Predictors Of Retinopathy Of Prematurity Research Articles

Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis.

Neonatal sepsis has been established as a risk factor for retinopathy of prematurity (ROP) but previous meta-analyses have predominately focused on late-onset sepsis (LOS). This meta-analysis aims to explore the association between early-onset sepsis (EOS) and the risk of ROP. Observational studies reporting (unadjusted) data on proven EOS in neonates with ROP were included. PubMed, Embase, and Cochrane Library were searched. Proven EOS was defined as a positive blood or cerebrospinal fluid culture. Effect sizes were calculated by using logistic random-effects models and meta-regression analyses. Primary outcomes were any stage ROP and severe ROP (≥stage 3, type I, aggressive [posterior] ROP, plus disease or requiring treatment). Potential confounders explored were gestational age at birth, birth weight, small for gestational age, maternal steroid use, necrotizing enterocolitis, LOS, and mechanical ventilation duration. Seventeen studies reporting the incidence of proven EOS in neonates with ROP were included. Proven EOS showed no significant association with any stage ROP (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 0.96-3.79, p = 0.067) but heterogeneity between studies was significantly high. Neonates with proven EOS had an increased risk for severe ROP (OR = 2.21; 95% CI: 1.68-2.90), and no significant confounders influencing this effect size were found in the meta-regression analysis. Neonates with proven EOS are at increased risk of severe ROP. Neonatologists need to be aware that EOS is an early predictor of ROP and should adapt their policy and treatment decisions where possible to reduce ROP. · This meta-analysis reveals a 2.2-fold increased risk of severe ROP in neonates with proven EOS.. · Future studies should distinguish between EOS and LOS when investigating risk factors of ROP.. · Treatment decisions should be adapted where possible in neonates with EOS before ROP screening begins..

Platelet count and platelet indices in early life of infant with retinopathy of prematurity

Background and objectives. Retinopathy of prematurity (ROP) is a complication of prematurity. Early detection of ROP is important because its management depends on prevention of severe ROP and its complications. Pro- and anti-angiogenic factors are involved in ROP pathogenesis. Platelet store and release these factors, but its role as predictor of ROP is still obscure. This study aimed to compare platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and platelet mass index (PMI) value between two age groups in early life of infant diagnosed with ROP. Materials and methods. This study was retrospective study of medical record data of infants born at “dr. Soetomo” General Academic Hospital Surabaya during 2021-2023. The infants were divided into two groups, they who have complete blood count result (CBC) in 0-7 days old (group 1) and 8-28 days old (group 2). We evaluated platelet count, MPV, PDW, and PMI value from CBC data. These data were analyzed using suitable statistical test. Results. Total of 126 infants were involved in this study. It consisted of 62 infants in group 1 and 64 infants on group 2. Platelet count was significantly different between groups (230.460±102.040/μL vs 313.664±182.890/μL, p=0,002). Value of MPV, PDW, and PMI were also significantly higher in group 2 (p<0.001). Frequency of thrombocytosis (>500.000/μL), high MPV (>10.05 fL), and high PMI (3640 fL/nL) were also significantly higher in group 2 (p<0.05). Conclusions. Higher platelet count, MPV, PDW, and PMI value were observed in 8-28 days old infant with ROP. They also more likely to experienced thrombocytosis, high MPV, and high PMI value.

Prenatal intrauterine growth restriction and risk of retinopathy of prematurity

Low birthweight and decreased postnatal weight gain are known predictors of worse retinopathy of prematurity (ROP) but the role of prenatal growth patterns in ROP remains inconclusive. To distinguish small for gestational age (SGA) from intrauterine growth restriction (IUGR) as independent predictors of ROP, we performed a retrospective cohort study of patients who received ROP screening examinations at a level IV neonatal intensive care unit over a 7-year period. Data on IUGR and SGA status, worst stage of and need for treatment for ROP, and postnatal growth was obtained. 343 infants were included for analysis (mean gestational age = 28.6 weeks and birth weight = 1138.2 g). IUGR infants were more likely to have a worse stage of ROP and treatment-requiring ROP (both p < 0.0001) compared to non-IUGR infants. IUGR infants were more likely to be older at worst stage of ROP (p < 0.0001) and to develop postnatal growth failure (p = 0.01) than non-IUGR infants. Independent of postnatal growth failure status, IUGR infants had a 4–5 × increased risk of needing ROP treatment (p < 0.001) compared to non-IUGR infants. SGA versus appropriate for gestational age infants did not demonstrate differences in retinopathy outcomes, age at worst ROP stage, or postnatal growth failure. These findings emphasize the importance of prenatal growth on ROP development.

