = 0.42–0.61), with only slight to fair agreement for all other components. This is a well-defined ROP database graded by one expert in a real-world setting in a masked fashion that correlated with the actual (remote in time) exams and known outcomes. This provides a foundation for subsequent study of telemedicine’s ability to longitudinally assess ROP disease trajectory, as well as for potential artificial intelligence approaches to retinal image grading, in order to expand patient access to timely, accurate ROP screening.

Study of prevelance of retinopathy of prematurity in tertiary care hospital

Retinopathy of prematurity (ROP) is a disorder seen in preterm babies. ROP is a potentially preventable cause of irreversible total blindness in premature infants. Recent advancements in neonatal care have led to an increase in the survival of low birth weight infants, resulting in a rise of ROP incidence. Globally, ROP is estimated to affect more than 50,000 infants annually. In India, every year, 500 children are estimated to become blind from ROP. If left untreated it can be a third epidemic which can be prevented by appropriate screening.To find the prevalence of ROP To identify the risk factors for ROP.Reterospective study analysis was done for 2.5 years at tertiary care hospital where after taking permission from institutional ethical committee 293 babies were enrolled in this study who were referred from paediatrician as per the standard guidelines of “Rashtriya Bal swasthya karyakram”. All babies were dilated with combination drops of Tropicamide 0.8%w/v and Phenylephrine hydrochloride 5%w/v. All the high risk term babies and preterm babies(&amp;#60;32 weeks) and &amp;#60;2 kg weight were examined 4 weeks postpartum and babies with &amp;#60;=28 weeks were examined at 2 weeks postpartum by Viteroretinal surgeon till the retina matures. Grading was done by following International classification of ROP. All babies retina were examined up to Ora Serrata, Collected data were analysed by Chi-square test.Among 293 babies Prevalence of ROP identified was 32%. 93 babies were very low birth weight (31.7%)(&amp;#60;1.0 kg BW), 35 babies were low birth weight (46%)(1 to 2.5 kg BW) as per the standard guidelines of World Health Organization for birth weight. ROP was found in 52 out of 93 very low birth weight babies(55%) and 40 out of 135 low birth weight babies(29%). P value was less than 0.0001 which was statistically significant. ROP was found in 80 Out of 157 pre term babies (50%). Logistic regression was performed to ascertain the effect of birth weight and gestational age.ROP occurs mostly in extreme low birth weight and preterm infants. In middle-income-countries like India, high rates of premature birth, and increasing resuscitation of premature infants, often with suboptimal standards of care, have resulted in a third epidemic of ROP. It is essential to screen premature babies and babies with low birth weight. Awareness regarding ROP screening is a key factor for it’s prevention.

Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines.

To evaluate the incidence and clinical indications for which eyes were treated for retinopathy of prematurity (ROP) outside the guidelines set by International Classification of ROP (ICROP). Medical records of the patients treated at a single tertiary care ophthalmology hospital for ROP from January 2016 to December 2019 were retrospectively analysed to evaluate the indications for which they were treated. Out of 241 eyes, 33 eyes (13.7%) were treated outside the guidelines. The reasons for the treatment outside the guidelines were structural changes (n = 24, 72.7%), persistent stage 3 ROP that did not show any sign of regression for 6weeks (n = 7, 21.2%) and active ROP with fellow eye being treated (n = 2, 6.1%). The recorded specific structural changes were tangential traction with temporal vessel straightening concerning for macular distortion and ectopia (n = 5, 15.2%), and stage 3 neovascularisation or ridge with anteroposterior traction with risk of progression to stage 4 disease (n = 19, 57.6%). Pre-plus disease was present in 11 eyes (33.3%).After the treatment, ROP stages regressed and retinal vessels grew either until the ora or at least into zone III in all the treated eyes. None of the eyes showed worsening of structural changes after treatment. The mean follow-up of the patients was 12.4 ± 11.7months. Experts occasionally recommend treatment in eyes with disease milder than type 1 ROP. This study may help paediatric retinal practitioners in decision-making in borderline cases.

