Retinopathy Of Prematurity Prediction Research Articles

The impact of intermittent hypoxemia on type 1 retinopathy of prematurity in preterm infants.

Intermittent hypoxemia (IH) may influence retinopathy of prematurity (ROP) development in preterm infants, however, previous studies had mixed results. This study tests the hypothesis that increased IH is associated with Type 1 ROP; a stage beyond which treatment is indicated. IH was quantified by continuously monitoring oxygen saturation (SpO2) using high-resolution pulse oximeters during the first 10 weeks of life. Statistical analyses assessed the relationship and predictive ability of weekly and cumulative IH for Type 1 ROP development. Most analyses showed no association between IH and Type 1 ROP adjusting for gestational age (GA) and birth weight (BW). However, cumulative IH of longer duration during weeks 5-10, 6-10, and 7-10 were significantly associated with Type 1 ROP adjusting for GA and BW, e.g., the adjusted odds ratio of Type 1 ROP was 2.01 (p = 0.03) for every 3.8 seconds increase in IH duration from week 6-10. IH did not provide statistically significant added predictive ability above GA and BW. For most analyses there was no significant association between IH and Type 1 ROP adjusting for GA and BW. However, infants with longer IH duration during the second month of life had higher risk for Type 1 ROP. The relationship and predictive ability of intermittent hypoxemia (IH) on retinopathy of prematurity (ROP) is controversial. This study shows no significant association between IH events and Type 1 ROP after adjusting for gestational age (GA) and birth weight (BW), except for cumulative IH of longer duration in the second month of life. In this cohort, IH does not provide a statistically significant improvement in ROP prediction over GA and BW. This study is the first to assess the cumulative impact of IH measures on Type 1 ROP. Interventions for reducing IH duration during critical postnatal periods may improve ROP outcomes.

Nomogram to predict severe retinopathy of prematurity in Southeast China.

To define the predictive factors of severe retinopathy of prematurity (ROP) and develop a nomogram for predicting severe ROP in southeast China. Totally 554 infants diagnosed with ROP hospitalized in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University and hospitalized in Taizhou Women and Children's Hospital were included. Clinical data and 43 candidate predictive factors of ROP infants were collected retrospectively. Logistic regression model was used to identify predictive factors of severe ROP and to propose a nomogram for individual risk prediction, which was compared with WINROP model and Digirop-Birth model. Infants from the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University (n=478) were randomly allocated into training (n=402) and internal validation group (n=76). Infants from Taizhou Women and Children's Hospital were set as external validation group (n=76). Severe ROP were found in 52 of 402 infants, 12 of 76 infants, and 7 of 76 infants in training group, internal validation group, and external validation group, respectively. Birth weight [odds ratio (OR), 0.997; 95% confidence interval (CI), 0.996-0.999; P<0.001], multiple births (OR, 1.885; 95%CI, 1.013-3.506; P=0.045), and non-invasive ventilation (OR, 0.288; 95%CI, 0.146-0.570; P<0.001) were identified as predictive factors for the prediction of severe ROP, by univariate analysis and multivariate analysis. For predicting severe ROP based on the internal validation group, the areas under receiver operating characteristic curve (AUC) was 78.1 (95%CI, 64.2-92.0) for the nomogram, 32.9 (95%CI, 15.3-50.5) for WINROP model, 70.2 (95%CI, 55.8-84.6) for Digirop-Birth model. In external validation group, AUC of the nomogram was also higher than that of WINROP model and Digirop-Birth model (80.2 versus 51.1 and 63.4). The decision curve analysis of the nomogram demonstrated better clinical efficacy than that of WINROP model and Digirop-Birth model. The calibration curves demonstrated a good consistency between the actual severe ROP incidence and the predicted probability. Birth weight, multiple births, and non-invasive ventilation are independent predictors of severe ROP. The nomogram has a good ability to predict severe ROP and performed well on internal validation and external validation in southeast China.