Postnatal Serum Insulin-Like Growth Factor I and Retinopathy of Prematurity in Latin American Infants

ABSTRACT Purpose Identifying at-risk infants for retinopathy of prematurity (ROP) is complex in countries with emerging economies as infants that lack conventional risk factors, such as low birth weight (BW) and young gestational age (GA), still go on to develop severe ROP. Potential biomarkers, like serum insulin-like growth factor 1 (IGF-1) and slow postnatal weight gain, have been identified as good predictors for ROP in developed countries. We sought to determine the relationship between IGF-1 levels and ROP in two Latin American countries where the burden of disease is still significant. Methods Prospective cohort study of infants in Guadalajara, Mexico and La Plata, Argentina. Filter-paper bloodspot IGF-1 assays were performed weekly from birth until hospital discharge or 40 weeks’ postmenstrual age (PMA). Results 112 infants were studied with a median BW of 1412 g (range 620 g-2390 g) and a median GA of 33 weeks (range 25–37). There was no significant difference in IGF-1 between infants who developed ROP and those who did not. Conclusion Low IGF-1 was not associated with ROP in these infants. The lack of an association between ROP and IGF-1 in Latin America supports the observation that growth-based predictive models do not perform as well in this setting where more mature babies still develop severe ROP.

Comparison between weight gain and Fenton preterm growth z scores in assessing the risk of retinopathy of prematurity

Several studies have shown that postnatal weight gain is a significant predictor for retinopathy of prematurity (ROP) in preterm infants. Using a cohort of 1,301 infants from a single-center ROP registry, we investigated whether incorporation of changes in Fenton preterm growth curve z scores (ie, deviation from the population average) provides improved predictive ability for developing ROP compared to weight gain alone. Three logistic regressions were fit to severe ROP: (1) baseline model that included gestational age and birth weight, (2) the baseline model adding weight gain, and (3) the baseline model adding change in z score. The area under the receiver operating characteristic curve (C index) was used to compare models. Both weight gain and change in z scores were significant predictors after adjusting for birth weight (P=0.01) and gestational age (P<0.01). The C indices were not significantly improved by including weight gain or z score to the baseline model; however, for a subset of subjects, change in weight z score may be a more useful measure compared to simple weight gain with regards to assessing risk for severe ROP.

Impact of higher target oxygen saturation levels on postnatal weight gain as a predictor for retinopathy of prematurity

The weight, insulin-like growth factor, neonatal, retinopathy of prematurity algorithm (WINROP) predicts severe ROP based on postnatal weight gain and has been validated in several studies. Oxygen supplementation is a well-known risk factor for ROP. In our NICU, target oxygen saturation levels were increased in 2014 which may affect the validity of WINROP.

Nitrogen and oxygen levels in placenta - a predictor for retinopathy of prematurity

To study the distribution of chemical elements in the placenta of pregnant women at 24-35 and 39-40 weeks of gestation, and to assess the possibility of using data on the levels of principle chemicals for predicting clinical manifestation of retinopathy of prematurity (ROP). The study examined 375 placenta tissue fragments of pregnant women for levels of the following chemical elements: carbon (C), nitrogen (N), oxygen (O), calcium (Ca), chlorine (Cl), potassium (K), sodium (Na) and phosphorus (P). Subjects were divided into 3 groups: 1st group consisted of 41 pregnant females (205 fragments of placenta tissue) at weeks 24-35 of gestation, whose children would not develop ROP; 2nd group included 14 mothers (70 fragments of placenta tissue) at weeks 39-40 of gestation; 3rd group - 20 pregnant (100 fragments of placenta tissue) at weeks 24-35 of gestation, whose children would be diagnosed with ROP. Examination of the eye fundi of children from ROP risk group was done by digital retinoscopy and indirect binocular ophthalmoscopy. Chemical composition of placenta was studied using energy-dispersive x-ray microanalysis based on scanning electron microscopy. Descriptive statistical values of chemical elements were obtained for the three study groups. Statistically significant percentile differences were detected in the levels of C, N and O in the samples (p<2.2·10-16). Differences in the levels of N, O, K, and Na in the placenta of pregnant women of the three study groups were determined. Comparative chemical analysis of the placentas of pregnant women at different gestation periods showed higher levels of N, K, Na, and lower levels of O in the group of mothers whose children would be diagnosed with ROP. Normalized nitrogen content in the placenta of women whose children would develop ROP was 12.9%. Thus, nitrogen content may serve as a pre-clinical marker of retinopathy of prematurity.

