Presence Of Retinopathy Of Prematurity Research Articles

Identifying associations of human surfactant protein A SNPs and allelic variants with retinopathy of prematurity

Retinopathy of prematurity (ROP) is the primary cause of childhood blindness worldwide. Previous studies showed that allelic single nucleotide polymorphic (SNP) variants of the human surfactant protein A genes (SP-A1, SP-A2) are associated with the development of respiratory distress syndrome and bronchopulmonary dysplasia (BPD). In this work, we hypothesized that SP-A SNPs and allelic variants are associated with altered risk of ROP in prematurely born infants. To test this hypothesis, we used a modified PCR-based method to detect variants of the SP-A1 and SP-A2 genes in a cohort of preterm infants. Infants born at <32 weeks’ gestation and/or<1500 grams were enrolled. Scavenged blood samples or cheek swabs were collected and DNA was extracted using the QIAamp DNA Mini Kit. We measured SNPs in SP-A1 and SP-A2 using Taqman probes for allelic discrimination by PCR or PCR/RFLP/sequencing method. Associations of SP-A1 and SP-A2 SNP allele frequencies with ROP and BPD were determined using chi-square and logistic regression analyses. Our results show that, of the total patient cohort (n=59), 42 patients had a BPD diagnosis (23 with ROP and 36 without ROP). DNA analysis of these samples identified associations of SP-A1 and SP-A2 SNPs and variants with ROP. For SP-A1, the following SNP associations were found for ROP using chi-square: rs1059047 (p=0.44), rs1136450 (p=0.63), rs1136451 (p=0.21), rs1059057 (p=0.52). For SP-A2, the following SNPs associations were identified with ROP: rs1059046 (p=0.51), rs17886395 (p=0.050), rs1965707 (p=0.031), rs1965708 (p=0.46). Logistic regression analysis indicated an association of ROP with the SP-A1 6A2 variant (p-value = 0.47, OR (6A2/*)=0.8036, 95%CI [0.2299 - 2.8082], OR (6A2/6A2) = 0.4327, 95%CI [0.1063 - 1.7615]), which conferred protection, as well as an association of ROP with SP-A2 6A2 (p-value = 0.0055) with decreased risk when 1A2 variant is present. We conclude that SP-A1/SP-A2 polymorphisms are associated with the presence of ROP in infants with BPD. The 6A4 SP-A1 and SP-A2 1A2 appear to confer protection in babies against ROP. Further studies will determine the mechanisms of this protective effect. Indiana University, University of Chicago Metcalf Internship Program Grant, The University of Oklahoma Health Sciences Center. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Severity of cystoid macular oedema in preterm infants observed using hand-held spectral domain optical coherence tomography improves weekly with postmenstrual age

ObjectiveTo investigate the relationship between cystoid macular oedema (CMO) measured in preterm infants using hand-held spectral domain optical coherence tomography (HH SD-OCT), with gestational age at birth (GA), birthweight (BW), diagnosis of retinopathy of prematurity (ROP) and the presence or absence of the external limiting membrane (ELM).MethodsWe conducted a prospective mixed cross-sectional/longitudinal observational study of 112 participants (23 to 36 weeks GA; n = 25 with, and n = 87 without, CMO). Retinal images were acquired using 344 HH SD-OCT (n = 66 with and n = 278 without, CMO) between 31 to 44 weeks postmenstrual age (PMA). CMO type (‘fovea’ and ‘dome’) was measured using thickness, width, area and peak.ResultsCMO was observed in 22.9% of preterm infants, and 19.2% of images. The mean values for thickness, width, area and peak of ‘dome’ CMO were 128.47 µm (SD +/- 34.23), 3624.45 µm (SD +/- 1323.03), 0.49 mm2 (SD +/- 0.28) and 279.81 µm (SD +/- 13.57) respectively. The mean values for thickness, width, area and peak of ‘fovea’ CMO were 64.37 µm (SD +/- 17.11), 2226.28 µm (SD +/- 1123.82), 0.16 mm2 (SD +/- 0.11) and 95.03 µm (SD +/- 26.99) respectively. Thickness, area width and peak were significantly greater for ‘dome CMO compared with ‘fovea’ CMO (P < 0.0001 for thickness, area and peak; P < 0.01 for width). Area and width significantly decreased with PMA for ‘dome’ and ‘fovea’ CMO (p = 0.0028; p < 0.001 respectively). No association was found between the presence of ROP and the detection of CMO or detection of CMO with absence of ELM.ConclusionsHH -OCT in preterm infants demonstrates that the severity of CMO appearance improves each week for both fovea and dome CMO.

