Retinopathy Of Prematurity In Infants Research Articles

Incidence and Characteristics of Retinopathy of Prematurity Patients With Late Gestational Age and Large Birth Weight in South China.

PurposeTo investigate the incidence and characteristics of retinopathy of prematurity (ROP) premature infants with late gestational age (GA) and large birth weight (BW) and show a 7-year trend of ROP incidence in South China.MethodsThis retrospective, cross-sectional study included premature infants who received ROP screening in a 7-year period (from 2010 to 2016) at the Sun Yat-sen Memorial Hospital (SYSMH), Guangzhou, South China. Infants were screened if they had GA <37 weeks or BW <2,500 g. All screened infants were divided into two groups: Group 1 (with both GA ≥ 35 weeks and BW ≥ 1,750 g) and Group 2 (others). The characteristics of ROP infants in Group 1 were analyzed and compared with those in Group 2.ResultsA total of 911 premature infants were screened, with 282 infants in Group 1 and 629 in Group 2. Both the incidences of any ROP (6.7 vs. 8.3%, p = 0.50) and Type 1 ROP (1.4 vs. 1.7%, p = 0.72) in Group 1 were comparable with those in Group 2. Lower proportions of respiratory distress (15.8 vs. 71.2%, p < 0.001), blood transfusion (5.3 vs. 32.7%, p = 0.028), and oxygen administration (31.6 vs. 86.5%, p < 0.001) among ROP patients in Group 1 than those in Group 2 were revealed. Vaginal delivery [OR: 4.73 (1.83–12.26)] was identified as a factor associated with ROP among the infants in Group 1. Forty percent (6/15) of Type 1 ROP in this study would have been missed under the current screening criteria in China (GA ≤ 34 weeks and/or BW ≤ 2,000 g). Trends of increased incidence of Type 1 ROP and decreased BW were exhibited in the 7-year study period.ConclusionsThese findings indicate that even the premature infants with late GA and large BW also have a high risk of developing ROP, especially for those delivered by vagina. The findings may provide a significant reference for ROP screening and neonatal care in South China and other regions with similar conditions.

Frequency of Retinopathy in Premature Infants in a Tertiary Care Hospital

Background: Retinopathy of prematurity is one of the important problems faced by neonates causing lifelong morbidity. It can be prevented by early detection and prompt treatment. Objective: To determine the frequency of retinopathy in premature infants in a Tertiary Care Hospital. Methodology: A three-centered cross-sectional study was conducted in tertiary care hospitals of Lahore. All neonates after taking informed consent form guardians were enrolled in the study according to selection criteria. All cases were screened for retinopathy of prematurity at four weeks of age for the first time and later followed up at 4 to 6 weeks interval according to disease stage on slit lamp by consultant ophthalmologist. The premature infants were diagnosed as retinopathy of prematurity based on the operational definition. Results: The mean age was 15.80±5.57 hours, mean gestational age of positive cases was 30.46±1.40 weeks and mean birth weight of positive cases was 1528.2.36±201.47 g. There were 15 (14%) cases who had retinopathy of prematurity while 96 (86%) cases had normal eyes. Among them 11 (73%) cases were of stage 1, 3 (20%) cases of stage 3 and 1(7%) case of stage 4 retinopathy of prematurity. Conclusions: In our study, retinopathy is observed in 14% of the premature infants. Keywords: Preterm birth, Gestational age, Complication, Retinopathy of prematurity

Twelve-year profile of screening results of retinopathy of prematurity at a tertiary care institute in Northwest China.