A Prospective Study on Retinopathy of Prematurity in a Teritiary Care Center

Background: Retinopathy of prematurity (ROP) is a vaso-proliferative retinopathy which occurs mostly in premature babies. The pathological change in ROP is peripheral retinal neovascularisation which may regress completely or leave sequelae from mild myopia to bilateral total blindness. International classification of ROP helped in uniform documentation and staging of ROP. In India, the incidence of ROP is between 38 and 51.9 p.c among low-birth-weight infants. Aim &amp; Objectives: To estimate the incidence of ROP among premature and / or low birth weight babies who were born and admitted to neonatal intensive care unit and attending neonatal follow-up clinic.Subjects and Methods:A hospital based, prospective analytical cross-sectional study was conducted in Department of Pediatrics at Shadan Institute of Medical Sciences, Teaching hospital and research center, Hyderabad, Telangana for a period of 6 months from 1st October 2018 to 31st March 2019. Prior to the study initiation, ethical clearance was obtained and written consent was taken from the parents of the respective babies. The study subjects included premature babies (less than or equal to 35 weeks of gestation) or low birth weight babies (less than or equal to 1500 grams). A predesigned, pre-tested, semi-structured proforma was used to collected the data. The data was collected, entered in Microsoft excel-2013 and analyzed using SPSS version-22 (trial). Data was presented in percentages, proportions and figures.Result:The ROP incidence in the study group was reported among 17.1 p.c of the study subjects.Conclusion:Low birth weight and prematurity are important risk factors for ROP.

Identification of Eyes At Risk for Severe Retinopathy of Prematurity (ROP) by Third Year Ophthalmology Residents in a Tertiary Hospital

Objective: The aim of the present study is to determine the efficiency of third year ophthalmology residents from a tertiary hospital in performing preliminary retinal examination to identify eyes at risk retinopathy of prematurity on the basis of retinal fundus findings up to International Classification of Retinopathy of Prematurity (ICROP) Zone II. Methods: This is a single-center, cross-sectional, prospective comparative research conducted from June to October 2015 at a tertiary training hospital in the Philippines. All infants referred for retinopathy of prematurity screening within the study period where included. The presence of retinal vessel dilatation and tortuosity were identified by third year ophthalmology residents using indirect funduscopy. The residents’ fundus findings were then compared to that of a retina consultant who is proficient in the diagnosis and management of retinopathy of prematurity (ROP). The Kappa index was used to rate inter-observer agreement. The correlation between ROP risk factors and the presence of abnormal retinal vessels were assessed using odd ratio computations. Fisher’s exact test was used to determine the correlation between retinopathy of prematurity and the presence of retinal dilatation and tortuosity. The McNemar’s test was also applied to determine significant differences in the retinal findings of the consultant and ophthalmology residents. Results: A total of 82 eyes of 41 premature infants were evaluated to determine if retinal findings observed by ophthalmology residents were comparable to that of a retina consultant. Odds ratios show that age of gestation, birth weight, and history of blood transfusion are significantly associated with the presence of retinopathy of prematurity. Retinal vessel tortuosity and dilatation are also more common among infants diagnosed with retinopathy of prematurity. There was no significant difference between the retinal vascular findings of the retina consultant and the third year ophthalmology resident in terms of identifying retinal vessel dilatation and tortuosity (P &lt; 0.05). Conclusion: After sufficient and in-depth ophthalmology training, third year ophthalmologists, who will be general ophthalmologists in the future, can reliably identify eyes at risk for severe retinopathy of prematurity on the basis of retinal vascular dilatation and/or tortuosity.

Retinopathy of Prematurity Among Very Low-Birth-Weight Infants in China: Incidence and Perinatal Risk Factors.

Retinopathy of prematurity (ROP) is the leading cause of blindness in children worldwide. This study aimed to determine the incidence and perinatal risk factors for ROP in very low-birth-weight (VLBW) Chinese infants. A retrospective study of the medical records of 504 VLBW infants screened for ROP from 2012 to 2015 was performed in West China Second University Hospital. VLBW infants were examined according to the Royal College of Ophthalmologists ROP guideline and retinopathy was graded following the International Classification of ROP. Perinatal risk factors for ROP were assessed using univariate and multivariate analyses. The overall incidence of ROP in our study was 26.0% (131/504). Stage 1 ROP, stage 2 ROP, and stage ≥3 ROP were detected in 17.5%, 5.4%, and 3.2% of the infants screened, respectively. In the univariate analysis, many perinatal risk factors were found to have a significant association with ROP. In the subsequent multivariate analysis, in vitro fertilization (IVF) (odds ratio [OR] = 1.896; 95% confidence interval [CI] 1.031-3.486), gestational age (GA) < 32 weeks (OR = 2.171; 95% CI 1.085-4.346), apnea (OR = 2.001; 95% CI 1.224-3.272), bronchopulmonary dysplasia (BPD) (OR = 5.098; 95% CI 2.307-11.265), sepsis (OR = 2.212; 95% CI 1.070-4.576), patent ductus arteriosus (PDA) (OR = 1.675; 95% CI 1.011-2.774), and blood transfusion (OR = 1.819; 95% CI 1.046-3.163) were independently associated with the development of ROP (all P < 0.05). In VLBW Chinese infants, IVF, GA < 32 weeks, apnea, BPD, sepsis, PDA, and blood transfusion were independent perinatal risk factors for ROP.