Rate of and time to complete retinal vascularization in premature infants and associated factors.

To evaluate the rate of and time to complete vascularization in premature infants and to explore associated factors. A monocentric, retrospective cohort study including 541 premature infants who underwent screening for retinopathy of prematurity (ROP) between July 2016 and June 2019. Patients underwent regular dilated fundus examinations with indirect ophthalmoscopy until complete vascularization. The worse eye of each patient was included for analyses. The proportion of infants with complete retinal vascularization at the last visit and the time to full vascularization were analyzed. Among all infants (average gestational age 31.29 ± 3.12 weeks), 490 (90.57%) had complete records of retinal vascularization outcomes, of whom 439 (89.59%) achieved complete vascularization. The average postmenstrual age (PMA) for complete vascularization was 45.39 ± 11.04 weeks, and 95.22% achieved completion before 64 weeks of PMA. ROP developed in 118 (22.56%) infants; 33 (6.10%) received anti-vascular endothelial growth factor (VEGF) treatment. For all infants screened for ROP, lower birth weight (BW), presence of ROP, and anti-VEGF therapy predicted delayed complete vascularization; for infants diagnosed with ROP, only lower BW predicted delayed complete vascularization. Subgroup analysis showed significant differences between patients without ROP, with untreated ROP, and with treated ROP in time to complete vascularization and its rate (99.7%, 66.2%, and 16.7%, respectively). Lower BW predicted delayed complete vascularization. Anti-VEGF therapy and the presence of ROP, including ROP severity, may also affect time to complete vascularization. These findings should help improve the understanding and management of persistent avascular retina in preterm infants.

Evaluation and modification of French screening guidelines for retinopathy of prematurity

To evaluate the current French screening guidelines for retinopathy of prematurity (ROP) and to suggest modifications to it. In this multicentric retrospective, noncomparative, interventional case series we included infants with a gestational age (GA) ≤32 weeks who were screened for ROP by fundus examination between 2011 and 2018. Main Outcome Measures were the presence of ROP and the need for treatment. A total of 2246 children with a mean GA of 28.9 ± 2.0 weeks and mean birth weight (BW) of 1141.1 ± 332.0 g were screened. Retinopathy of prematurity (ROP) was found in 683 infants (30.4%), of whom 145 (6.5%) had type 2 ROP and 58 (2.6%) had type 1 ROP. Mean GA of infants with type 1 ROP needing treatment was 25.9 + 1.5 weeks (range: 23.6-30) and mean BW was 774.1 ± 173.7 g (range: 540-1400). Both GA and BW had an impact on the development of type 1 and 2 ROP. None of the infants needing treatment had a GA of 31 weeks or more. None of the children needed treatment before 33 weeks of postmenstrual age (PMA) or 6 weeks of postnatal age (PNA). It seems possible to decrease the screening of premature infants to ≤31 weeks of GA and to start screening at 31 weeks PMA for infants having a GA < 26 weeks and at 6 weeks PNA for more mature children.

Ophthalmic complications in retinopathy of prematurity in the first decade of life in Korea using the national health insurance database

The aim of this study is to investigate the epidemiology of ophthalmic complications of retinopathy of prematurity (ROP) after preterm birth using population-based database in South Korea. Using the National Health Insurance database, ophthalmic complications among premature infants born in 2007–2008 during their 10-year follow-up period were identified. Annual cumulative incidence rate and period prevalence of complications at each age were analyzed among those with ROP and those who underwent treatment for ROP (tROP). The hazard ratios (HRs) according to the presence of ROP and treatment for ROP were also analyzed. We identified 18,256 premature infants, 6995 of whom had ROP. The prevalence at 10th year for overall ophthalmic complications was 11.1% and 35.9% among ROP and tROP, respectively. Strabismus, amblyopia, and glaucoma were the three most common complications. The presence of ROP was associated with higher risk of complications (HR 1.53, 95%CI 1.44–1.61) among premature infants, and the presence of treatment for ROP was associated with higher risk of complications (HR 4.31, 95%CI 3.74–4.98) among ROP cases. This study reports the nationwide epidemiologic data on ophthalmic complications of ROP during the first decade of life, which will help advance our understandings and establish national strategies in managing ROP.