Prediction of Premature Retinopathy Fundus Images Using Dense Network Model for Intelligent Portable Screening Device

Retinopathy of Prematurity (ROP) is a serious retinal condition that affects preterm babies and, if ignored, can result in irreversible blindness. The challenges are related to variability and inconsistency among observers in diagnosing ROP, so the development of an automated system for ROP prediction becomes imperative. While various methods have been explored for automated ROP diagnosis, dedicated models with satisfactory performance have been lacking. This study aims to address these gaps with the objective to construct a multi-channel dense Convolutional Neural Network (MCD-CNN) which is tailored for ROP prediction, suitable for large-scale infant screening. The process involves utilizing CLAHE pre-processing, image labelling, image denoising, making and image generation for retinal vessel prediction in fundus images. The multi-channel CNN uses the feature selection method to extract and choose features from pre-processed pictures. The findings show that the suggested model attains a noteworthy 97.5% accuracy, 98% sensitivity, and 98.5% specificity. Significantly, this outperforms both pre-trained models and deep learning classifiers. Overall, the study contributes to improving ROP diagnosis and fostering accessibility to healthcare, particularly in remote areas.

Development and Validation of a Deep Learning Model to Predict the Occurrence and Severity of Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is the leading cause of childhood blindness worldwide. Prediction of ROP before onset holds great promise for reducing the risk of blindness. To develop and validate a deep learning (DL) system to predict the occurrence and severity of ROP before 45 weeks' postmenstrual age. This retrospective prognostic study included 7033 retinal photographs of 725 infants in the training set and 763 retinal photographs of 90 infants in the external validation set, along with 46 characteristics for each infant. All images of both eyes from the same infant taken at the first screening were labeled according to the final diagnosis made between the first screening and 45 weeks' postmenstrual age. The DL system was developed using retinal photographs from the first ROP screening and clinical characteristics before or at the first screening in infants born between June 3, 2017, and August 28, 2019. Two models were specifically designed for predictions of the occurrence (occurrence network [OC-Net]) and severity (severity network [SE-Net]) of ROP. Five-fold cross-validation was applied for internal validation. Area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity to evaluate the performance in ROP prediction. This study included 815 infants (450 [55.2%] boys) with mean birth weight of 1.91 kg (95% CI, 1.87-1.95 kg) and mean gestational age of 33.1 weeks (95% CI, 32.9-33.3 weeks). In internal validation, mean AUC, accuracy, sensitivity, and specificity were 0.90 (95% CI, 0.88-0.92), 52.8% (95% CI, 49.2%-56.4%), 100% (95% CI, 97.4%-100%), and 37.8% (95% CI, 33.7%-42.1%), respectively, for OC-Net to predict ROP occurrence and 0.87 (95% CI, 0.82-0.91), 68.0% (95% CI, 61.2%-74.8%), 100% (95% CI, 93.2%-100%), and 46.6% (95% CI, 37.3%-56.0%), respectively, for SE-Net to predict severe ROP. In external validation, the AUC, accuracy, sensitivity, and specificity were 0.94, 33.3%, 100%, and 7.5%, respectively, for OC-Net, and 0.88, 56.0%, 100%, and 35.3%, respectively, for SE-Net. In this study, the DL system achieved promising accuracy in ROP prediction. This DL system is potentially useful in identifying infants with high risk of developing ROP.

Prediction model to predict type 1 retinopathy of prematurity using gestational age and birth weight (PW-ROP)

PurposeTo develop a prediction model for type 1 retinopathy of prematurity (ROP) from an Asian population.MethodsThis retrospective cohort study included 1043 premature infants who had ROP screening in a tertiary...

PREDICTIVE MODEL FOR RETINOPATHY OF PREMATURITY IN A TERTIARY HOSPITAL IN INDONESIA

Background: To develop a predictive model for the diagnosis of ROP in Indonesia. In the author's experience, no Indonesian ROP prediction model has been published. Early diagnosis of Retinopathy of Prematurity (ROP) is essential to prevent visual impairment and blindness in the preterm infant. The incidence of ROP reported approximately 65% of the infant with birth weight (BW) <1250 grams and represents a significant clinical problem accounting for up to 40% of childhood blindness worldwide. Many predictive models had been developed for ROP screening tools in the setting of high-income countries. However, the application somewhat irrelevant to the NICU service condition in the developing countries, including Indonesia. Methods: This retrospective cohort study was performed at Dr. Soetomo General Hospital Surabaya, Indonesia, from May 2009 to April 2011. The ophthalmologist performed binocular indirect ophthalmoscope (BIO) examination to the 248 preterm infants who admitted to the Neonatal Intensive care unit between May 2009 to April 2011. The potential predictors consisted of gestational age (GA), BW, oxygen therapy, sepsis, small for gestational age (SGA), blood transfusion, asphyxia, and respiratory distress syndrome (RDS) were analyzed. Results: Of the 248 preterm infants, 32(12.9%) were diagnosed with various stages of ROP. The model had three significant variables: oxygen therapy (OR= 36.93; 95% CI= 4.73 to 288.02), sepsis (OR= 4.86; 95% CI= 1.85 to 12.82), and SGA (OR= 3.99, 95% CI= 1.47 to 10.82). The area below the Receiver Operating Characteristics (ROC) curve was 90.4%. The score had a sensitivity of 89.0% and a specificity of 78.0%. Conclusions: This is the first Indonesian predictive model and a scoring system developed for the ROP screening tool of the preterm infant. This simpler tool was expected to reduce the number of ophthalmologic examinations required to detect ROP, especially in resource-limited settings.