Incidence and Risk Factors of Retinopathy of Prematurity From 2 Neonatal Intensive Care Units in a Hong Kong Chinese Population.

To determine the incidence and risk factors of retinopathy of prematurity (ROP) in very low birth weight (VLBW) preterm Chinese infants. Retrospective review. Medical records were reviewed for all neonates screened for ROP between January 2007 and December 2012 in Hong Kong. Screening was offered to VLBW (≤1500 g) and/or preterm (gestation, ≤32 weeks) neonates using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP by 3 pediatric ophthalmologists. Maternal and neonatal covariates were analyzed using univariate and multivariable logistic regression analyses for both ROP and type 1 ROP. Of the 513 screened infants, the mean gestational age (GA) was 30.0 ± 2.5 weeks and the mean birth weight (BW) was 1232.6 ± 325.2 g. The incidence of ROP and type 1 ROP was 18.5% and 3.7%, respectively. In univariate analysis, a lighter BW, lower GA, blood transfusion, patent ductus arteriosus, nonsteroidal anti-inflammatory drug use, postnatal hypotension, inotropes usage, low Apgar scores, sepsis, mechanical ventilation, supplementary oxygen use, respiratory distress syndrome, anemia, surfactant use, and bronchopulmonary dysplasia were found to be associated with the development of both ROP and type 1 ROP (P < 0.05). In multivariable logistic regression analysis, BW, GA, and intraventricular hemorrhage were significant risk factors for ROP. Preeclampsia and eclampsia were the only protective factors for ROP development on multivariable logistic regression analysis (P = 0.02). In VLBW preterm Chinese infants, lower GA, lighter BW, and intraventricular hemorrhage were significant risk factors for ROP, whereas preeclampsia and eclampsia were protective.

Role of Serum Levels of Vascular Endothelial Growth Factor and Its Receptor in Retinopathy of Prematurity.

Background:Retinopathy of prematurity (ROP) is a disorder of developing retina of low birth weight preterm infants which can lead to blindness. One theory attributes the fibrosis seen in ROP to deregulation of vascularization in the retina. Vascular endothelial growth factor (VEGF) is one of the important mediators involved in vascularization.Objectives:This study was carried out to assess the role of VEGF and its receptor in retinopathy of prematurity.Patients and Methods:Around 200 preterm infants born in SSK hospital were screened at 33 - 34 weeks. These babies were followed up according to the international classification of retinopathy of prematurity (ICROP) criteria. Those infants who developed ROP at 38 - 40 weeks were enrolled in group A while an equal number of infants who did not develop ROP were included in group B. Each group comprised of 30 subjects each. Venous sampling was carried out twice, once at 33 - 34 weeks and then again at 38 - 40 weeks. VEGF and VEGF-R2 were estimated by commercially available ELISA kits.Results:There was no statistically significant difference between the levels of VEGF and VEGF-R2 in both groups at first visit as well as the follow up visit. However, the intra-group difference was significant between the first and the final visit in VEGF and VEGF-R2 levels in the cases with ROP. In the control population, the VEGF levels were significantly lower in the follow up visit as compared to the initial visit.Conclusions:Our study demonstrates that a significant difference is seen in the serum VEGF and VRGF-R2 in the second visit of the infants with ROP demonstrating that VEGF might be responsible for the initiation and aggravation of ROP.

Incidence and risk factors for retinopathy of prematurity in multiple gestations: a Chinese population study.

To determine the incidence and risk factors of retinopathy of prematurity (ROP) among new-born Chinese infants of multiple gestations.A retrospective review of medical records was performed for all neonates of multiple gestations screened for ROP between January 2007 and December 2012 in 2 neonatal intensive care units in Hong Kong. Screening was offered to very low birth weight (VLBW; ≤1500 g) and/or preterm (gestation ≤32 weeks) neonates using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP by 3 pediatric ophthalmologists. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP.A total of 153 Chinese infants of multiple gestations were included in the study. The mean gestational age (GA) was 30.8 ± 2.4 weeks and the mean birth weight (BW) was 1284.8 ± 267.4 g. The incidence of ROP and Type 1 ROP was 11.8% and 3.9%, respectively. On univariate analysis, younger GA, lighter birth weight, postnatal hypotension, inotropes use, bronchopulmonary disease, and intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP (all P ≤ 0.04). On multivariate analysis, younger GA, surfactant use, invasive mechanical ventilation, higher mean oxygen concentration, thrombocytopenia, intraventricular hemorrahage, total parental nutrition, and hypoglycemia were significant risk factors for ROP. For Type 1 ROP, there were no significant dependent risk factors.In preterm Chinese infants born from multiple gestations, prematurity, lighter weight, postnatal hypotension, inotropes use, bronchopulmonary dysplasia, and an intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP.