Perinatal risk factors associated with central retinal changes in former preterm children on optical coherence tomography angiography.

To assess the association between perinatal risk factors for retinopathy of prematurity (ROP) and central retinal structures of former preterm children seen on optical coherence tomography angiography (OCTA). This prospective cohort study included 40 children with a history of preterm birth and 33 healthy full-term children. We documented their birth weight, gestational age, other significant risk factors for ROP development and presence of ROP. Imaging was performed using swept-source OCTA, and quantitative evaluation was performed. Analytic parameters included the area of foveal avascular zone (FAZ), foveal depth (FD), central subfoveal retinal thickness (CSFT) and capillary density index (CDI) of the deep and superficial capillary plexus. Preterm children had significantly smaller FAZ, lower FD and higher CSFT compared to controls (all p < 0.001). Both groups exhibited no differences in total CDI at the superficial (p = 0.969) and deep capillary plexus (p = 0.370). The duration of mechanical ventilation correlated negatively with FAZ and FD but positively with CSFT. The duration of supplemental oxygen treatment correlated negatively with FD. The presence of intraventricular haemorrhage correlated negatively with FAZ and FD but positively with CSFT. Regression analysis found that the duration of mechanical ventilation and the presence of bronchopulmonary dysplasia were associated with lower FD (p = 0.002 and 0.01, respectively) and higher CSFT (p = 0.002 and 0.028, respectively). Central retinal anomalies were identified in former preterm children using OCTA. Macular changes were associated with several risk factors for ROP development.

Effects of Breastfeeding and Perinatal Factors on Development of Retinopathy of Prematurity

Objective: Breastfeeding is very important for the development and well-being of an infant. Other perinatal factors also influence the well-being of the infant like the method of conception, delivery method and multiple pregnancy. Our aim in this study is to investigate the effects of these factors on the development of retinopathy of prematurity (ROP). Methods: The records of premature infants who were screened for ROP between 2015 and 2018. Gestational age (GA), birth weight (BW), sex, time spent in neonatal intensive care unit (NICU), assisted reproduction method, method of delivery, breastfeeding and multiple births were noted. The presence of ROP, stage and zone of the disease, treatment for ROP were recorded. Results: GA and BW were significantly lower and time spent in NICU was significantly longer in infants with ROP (p<0.001). Only breastfed patients had a lower rate of ROP than other groups, however they had significantly higher GA, BW and lower time in NICU. Assisted conception significantly decreased the presence of any stage ROP (p=0.037). Delivery method and multiple pregnancy didn’t have an effect on the presence of ROP. Conclusion: Low GA, low BW and more time spent in NICU are the major risk factors for development of ROP. The relation between ROP and breastfeeding is not reliable because of the significant difference of BW, GA and time spent in NICU that exists between the only breastfed group and others. Assisted reproductive techniques decreased the incidence of ROP which might be due to the advances in the assisted reproduction methods.

Retinopathy of Prematurity among Syrian Refugees: Incidence and Severity.

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

Chorioamnionitis as a risk factor for retinopathy of prematurity: An updated systematic review and meta-analysis.

The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) is difficult to establish, because CA-exposed and CA-unexposed infants frequently present different baseline characteristics. We performed an updated systematic review and meta-analysis of studies reporting on the association between CA and ROP. We searched PubMed and EMBASE for relevant articles. Studies were included if they examined preterm or very low birth weight (VLBW, <1500g) infants and reported primary data that could be used to measure the association between exposure to CA and the presence of ROP. Of 748 potentially relevant studies, 50 studies met the inclusion criteria (38,986 infants, 9,258 CA cases). Meta-analysis showed a significant positive association between CA and any stage ROP (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.11 to 1.74). CA was also associated with severe (stage ≥3) ROP (OR 1.63, 95% CI 1.41 to 1.89). Exposure to funisitis was associated with a higher risk of ROP than exposure to CA in the absence of funisitis. Additional meta-analyses showed that infants exposed to CA had lower gestational age (GA) and lower birth weight (BW). Meta-regression showed that lower GA and BW in the CA-exposed group was significantly associated with a higher risk of ROP. Meta-analyses of studies with data adjusted for confounders could not find a significant association between CA and ROP. In conclusion, our study confirms that CA is a risk factor for developing ROP. However, part of the effects of CA on the pathogenesis of ROP may be mediated by the role of CA as an etiological factor for very preterm birth.