Impact of higher oxygen saturation levels on postnatal weight gain to predict retinopathy of prematurity.

Retinopathy of prematurity (ROP) is the leading cause of vision loss in children. A well-known risk factor for the development of ROP is duration of oxygen supplementation. Other postnatal factors have also been associated with ROP risk, including poor post-natal weight gain. The weight, insulin-like growth factor, neonatal retinopathy of prematurity (WINROP) algorithm predicts severe ROP based on postnatal weight gain and has been validated in several studies,1,2 including a high sensitivity for prediction of severe ROP in our local NICU populations. However, target oxygen saturation levels were subsequently increased in many NICUs based on results from the Neonatal Oxygen Prospective Meta-analysis (NeOProM) Collaboration, which showed statistically higher death and disability rates among preterm infants randomized to a lower oxygen-saturation target range (85 - 89%) versus a higher target range (91 - 95%),3 which may affect the incidence and severity of ROP4 as well as the validity of the WINROP algorithm. In 2018, Lundgren et al reported that the WINROP algorithm was no longer able to predict ROP requiring treatment at their institution after the implementation of higher target oxygen saturation levels, with a sensitivity of only 50%.5 The objective of this review was to evaluate WINROP's ability to identify infants at risk for severe ROP at our institution after target oxygen saturation levels were increased in 2014.

Optical Coherence Tomography-Angiography in Pediatric Ophthalmological Practice (Review)

Data from sources of domestic and foreign literature for 2016–2019 is presented in the review of literature. This data concerned of applying the method of optical coherent tomography-angiography in pediatric ophthalmic practice. OCT-A is a non-invasive research method, without the use of fluorescent dyes. The procedure is performed relatively quickly, with the possibility of additional repetition. The method allows to conduct visualization of the vascular network of the retina layer-by-layer, perform its quantitative analysis: to evaluate the density of the microvascular bed and measure the area of non-perfusion zones. Having appeared as a result of a qualitative modernization of OCT, a new method of visualization of vessels OCT-A is actively used in the diagnosis of pathologies such as glaucoma, diabetic retinopathy, post-thrombotic retinopathy, age-related macular degeneration, central serous chorioretinopathy, etc. In present time OCT-A being performed in adult medicine, it is actively used in various areas of pediatric ophthalmology. Presently, pediatric patients with diabetes mellitus, sickle cell anemia, amblyopia, retinal artery occlusion, and coats disease have been performed with OCT-A studies. Retinopathy of prematurity (ROP) is required a special attention among children’s eye diseases. However, mentioning about OCT angiographic studies in patients with ROP are quite rare in the literature. Nevertheless, the available data indicate the enormous diagnostic potential of OCT-A in this severe vasoproliferative disease. The method give possibility for fully control the pathological process, to evaluate the effectiveness of the treatment and timely prevent the development of severe stages of ROP. Due to the information and diagnostic potential, it is necessary to continue research on the possibilities of the OCT-A method in the diagnosis, analysis of treatment results and prediction of ROP.

Assessment of the G-ROP study criteria for predicting retinopathy of prematurity: results from a tertiary centre in Turkey.