Incidence and risk factors for retinopathy of prematurity in extreme low birth weight Chinese infants

The objective of this study is to determine the incidence and risk factors of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) Chinese infants. A retrospective medical record review of all ELBW (≤1,000 g) neonates screened for ROP from 2007 to 2012 was performed in Hong Kong. ROP screening was conducted at 2 neonatal intensive care units by 3 pediatric ophthalmologists using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP. In 131 ELBW Chinese infants, the mean gestational age (GA) and birth weight (BW) were 27.3 ± 3.3 weeks and 806.9 ± 133.7 g, respectively. The incidence of ROP and Type 1 ROP was 53.4 and 14.5 %, respectively. For ROP, a lighter BW, smaller GA, vaginal delivery, postnatal hypotension, inotrope use, bronchopulmonary dysplasia, surfactant use, invasive mechanical ventilation, and supplementary oxygen were independent risk factors for ROP, while PET was protective (P ≤ 0.02). On multivariate analysis, a smaller GA was a risk factor, while PET and congenital heart disease were protective for ROP development (P ≤ 0.01). For Type 1 ROP, a lighter BW, smaller GA, surfactant use, and invasive mechanical ventilation were independent risk factors for ROP, while PET was protective (P ≤ 0.02). There were no significant covariates on multivariate analysis for Type 1 ROP. In ELBW, preterm Chinese infants, a smaller GA was a risk factor for ROP, while PET and congenital heart disease were protective for ROP development in multivariate analysis.

Legal Briefs: Blindness From Retinopathy of Prematurity

A 535-g 24-weeks’-gestation boy, twin a, is delivered by cesarean delivery to a 31-year-old G1P0 woman. Her pregnancy was complicated by a twin-to-twin-transfusion, emerging intrauterine growth retardation in twin A, 4-day rupture of membranes, and premature labor. The infant was delivered after a full course of antenatal steroids. The Apgar scores were 5 and 7 at 1 and 5 minutes, respectively. The infant received surfactant replacement therapy in the delivery room and a transfusion several hours after birth for a hematocrit level of 25% (0.25). He did not require further surfactant dosing, but was receiving assisted ventilation for approximately 6 weeks. He had a benign neonatal course. The neonatologist consulted an ophthalmologist to do the screening examinations for retinopathy of prematurity (ROP). The first examination was done timely according to the American Academy of Pediatrics and the American Ophthalmology Guidelines, and it was performed at 6 weeks when the infant was 30 weeks old. The evaluation revealed incomplete vascularization, documented by the ophthalmologists as “fetal fundi.” The next examination was when the child was 8 weeks, or 31 6/7 weeks’ postmenstrual age (PMA). The findings were reported to be ROP “grade” II zone II OS, no plus disease. No diagrams were used in the charting. The plaintiff neonatologist and ophthalmologists were critical about the ophthalmologist not using the terminology of the International Classification of Retinopathy of Prematurity (ICROP). They maintained that ROP should be described by severity by using the term “ stage, ” not grade and Roman numerals I, II, and III. A properly documented ROP examination would include drawings of the retinas with specific standardized methods of diagramming the location and extent of the stages. Failures to indicate the ROP demonstrated that the ophthalmologist was, at best, only casually familiar with ICROP. Because the ICROP is the foundation …