Is human milk feeding protective for Retinopathy of Prematurity?

Objective:To find the association between breast milk feeding with retinopathy of prematurity (ROP) in preterm infants.Methods:This was a cross sectional study to examine the effects of breast milk feeding on ROP. Premature newborns below 34 weeks from neonatal unit retinopathy of prematurity program during the years 2015 to 2017 of The Lahore General Hospital were included. We recorded the gestational age, birth weight, presence of ROP and the type of feeding (breastfeeding vs. formula milk).Results:Out of 428 preterm babies 210 (49%) were males. More babies were between 32-34 weeks of gestation 229 (53.5%) as compared to < 32 weeks 199 (46.5%). Among all 428 preterm infants 19(4.4%) developed ROP. Majority 13 (68.4%) who developed ROP were <32 weeks of gestation (p=0.042). The mean birth weight of infants without ROP was 1.51± 0.36 kg (95%CI; 1.47-1.55), while it was 1.36 ± 0.29 kg (95%CI; 1.22-1.50) with ROP and all who developed ROP were < 2kg. The estimated odds ratio of developing ROP for breast fed versus top feeding was (ORs: 0.571, 95% CI; 0.222- 1.489). There was a trend toward lower incidence of ROP in the group of newborns who received breast-feeding (36.8%) as compared to top feeding (63.2%) but almost similar percentage who didn’t develop ROP were breast fed or top fed with statistically insignificant results (p= 0.24).Conclusions:Slightly lesser percentage of preterm babies who were breast fed developed retinopathy of prematurity.

Assessment of a Tele-education System to Enhance Retinopathy of Prematurity Training by International Ophthalmologists-in-Training in Mexico

To evaluate a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmologists-in-training in Mexico. Prospective, randomized cohort study. Fifty-eight ophthalmology residents and fellows from a training program in Mexico consented to participate. Twenty-nine of 58 trainees (50%) were randomized to the educational intervention (pretest, ROP tutorial, ROP educational chapters, and posttest), and 29 of 58 trainees (50%) were randomized to a control group (pretest and posttest only). A secure web-based educational system was created using clinical cases (20 pretest, 20 posttest, and 25 training chapter-based) developed from a repository of over 2500 unique image sets of ROP. For each image set used, a reference standard ROP diagnosis was established by combining the clinical diagnosis by indirect ophthalmoscope examination and image-based diagnosis by multiple experts. Trainees were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters. The accuracy of ROP diagnosis (e.g., plus disease, zone, stage, category) was determined using sensitivity and specificity calculations from the pretest and posttest results of the educational intervention group versus control group. The unweighted kappa statistic was used to analyze the intragrader agreement for ROP diagnosis by the ophthalmologists-in-training during the pretest and posttest for both groups. Trainees completing the tele-education system had statistically significant improvements (P < 0.01) in the accuracy of ROP diagnosis for plus disease, zone, stage, category, and aggressive posterior ROP (AP-ROP). Compared with the control group, trainees who completed the ROP tele-education system performed better on the posttest for accurately diagnosing plus disease (67% vs. 48%; P= 0.04) and the presence of ROP (96% vs. 91%; P < 0.01). The specificity for diagnosing AP-ROP (94% vs. 78%; P < 0.01), type 2 ROP or worse (92% vs. 84%; P= 0.04), and ROP requiring treatment (89% vs. 79%; P < 0.01) was better for the trainees completing the tele-education system compared with the control group. Intragrader agreement improved for identification of plus disease, zone, stage, and category of ROP after completion of the educational intervention. A tele-education system for ROP education was effective in improving the diagnostic accuracy of ROP by ophthalmologists-in-training in Mexico. This system has the potential to increase competency in ROP diagnosis and management for ophthalmologists-in-training from middle-income nations.

Retinopathy of prematurity: A comprehensive risk analysis for prevention and prediction of disease.