The postnatal growth and retinopathy of prematurity (G-ROP) study has proposed a new model for retinopathy of prematurity (ROP) prediction based on gestational age, birth weight and postnatal weight gain. The purpose of the current study is to assess the efficacy of the G-ROP modelfor predicting ROP among a Turkish cohort of premature infants. Records of infants who underwent ROP screening examinations between 2012 and 2019 were reviewed retrospectively. Infants with a documented ROP outcome and regular body weight measurements until day 40 of life were included. The G-ROP model was applied to the study group. The outcome measures were sensitivity and specificity of the model for detecting any stage ROP and treated ROP. A total of 242 infants were included. The G-ROP model identified 168 infants to be screened for ROP. The sensitivity was 88.3% for detecting any stage ROP and 91.2% for treated ROP. The specificity for any stage ROP and treated ROP was 51.7% and 34.1%, respectively. The incorporation of bronchopulmonary dysplasia to the model increased the sensitivity to 100% with 22.7% reduction in the number of screened infants. The G-ROP model is a simple and effective method for ROP prediction. However, in the current cohort, a small number of infants requiring treatment would be missed if G-ROP criteria were applied. The model may be modified with addition of bronchopulmonary dysplasia to detect all treatment requiring cases. Prospective studies among larger groups are necessary to assess the applicability of the modified model.

POOR POSTNATAL WEIGHT GAIN AS A PREDICTOR OF RETINOPATHY OF PREMATURITY.

SUMMARYThe purpose of this study was to re-evaluate cut-off values used in screening for retinopathy of prematurity (ROP) in Croatia and to propose postnatal weight gain as an additional criterion, based on the Colorado Retinopathy of Prematurity prediction model. Medical records of 267 premature infants from the Zagreb University Hospital Centre that underwent ROP screening between January 2009 and December 2010 were reviewed retrospectively. Collected data included gestational age, birth weight, sex, weekly weight measurements and fundus examination records. Results showed the cut-off values of gestational age (GA) and birth weight (BW) used in Croatia to be appropriate and postnatal weight gain in the first 28 days could be used as an additional criterion on screening in the following way: net weight gain in the first 28 days of ≤932 g for prediction of any form of ROP and of ≤660 g for prediction of severe ROP should be added to the existing criteria of GA (≤32 weeks) and/or BW (≤1500 g). Infants with a non-physiological postnatal weight gain are exception. This is the first Croatian study to propose postnatal weight gain as an additional criterion on ROP screening and requires further validation on a larger sample of Croatian infants.

Placental CpG Methylation of Inflammation, Angiogenic, and Neurotrophic Genes and Retinopathy of Prematurity.

PurposeExtremely preterm infants are at increased risk for retinopathy of prematurity (ROP). We previously identified several inflammatory proteins that were expressed early in life and are associated with an increased risk of ROP and several angiogenic and neurotrophic growth factors in the neonatal systemic circulation that are associated with a lower risk of ROP. In this paper, we report the results of a set of analyses designed to test the hypothesis that placental CpG methylation levels of 12 inflammation-, angiogenic-, and neurotrophic-associated genes predict the occurrence of prethreshold ROP in extremely preterm newborns.MethodsWe used placental CpG methylation data from 395 newborns from the Extremely Low Gestational Age Newborns study.ResultsMultivariable regression models revealed that placental DNA methylation of 16 CpG sites representing 8 genes were associated with prethreshold ROP. Specifically, CpG methylation in the serum amyloid A SAA1 and SAA2, brain-derived neurotrophic factor (BDNF), myeloperoxidase (MPO), C-reactive protein (CRP), angiopoietin 1 (ANGPT1), and tumor necrosis factor receptor superfamily member 1B (TNFRSF1B) genes was associated with a lower risk of prethreshold ROP. Conversely, CpG methylation at three probes within tumor necrosis factor receptor superfamily member 1A (TNFRSF1A) and in two alternative probes within the BDNF and ANGPT1 genes was associated with an increased risk of ROP.ConclusionsCpG methylation may be a useful marker for improving ROP prediction, opening the opportunity for early intervention to lessen disease severity.

Can IL-33 and Endocan be New Markers for Retinopathy of Prematurity?

Retinopathy of Prematurity (ROP) is a pathophysiologic condition of the retina due to abnormal proliferation of retinal vessels. The study aimed too ascertain the importance of vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), interleukin-33 (IL-33) and endocan in the diagnosis and follow-up of ROP. This prospective cohort study was conducted in the neonatal intensive care unit (NICU) of Health Science University, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey, between February 2017 and August 2018. Preterm infants (gestational age (GA) of ≤32 weeks and birth weight of ≤1500 gr), diagnosed ROP were included in the study. VEGF, IGF-1, IL-33 and endocan levels were evaluated in the cord blood and in the serum before and after treatment of infants in the ROP and control groups. A final number of 146 infants were included in the study. During the study period, 73 infants were identified as the ROP group, and 73 infants were allocated as the control group. In the ROP group, the cord blood VEGF value was higher than the control group (p <0.05). However, IGF-1 levels in the cord blood were lower in the ROP group than control (P<0.05). IL-33 and endocan values in the cord blood were similar in both control and ROP groups (p>0.05). Although serum levels of IL-33, VEGF and endocan were higher before laser treatment, these biomarkers decreased significantly after laser treatment (p <0.05). We determined that serum IL-33 and endocan levels might be suggested as sensitive novel markers for the prediction of severe ROP.