Regaining birth weight and predicting ROP—a prospective, pilot study

Background: Poor postnatal weight gain is a well-known risk factor for developing retinopathy of prematurity (ROP). Algorithms that predict ROP based on serial weight gain have not been generalizable in non-Caucasian populations. The duration taken to regain the lost weight is culturally important among Indian mothers. We report the correlation between this duration and the risk of developing ROP. Methods: Sixty-eight Asian Indian infants born Results: The mean BW of the cohort was 1,270±340 grams and mean gestational age (GA) was 31±2 weeks. Thirty-three infants (48.5%) developed no ROP, 20 infants (29.4%) developed type 2 ROP and 15 infants (22.1%) developed type 1 ROP. The mean number of days to regain the lost weight was 11.9+4.6, 17.9+7.9 and 26.6+12.9 days for the No ROP, type 2 and type 1 groups respectively (P Conclusions: The date when a child regains its lost BW is culturally important and easily recalled by mothers. We report the use of this simple estimate as a predictor of ROP. This method could be useful in stratifying risk and predicting the development of “treatment requiring ROP” even before 21 days of life, which is the first mandated screening visit in India.

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.

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.

Birth weight and gestational age on retinopathy of prematurity in discordant twins in China.

To assess the relative effect of birth weight and gestational age on retinopathy of prematurity (ROP) using preterm twin pairs discordant for birth weigh in a tertiary neonatal intensive care unit in China. Fifty-six discordant twin pairs of 112 preterm infants were retrospectively analyzed. The twin pairs were divided into two subgroups based on birth weight in each pair. The occurrence of ROP and severe ROP requiring treatment were compared between the lower birth weight infants and their co-twins with the higher birth weight. Some neonatal morbidities related to prematurity and neonatal characteristics were also compared between the twin pairs. Based on the univariate analysis, gestational age and birth weight were significantly associated with the occurrence and progression of ROP. But no significant differences in ROP between larger and smaller infants were observed in the twin-paired analysis. The incidence of neonatal morbidities regarding respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), sepsis and neonatal characteristics regarding gender distribution, one- and five-minute Apgar score, postnatal steroid treatment, blood transfusion, supplemental oxygen therapy, and mechanical ventilation were not different between the twins. However, gestational age of ≤28wk was significantly associated with significantly higher rates of ROP and severe ROP. Gestational age is a better predictor of ROP than birth weight in the twin-paired study.

A co-twin study of the relative effect of birth weight and gestational age on retinopathy of prematurity

To determine the relative effect of birth weight and gestational age on retinopathy of prematurity (ROP) using preterm twin pairs discordant for birth weight. This study was a retrospective cohort study including 55 consecutive twin pairs of 110 preterm infants (gestational age ≤33 weeks). The outcomes of ROP including occurrence (any stage), severe ROP (stage 3 or more), and clinically significant ROP requiring laser treatment were compared between twins with the lower birth weight from each pair and their co-twins with the higher birth weight. Using twin pairs having different birth weight and identical gestational age, the independent effects of prematurity and intrauterine growth on ROP could be evaluated. Other perinatal morbidities related to prematurity were also compared between twin pairs. No significant differences in ROP between larger and smaller infants were observed in the twin-paired analysis while analysis on individual infants showed strong association between small birth weight and ROP outcomes. However, in both the larger and smaller infant groups, gestational age of <28 weeks was significantly associated with ROP outcomes. No differences were found between twin pairs regarding other perinatal morbidities including bronchopulmonary dysplasia, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, and periventricular leukomalacia. Birth weight is not associated with ROP, while gestational age is in the twin-paired study, suggesting that gestational age is a better predictor of ROP than birth weight. This indicates that maturity is more important in the pathogenesis of ROP than intrauterine growth.

Published Genetic Variants in Retinopathy of Prematurity: Random Forest Analysis Suggests a Negligible Contribution to Risk and Severity

Purpose: Our recent investigations suggested association between severe retinopathy of prematurity (ROP) and some genetic polymorphisms contributing to angiogenesis. While these findings may help to identify specific elements in ROP pathogenesis, the predictive value of these genetic variants at birth is unknown. We applied a high-dimensional nonparametric method called random forest technique (RFT) to evaluate the predictive value of genetic polymorphisms in ROP at birth. Methods: We used published genetic (i.e., VEGF T−460C, G+ 405C, and C−2578A; IGF-I receptor G+ 3174A, angiopoietin II G−35C; estrogen receptor PvuII Pp; and endothelial NO-synthase 27-bp b/a and T−786C) and birth data of 134 preterm infants without and 103 preterm infants with ROP requiring laser or cryotherapy. We used RFT to determine the relative importance scores (IS) of each clinical parameter at birth and genetic polymorphisms in the prediction of ROP. The accuracy of ROP prediction at birth was calculated when birth data, genotype data, and birth data PLUS genotype data were taken into account. Results: The most important predictors of ROP were prematurity, low birth weight, intrauterine retardation, and Apgar scores with IS values between 7.46 and 13.20. IS values of genotype data were much lower in the range between 0.86 and 4.19. When birth data solely, genotype data solely, and birth data plus genotype data together were used for prediction, the accuracy of prediction was 0.653, 0.636, and 0.674, respectively. Conclusions: The tested genetic polymorphisms (including those published as significant risk factors of ROP) are not good predictors of ROP at birth.