BackgroundRetinopathy of prematurity (ROP) is a blinding morbidity of preterm infants. Our current screening criteria have remained unchanged since their inception and lack the ability to identify those at greatest risk.ObjectivesWe sought to comprehensively analyze numerous proposed maternal, infant, and environmental ROP risk variables in a robustly phenotyped population using logistic regression to determine the most predictive model for ROP development and severity. We further sought to determine the statistical interaction between significant ROP risk variables, which has not previously been done in the field of ROP. We hypothesize that our comprehensive analysis will allow for better identification of risk variables that independently correlate with ROP disease. Going forward, this may allow for improved infant risk stratification along a time continuum from prenatal to postnatal development, making prevention more feasible.MethodsWe performed a retrospective cohort analysis of preterm infants referred for ROP screening in one neonatal intensive care unit from 2010–2015. The primary outcome measure was presence of ROP. Secondary outcome measures were ROP requiring treatment and severe ROP not clearly meeting current treatment criteria. Univariate, stepwise regression and statistical interaction analyses of 57 proposed ROP risk variables was performed to identify variables which were significantly associated with each outcome measure.ResultsWe identified 457 infants meeting our inclusion criteria. Within this cohort, numerous factors showed a significant individual association with our ROP outcome measures; however, stepwise regression analysis found the most predictive model for overall ROP risk included estimated gestational age, birth weight, the need for any surgery, and maternal magnesium prophylaxis. The corresponding Area Under the Curve (AUC) for this model was 0.8641, while the traditional model of gestational age and birth weight predicted ROP disease less well with an AUC of 0.8489. Development of severe ROP was best predicted by estimated gestational age (week), the need for any surgery and increased probability of death or moderate-severe BPD at 7 days. Finally, the model most predictive for type 1 ROP included estimated gestational age (week) and the presence of severe chronic lung disease. No significant statistical interaction was found between variables.ConclusionsOur work is unique as we report comprehensive analysis of the greatest number of proposed ROP risk variables to date in a robustly phenotyped population. We describe novel risk models for our ROP outcome measures and demonstrate independence of these variables using statistical modeling not previously applied to ROP. This may better allow for individual infant risk stratification and importantly mitigation of future risk.

Peripapillary Choroidal Thickness in Former Preterm and Full-Term Infants Aged From 4 to 10 Years.

The aim of the study was to investigate peripapillary choroidal thickness in former preterm and full-term infants with spectral-domain optical coherence tomography (SD-OCT). Subanalysis of infants with successful peripapillary choroidal thickness measurements of a prospective, controlled, cross-sectional, hospital-based study in a tertiary center of maximum care. The study examined 503 infants aged 4 to 10 years at the time of examination. Infants were divided into different groups: group 1 born with gestational age (GA) ≥37 weeks, group 2 born with GA between 29 and 32 weeks without ROP (retinopathy of prematurity), group 3 born with GA ≤28 weeks without ROP, and group 4 born with GA ≤32 weeks and presence of ROP. Peripapillary choroidal measurements were available for 388 of 503 participants. No significant differences were found among the four groups for global peripapillary choroidal thickness. Multivariable analysis revealed no association with low GA, birth weight, ROP occurrence, perinatal adverse events, and logMAR visual acuity. Only infants born small for GA (SGA) revealed peripapillary choroidal thinning in the superior (P = 0.033) and nasal (P = 0.024) sectors compared with infants born appropriate for GA (AGA). Infants SGA had lower visual acuity than AGA infants (0.03 ± 0.07 logMAR SGA versus 0.01 ± 0.05 logMAR AGA; P = 0.029). Our results indicate that prematurity itself does not affect choroidal thickness in the peripapillary region. Only infants born SGA revealed peripapillary choroidal thinning compared with AGA infants. Our data indicate that fetal growth restriction leads to choroidal long-term alterations in the peripapillary region.

Foveal Layer Morphology Detected on Spectral Domain Optical Coherence Tomography and its Correlation with Visual Acuity in Asian Indian Premature Infants in their First Year of Life

ABSTRACTPurpose: To report foveal microanatomy imaged on handheld spectral domain optical coherence tomography (SDOCT) and correlate it with visual acuity in Asian Indian premature infants.Methods: A retrospective analysis of 32 Asian Indian premature infants, 10 with Type 2 retinopathy of prematurity (ROP), were imaged between 3 and 12 months of corrected postmenstrual age (PMA) on the handheld SDOCT (Envisu 2300, Bioptigen, DNC, USA). The foveal findings on these images were correlated with visual acuity measured using Teller acuity cards. The study cohort was divided into three groups based on the corrected age, 3–<6 months, 6–<9 months, and 9–12 months. SDOCT images of the foveal center were analyzed for inner retinal layer (IRL) persistence or fusion and presence of the external limiting membrane (ELM), inner segment–outer segment or the ellipsoid zone (EZ), and the outer segment–retinal pigment epithelium (OS-RPE) layers.Results: The mean visual acuity of the three groups was 1.60, 1.63, and 1.23 logMAR, respectively (p < 0.001). Visual acuity significantly correlated with all four layers (IRL fusion, ELM, EZ, and OS-RPE in the 3–<6-month group [p < 0.001], IRL fusion only in 6–<9-month group (p < 0.001), and IRL fusion and EZ in the 9–12-month group (p < 0.001 and p = 0.01, respectively).Conclusions: The study provides insights into our understanding of a premature infant’s foveal maturation in the first year. Inner retinal fusion or maturation is the most important event that correlates with better visual acuity throughout the first year. In addition, between 9 and 12 months PMA, the completion of the EZ at the foveal center positively influenced visual acuity. The presence of ROP did not influence development of the layers, but the sample size was small for subgroup analysis.