WINROP algorithm for prediction of sight threatening retinopathy of prematurity: Initial experience in Indian preterm infants.

Purpose:To determine the efficacy of the online monitoring tool, WINROP (https://winrop.com/) in detecting sight-threatening type 1 retinopathy of prematurity (ROP) in Indian preterm infants.Methods:Birth weight, gestational age, and weekly weight measurements of seventy preterm infants (<32 weeks gestation) born between June 2014 and August 2016 were entered into WINROP algorithm. Based on weekly weight gain, WINROP algorithm signaled an alarm to indicate that the infant is at risk for sight-threatening Type 1 ROP. ROP screening was done according to standard guidelines. The negative and positive predictive values were calculated using the sensitivity, specificity, and prevalence of ROP type 1 for the study group. 95% confidence interval (CI) was calculated.Results:Of the seventy infants enrolled in the study, 31 (44.28%) developed Type 1 ROP. WINROP alarm was signaled in 74.28% (52/70) of all infants and 90.32% (28/31) of infants treated for Type 1 ROP. The specificity was 38.46% (15/39). The positive predictive value was 53.84% (95% CI: 39.59–67.53) and negative predictive value was 83.3% (95% CI: 57.73–95.59).Conclusion:This is the first study from India using a weight gain-based algorithm for prediction of ROP. Overall sensitivity of WINROP algorithm in detecting Type 1 ROP was 90.32%. The overall specificity was 38.46%. Population-specific tweaking of algorithm may improve the result and practical utility for ophthalmologists and neonatologists.

A predictive score for retinopathy of prematurity by using clinical risk factors and serum insulin-like growth factor-1 levels.

To detect the impact of insulin-like growth factor-1 (IGF-1) and other risk factors for the early prediction of retinopathy of prematurity (ROP) and to establish a scoring system for ROP prediction by using clinical criteria and serum IGF-1 levels. The study was conducted with 127 preterm infants. IGF-1 levels in the 1st day of life, 1st, 2nd, 3rd and 4th week of life was analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrences of any stage ROP. A validation cohort containing 107 preterm infants was included in the study and the predictive ability of ROP score was calculated. Birth weights (BW), gestational weeks (GW) and the prevalence of breast milk consumption were lower, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) were more frequent, the duration of mechanical ventilation and oxygen supplementation was longer in patients with ROP (P<0.05). Initial serum IGF-1 levels tended to be lower in newborns who developed ROP. Logistic regression analysis revealed that low BW (<1250 g), presence of intraventricular hemorrhage (IVH) and formula feeding increased the risk of ROP. Afterwards, the scoring system was validated on 107 infants. The negative predictive values of a score less than 4 were 84.3%, 74.7% and 79.8% while positive predictive values were 76.3%, 65.5% and 71.6% respectively. In addition to BW <1250 g and IVH, formula consumption was detected as a risk factor for the development of ROP. Breastfeeding is important for prevention of ROP in preterm infants.

Implementing higher oxygen saturation targets reduced the impact of poor weight gain as a predictor for retinopathy of prematurity.

ABSTRACTAimThis study evaluated poor weight gain as a risk factor for infants who required treatment for retinopathy of prematurity (ROP), by comparing those born before and after the implementation of higher oxygen saturation (SpO2) targets at the Queen Silvia Children's Hospital, Gothenburg, Sweden.MethodsWe compared infants born at less than 31 weeks, who were screened and, or, treated for ROP: 127 in 2011–2012 when SpO2 targets were 88–92% and 142 in 2015–2016 when they were 91–95%. The subjects were reviewed for birth characteristics, weekly weight and ROP treatment. Data were analysed using the weight, insulin‐like growth factor 1, neonatal, ROP (WINROP) prediction tool.ResultsThe 2011–2012 infants who needed ROP treatment (12.6%) had significantly poorer postnatal weight gain than those who did not, but this was not seen in the treated (17.6%) and nontreated ROP groups in 2015–2016. WINROP sensitivity decreased from 87.5% in 2011–12 to 48% in 2015–2016.ConclusionAfter the SpO2 target range was increased from 88–92% to 91–95%, postnatal weight gain was no longer a significant risk factor and WINROP lost its ability to predict ROP requiring treatment. Risk factors clearly change as neonatal care develops.