Incidence and risk factors of retinopathy of prematurity

Background Retinopathy of prematurity (ROP) is one of themain causes of visual impairment in premature infants.Objective To determine the incidence and risk factors for ROPin premature infants.Methods This retrospective study included premature infantsborn in Stella Maris Women's and Children's Hospital and admittedto the neonatal intensive care unit (NICU) and NeonatologyDepartment from November 2009 to May 2012. We included allpremature infants with body weight (BW) &lt; 1500 g or gestationalage (GA) &lt; 32 weeks, and selected infants with BW 1500 - 2000g or GA &gt; 32 weeks with unstable clinical courses who had beenscreened for ROP. Data was analyzed with Fisher's exact test andindependent t test.Results Of the 48 premature infants in the study, ROP wasdetected in 6 (12.5%) of the subjects. Stages ofROPwere classifiedaccording to the International Classification ofRetinopathyof Prematurity. Stage 1 ROP was detected in 1 (2.1 %) subject;stage 2 ROP was detected in 3 (6.25%) subjects; and stage 3ROP was found in 2 ( 4.2%) subjects. The 2 infants with stage3 ROP required surgery. No ROP was detected in infants withGA ~30 weeks or BW &gt; 1250 g. Respiratory distress syndrome(RDS), sepsis, blood transfusion, and apnea were found to beassociated with development ofROP. Duration of oxygen therapywas found to be a significant risk factor for ROP in a comparisonof the no ROP group to the ROP group: 14.0 (SD 9.508) daysvs. 3.81 (SD 5 .218) days, respectively (P&lt;0.05). In addition,the duration of continuous positive airway pressure (CPAP)usage was also a significant risk factor for ROP, with 1.83 (SD1.329) days in the ROP group vs. 0.76 (SD 1.122) days in theno ROP group (P&lt;0.05).Conclusions The incidence of ROP in the premature infants inour study is 12.5%. Retinopathy of prematurity is associated withlower BW, lower GA, lower Apgar score at the 5th minute, RDS, sepsis, apnea, blood transfusion, aminophylline usage, as well aslonger duration of oxygen therapy and CPAP usages.

Retinopathy of prematurity screening in 2185 premature infants

To determine the incidence and risk factors of retinopathy of prematurity (ROP) among premature infants. The fundus examination data of 2185 cases of premature infants [birth body weight ≤ 2000 g or gestational age (GA) ≤ 34 weeks] in neonatal intensive care unit of Bayi Children's Hospitals in Beijing between January 2009 and December 2010 were collected and retrospectively analyzed. Of 2185 cases of premature infants (1571 had used supplemental oxygen) received RetCam-II ophthalmoscopy screening, 287 cases developed ROP with the incidence of 13.1% according to the international classification of ROP (ICROP), including 34 cases (11.9%) suffering from zone I, 147 cases (51.2%) from zone II, and 106 cases (36.9%) from zone III. Stage 1, 2 and 3 lesions were 117 cases, 142 cases and 28 cases, accounting for 40.8%, 49.5% and 9.7%, respectively, while stage 4 and stage 5 lesions were not found. Thirty-six cases developed plus disease, accounting for 12.5%. Between ROP and Non-ROP groups, there were significant differences in birth weight (1269.9 ± 380.0) g vs (1479.7 ± 359.3) g vs (1633.9 ± 352.3) g, gestational age (30.6 ± 2.0) g vs (32.4 ± 1.8) W and time of supplemental oxygen [Median 10 d (0 to 71 d) vs 2 d (0 to 36 d)]. Among zone I, II and III groups, there were significant differences in birth weight (1269.9 ± 380.0) g vs (1479.7 ± 359.3) g vs (1633.9 ± 352.3) g, gestational age (29.3 ± 2.2) W vs (30.5 ± 1.9) W vs (31.2 ± 1.8) W and time of supplemental oxygen[Median 14 d (0 to 52 d)vs 10 d (0 to 71 d) vs 8 d (0 to 52 d)] (χ(2) = 257.5, 371.7, 6.695; P < 0.05), while among stage 1, 2 and 3 groups, there were also significant differences in birth weight (1593.3 ± 413.7) g vs (1481.3 ± 336.7) g vs (1325.3 ± 313.7) g, gestational age (30.9 ± 2.0) W vs (30.6 ± 1.9) W vs (29.5 ± 1.7) W and time of supplemental oxygen [Median 8 d (0 to 52 d) vs 11 d (0 to 65 d) vs 12 d (0 to 71 d)] (χ(2) = 230.8, 273.5, 6.695; P < 0.05). In 1004 cases admitted in 2009, 150 developed ROP with the incidence of 14.9%; while in 1181 cases admitted in 2010, 137 developed ROP with the incidence of 11.6%. There was significant differences in the incidence of ROP between these two years (χ(2) = 5.305, P < 0.05). Thirty-eight infants (1.7%) received laser therapy and only 3 infants progressed to stage 4 after laser therapy. Three infants with laser failed stopped progress after vasectomy. Finally, all patients were cured without blindness. Less birth weight, shorter GA and time of supplemental oxygen are close related to the development of ROP. It is necessary to pay high attention to the screen on premature infants with smaller gestation age, lower birth weight or using oxygen for the reduction or even avoid of blindness.