Retinopathy of Prematurity in Triplets.

Objectives:To investigate the incidence, severity and risk factors of retinopathy of prematurity (ROP) in triplets.Materials and Methods:The medical records of consecutive premature triplets who had been screened for ROP in a single maternity hospital were analyzed and presence and severity of ROP; birth weight, gender, gestational age of the infant; route of delivery and the mode of conception were recorded.Results:A total of 54 triplets (40 males, 14 females) who were screened for ROP between March 2010 and February 2013 were recruited for the study. All triplets were delivered by Caesarean section and 36 (66.7%) were born following an assisted conception. During follow-up, seven (13%) of the infants developed ROP of any stage and two (3.7%) required laser photocoagulation. The mean gestational age of triplets with ROP was 27.6±1.5 (27-31) weeks whereas it was 32.0±1.5 (30-34) weeks in those without ROP (p=0.002). The mean birth weights of triplets with and without ROP were 1290.0±295.2 (970-1600) g and 1667.5±222.2 (1130-1960) g, respectively (p<0.001). The presence of ROP was not associated with gender (p=0.358) or mode of conception (p=0.674).Conclusion:ROP in triplets seems to be mainly related to low gestational age and low birth weight. Further prospective randomized studies are necessary to demonstrate risk factors of ROP in triplets and to determine if and how gemelarity plays a role in the development of ROP.

Epidemiologic profile of preterm infants with retinopathy of prematurity in the Dr. Homero de Miranda Gomes Regional Hospital in São José

Objectives: To evaluate the prevalence of retinopathy of prematurity (ROP) in premature newborns (gestational age < 37 weeks) and / or birth weight £ 1,500g and those with risk factors, born at the Dr. Homero de Miranda Gomes Regional Hospital in Sao Jose (HRSJ) between January 2007 and January 2011. Methods: Cross-sectional, retrospective, observational and analytical study. Data were obtained from medical records at the HRSJ. Results: The presence of 37.81% of retinopathy in newborns was observed, with stage 1 being the most prevalent. No statistical difference was found between the sexes (p = 0.993). The presence of ROP was higher in the group with PN < 1,000 grams (83.33%), evaluated over 6sixweeks of age and with gestational ages less than 32 weeks (49.48%). Risk factors with statistical significance were: oxygen therapy, mechanical ventilation, patent ductus arteriosus, perinatal asphyxia, respiratory distress syndrome, blood transfusions, intraventricular hemorrhage, sepsis, neonatal infection and hyaline membrane disease. Conclusion: It is concluded that: the gender factor and multiple pregnancy were not statistically significant. The newborns with lower birth weight and gestational age have an increased risk for developing ROP. Regarding oxygentherapy, the prevalence is higher in the exposed and proportional to the period of oxygen.

Analysis of the horizontal corneal diameter, central corneal thickness, and axial length in premature infants.

To determine the horizontal corneal diameter, central corneal thickness, and axial length in premature infants. Infants with a birth weight of less than 2,500 g or with a gestation period of less than 36 weeks were included in the study. Infants with retinopathy of prematurity (ROP) were allocated to Group 1 (n=138), while those without ROP were allocated to Group 2 (n=236). All infants underwent a complete ophthalmologic examination, including corneal diameter measurements, pachymetry, biometry, and fundoscopy. Between-group comparisons of horizontal corneal diameter, central corneal thickness, and axial lengths were performed. Independent sample t-tests were used for statistical analysis. Data was obtained from 374 eyes of 187 infants (102 female, 85 male). The mean gestational age at birth was 30.7 ± 2.7 weeks (range 25-36 weeks), the mean birth weight was 1,514 ± 533.3 g (range 750-1,970 g), and the mean postmenstrual age at examination was 40.0 ± 4.8 weeks. The mean gestational age and the mean birth weight of Group 1 were statistically lower than Group 2 (p<0.05). There were no significant differences in horizontal corneal diameter, central corneal thickness, and axial length between the two groups (p>0.05). The presence of ROP in premature infants does not alter the horizontal corneal diameter, central corneal thickness, or axial length.