G protein-coupled receptor 91 signaling in diabetic retinopathy and hypoxic retinal diseases

G protein-coupled receptor 91 (GPR91) is a succinate-specific receptor and activation of GPR91 could initiate a complex signal transduction cascade and upregulate inflammatory and pro-angiogenic cytokines. In the retina, GPR91 is predominately expressed in ganglion cells, a major cellular entity involved in the pathogenesis of diabetic retinopathy (DR) and other hypoxic retinal diseases. During the development of DR and retinopathy of prematurity (ROP), chronic hypoxia causes an increase in the levels of local succinate. Succinate-mediated GPR91 activation upregulates vascular endothelial growth factor (VEGF) through ERK1/2-C/EBP β (c-Fos) and/or ERK1/2-COX-2/PGE2 signaling pathways, which in turn, leads to the breakdown of blood-retina barriers in these disorders. In this review, we will have a brief introduction of GPR91 and its biological functions and a more detailed discussion about the role and mechanisms of GPR91 in DR and ROP. A better understanding of GPR91 regulation may be of great significance in identifying new biomarkers and drug targets for the prediction and treatment of DR, ROP, and hypoxic retinal diseases.

Screening Tool for Early Postnatal Prediction of Retinopathy of Prematurity in Preterm Newborns (STEP-ROP)

Background: Retinopathy of prematurity (ROP) is a disorder of the preterm newborn characterized by neurovascular disruption in the immature retina that may cause visual impairment and blindness. Objective: To develop a clinical screening tool for early postnatal prediction of ROP in preterm newborns based on risk information available within the first 48 h of postnatal life. Methods: Using data submitted to the Vermont Oxford Network (VON) between 1995 and 2015, we created logistic regression models based on infants born <28 completed weeks gestational age. We developed a model with 60% of the data and identified birth weight, gestational age, respiratory distress syndrome, non-Hispanic ethnicity, and multiple gestation as predictors of ROP. We tested the model in the remaining 40%, performed tenfold cross-validation, and tested the score in ELGAN study data. Results: Of the 1,052 newborns in the VON database, 627 recorded an ROP status. Forty percent had no ROP, 40% had mild ROP (stages 1 and 2), and 20% had severe ROP (stages 3-5). We created a weighted score to predict any ROP based on the multivariable regression model. A cutoff score of 5 had the best sensitivity (95%, 95% CI 93-97), while maintaining a strong positive predictive value (63%, 95% CI 57-68). When applied to the ELGAN data, sensitivity was lower (72%, 95% CI 69-75), but PPV was higher (80%, 95% CI 77-83). Conclusions: STEP-ROP is a promising screening tool. It is easy to calculate, does not rely on extensive postnatal data collection, and can be calculated early after birth. Early ROP screening may help physicians limit patient exposure to additional risk factors, and may be useful for risk stratification in clinical trials aimed at reducing ROP.

Serum lactate levels and perfusion index: are these prognostic factors on mortality and morbidity in very low-birth weight infants?

Aim: Early hemodynamic assessment of global parameters in critically ill newborns fails and requires mostly invasive measurements in neonatal intensive care unit. Clinical signs are frequently used for assessment of peripheral perfusion. Perfusion index (PI) is a new noninvasive numerical value of peripheral perfusion. Serum lactate levels and PI are the indicators that are important in determining prognosis of preterm infants. In this study, we aimed to investigate the relationship of serum lactate levels and PI with mortality and morbidity in very low-birth weight infants (VLBW).Study design: This study was conducted between July 2014 and July 2015 in a Level III NICU. The study enrolled preterm infants with a gestational age ≤ 32 weeks, birth weight ≤ 1500 g. Serum lactate levels from blood gases and PI, SpO2 measurements were recorded at 1st, 12th and 24th hours by using a new generation pulse-oximeter. Morbidities and mortalities were documented.Results: A total of 60 VLBW infants were enrolled the study. Mean birth weight and gestational age were 991 ± 288 g and 27.5 ± 2.5 w, respectively. Retinopathy of prematurity (ROP) was significantly higher in the patients with high lactate levels (>4 mg/dl) at 1st hour and low-PI levels (<0.5) at 12th hour of life (p = 0.042, p = 0.015), respectively. Bronchopulmonary displasia (BPD) was significantly higher in the patients with low PI (< 0.5) at 1st hour. Lactate and PI values were not significantly correlated with necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosus, sepsis and mortality.Conclusion: High lactate levels (> 4 mg/dl) and low PI (< 0.5) could be used as early parameters for prediction of ROP and BPD. This data suggests that in VLBW infants lactate levels and PI parameters during the first 24 h will be effective in determining the prognosis of the disease. We believe that larger, randomized controlled clinical trials are likely to establish the true benefit.