The association between stage 3 or higher retinopathy of prematurity and other disorders of prematurity

Objective To evaluate the association between stage III or higher retinopathy of prematurity (ROP) and other prematurity disorders and parameters. Design Retrospective, case–control study. Participants The subjects of the study were 55 consecutive premature neonates with stage III or higher ROP and 110 consecutive premature neonates without ROP. Methods We compared consecutive premature neonates regarding the presence of ROP and other disorders as well as demographic and laboratory parameters. Results Gestational age ( p < 0.001); birth weight ( p < 0.001); male sex ( p = 0.031); bilirubin levels ( p < 0.001); breast feeding ( p < 0.001); clinical and laboratory sepsis ( p < 0.001); number of sepsis events ( p < 0.001); ventilation need ( p < 0.001); number of ventilation days ( p < 0.001); theophylline and surfactant use ( p < 0.001); blood transfusions ( p < 0.001); number of blood transfusions ( p < 0.001); intraventricular hemorrhage and bronchopulmonary dysplasia ( p = 0.001); and other factors differed in the two groups. The logistic regression model showed a correlation between low gestational age (OD 0.474, CI 0.359-0.626); male sex (OD 2.991, CI 1.077-8.305); blood transfusion (OD 14.159, CI 1.570-127.7); and sepsis (OD 12.376, CI 2.532-60.503). Conclusions Certain disorders and parameters, such as sepsis and blood transfusions, may be predict the appearance of stage III or higher ROP. Close monitoring of neonates with these findings is imperative. Early detection and treatment of sepsis and reduction of blood transfusions may decrease the incidence of ROP that requires treatment.

Ocular Findings in Low Birthweight and Premature Babies in the First Year: Do We Need to Screen?

There is no standardized approach for the ophthalmic care follow-up of children screened for retinopathy of prematurity (ROP). The authors report the ocular findings at 12 months in preterm and low birthweight babies screened for ROP over a 5-year period (1998-2003). The case notes of 211 babies were retrospectively reviewed for birth details, maternal details, presence of ROP, and findings at follow-up screening which included visual acuity, refraction at 12 months, presence of squint, and any other ocular problems. At 1 year follow-up, 16.6% of ROP positive children failed a screening visit because of squint (6.66%), refractive error (6.66%), and optic nerve abnormalities (3.33%). At 1 year follow-up, 10% of ROP negative children had failed a screening visit because of squint (3.75 %), refractive error (3.75%), and other pathology (2.5%). The authors recommend screening all babies with ROP at 12 months to identify amblyogenic factors such as squint and refractive error. Parents of infants who do not develop ROP should be advised of the increased risk of visual problems in their children and to have their child examined in the preschool period.

Risk Factors for Adverse Neurodevelopment in Extremely Low Birth Weight Infants with Normal Neonatal Cranial Ultrasound

To determine risk factors associated with adverse developmental outcome at 5 years in extremely low birth weight infants or extremely premature infants (<28 weeks) with normal neonatal cranial ultrasounds. Data were collected prospectively on 152 infants with gestation <28 weeks or birth-weight <1000 g. Infants were grouped into those with normal development, mild-to-moderate impairment (IQ 70 to 84, or hearing loss 30 to 89 dB, visual acuity 6/18 to 6/60, or mild/moderate cerebral palsy (CP)) and severe impairment (IQ <70, hearing loss > or =90 dB, visual acuity <6/60, or severe CP). Five-year outcomes were available for 144/152 children (95%). In all, 89 (62%) infants had normal development, 39 (27%) had mild-moderate impairment and 16 (11%) had severe impairment. On multivariate logistic regression analysis, factors associated with developmental impairment were serum bilirubin > or =200 micromol/l (odds ratio (OR) - 4.06, p=0.003) and retinopathy of prematurity (ROP) (OR - 1.6, p=0.03). A serum bilirubin > or =200 micromol/l and presence of ROP are postnatal risk factors associated with an adverse developmental outcome in infants with normal cranial ultrasounds.