Predictors for the development of referral-warranted retinopathy of prematurity in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study.

Detection of treatment-requiring retinopathy of prematurity (ROP) involves serial eye examinations. An ROP prediction model using predictive factors could identify high-risk infants and reduce required eye examinations. To determine predictive factors for the development of referral-warranted (RW) ROP. This multicenter observational cohort study included secondary analysis of data from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study. Infants included in the study had a birth weight (BW) of less than 1251 g. Serial ROP examinations of premature infants who had 2 or more ROP examinations. Incidence of RW-ROP (defined as the presence of plus disease, zone I ROP, or ROP stage 3 or greater in either eye) and associations with predictive factors. Among 979 infants without RW-ROP at first study-related eye examination (median postmenstrual age, 33 weeks; range, 29-40 weeks) who underwent at least 2 eye examinations, 149 (15.2%) developed RW-ROP. In a multivariate model, significant predictors for RW-ROP were male sex (odds ratio [OR], 1.80; 95% CI, 1.13-2.86 vs female), nonblack race (OR, 2.76; 95% CI, 1.50-5.08 for white vs black race and OR, 4.81; 95% CI, 2.19-10.6 for other vs black race), low BW (OR, 5.16; 95% CI, 1.12-7.20 for ≤500 g vs >1100 g), younger gestational age (OR, 9.79; 95% CI, 3.49-27.5 for ≤24 weeks vs ≥28 weeks), number of quadrants with preplus disease (OR, 7.12; 95% CI, 2.53-20.1 for 1-2 quadrants and OR, 18.4; 95% CI, 4.28-79.4 for 3-4 quadrants vs no preplus disease), stage 2 ROP (OR, 4.13; 95% CI, 2.13-8.00 vs no ROP), the presence of retinal hemorrhage (OR, 4.36; 95% CI, 1.57-12.1 vs absence), the need for respiratory support (OR, 4.99; 95% CI, 1.89-13.2 for the need for controlled mechanical ventilator; OR, 11.0; 95% CI, 2.26-53.8 for the need for high-frequency oscillatory ventilation vs no respiratory support), and slow weight gain (OR, 2.44; 95% CI, 1.22-4.89 for weight gain ≤12 g/d vs >18 g/d). These characteristics predicted the development of RW-ROP significantly better than BW and gestational age (area under receiver operating characteristic curve, 0.88 vs 0.78; P < .001). When controlling for very low BW and prematurity, the presence of preplus disease, stage 2 ROP, retinal hemorrhage, and the need for ventilation at time of first study-related eye examination were strong independent predictors for RW-ROP. These predictors may help identify infants in need of timely eye examinations.

Preclinical Screening for Retinopathy of Prematurity Risk Using IGF1 Levels at 3 Weeks Post-Partum

Following current recommendations for preventing retinopathy of prematurity (ROP) involves screening a large number of patients. We performed a prospective study to establish a useful screening system for ROP prediction and we have determined that measuring serum levels of IGF1 at week three and the presence of sepsis have a high predictive value for the subsequent development of ROP. A total of 145 premature newborn, with birthweight <1500 g and/or <32 weeks gestational age, were enrolled. 26.9% of them showed some form of retinopathy. A significant association was found between the development of retinopathy and each of the following variables: early gestational age, low birthweight, requiring mechanical ventilation, oxygen treatment, intracranial haemorrhage, sepsis during the first three weeks, bronchopulmonary dysplasia, the need for erythrocyte transfusion, erythropoietin treatment, and low levels of serum IGF1 in the third week. A multiple logistic regression analysis was used to obtain curves for the probability of developing ROP, based on the main factors linked with ROP, namely serum levels of IGF1 and presence of sepsis. Such preclinical screening has the ability to identify patients with high-risk of developing retinopathy and should lead to better prediction for ROP, while at the same time optimising the use of clinical resources, both human and material.