To report the changes in detection rate and characteristics of retinopathy of prematurity (ROP) in infants, during a 12-year period in Northwest China. The medical records of infants were retrospectively collected and reviewed using an established clinical database. The detection rate and severity of ROP were compared between two consecutive periods (P1: 2008-2013, P2: 2014-2019). Gender, gestational age (GA), birth weight (BW), multiple births, delivery pattern, and postmenstrual age of the first fundus screen were analyzed in all visiting infants. During the 12-year study period, 7832 infants were initially included; among them, 1266 (16.16%) were diagnosed with ROP, 441 of whom (5.63%) developed severe ROP. Throughout the study period, the total number of infants being screened showed a trend of slight fluctuation after a rapid increase; however, an annual increase was observed in the number of infants diagnosed with ROP and severe ROP. The proportion of each stage at the first screening of infants with ROP was stable. The detection rate of ROP increased from 2.33% in 2008 to 16.18% in 2010, decreased to 10.73% in 2014, and then increased to 27.47% in 2019. For severe ROP, the detection rate gradually increased from 0 in 2008 to 12.49% in 2019. Among the infants with ROP, 96 (7.58%) did not meet the screening criteria set by the Chinese Medical Association in 2014 (GA<32wk, or BW<2000 g); among them, 14 (1.11%) needed treatment because of severe ROP. From 2008 to 2019, the detection rates of ROP and severe ROP in infants screened in Northwest China were 16.16% and 5.63%, respectively. The characteristics of the ROP infants were similar to those in other middle-income regions. The "tertiary prevention network of ROP" is a potentially effective screening approach.

Clinical parameters in different stages, zones, and remission/progression statuses of retinopathy of prematurity.

Background:Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in premature infants that causes lifetime visual impairment and blindness in the early ages. In this study, we investigated the differences in the values of clinical laboratory parameters between different ROP and its remission/progression statuses regarding stages and zones.Methods:This historical cohort study includes 828 infants divided into two groups after the first examination containing ROP infants and controls. The biochemical and hematological parameters of the two groups have been collected from the patient’s history.Results:In infants with ROP, the hematopoiesis-related parameters, including the mean level of hemoglobin, total bilirubin, potassium, calcium were significantly less than controls (P=0.039, P=0.001, P=0.001, and P=0.046, respectively). The percentages of reticulocyte and the levels of BUN in ROP patients were significantly higher than in normal infants (P=0.015 and p <0.001, respectively). Moreover, the levels of hemoglobin and BUN were significantly different in the different zones of ROP (P=0.017 and P=0.001, respectively). Also, higher hemoglobin levels, total bilirubin, and CRP were observed in the reduced stages of ROP (P=0.041, P=0.045, and P=0.039, respectively).Conclusion:Laboratory parameters are different in different stages, zones and remission/ progression ROP infants.

Effectiveness of Reverse Kangaroo Mother Care Position in Decreasing Adverse Physiological Events and Pain during Screening of Premature Infants for Retinopathy of Prematurity

Background. Retinopathy of prematurity (ROP) screening is uncomfortable and even painful in preterm infants.&#x0D; Objective. To determine the effectiveness of the Reverse-Kangaroo Mother Care (R-KMC) position compared with the conventional position in decreasing adverse physiological events and pain during ROP screening.&#x0D; Methods. This was a parallel randomized controlled trial with two arms- R-KMC position and conventional position (control). The primary outcomes included increased oxygen saturation, decreased heart and respiratory rates, and decreased pain intensity measured by Prematurity Infant Pain Profile (PIPP).&#x0D; Results. There were 100 preterm infants recruited. There were no differences in baseline characteristics, mean ROP screening duration, mean physiological parameters after the mydriatic application and during ROP screening between the two. Only the mean respiratory rates were significantly lower among the R-KMC group during the application of mydriatric agent. (50.26 ± 6.18 vs. 51.6 ± 8.35; p=0.0191). Relative risk (RR) in the control group is 37 to 84 versus 40 to 68 in the R-KMC group. The R-KMC group had a significantly lower mean PIPP score (6.5±2.06 vs. 8.8±2.80; p&lt;0.0001) after mydriatic application and during ROP screening (7.6±2.05 vs. 9.8±2.90; p&lt;0.0001) compared with control. No apnea was observed after mydriatic application, but one apneic episode was in control during ROP screening. 26% of the ROP screeners recommended the R-KMC position during ROP screening, while a majority (70%) was neutral.&#x0D; Conclusion. R-KMC position, a low-cost intervention, significantly reduces pain during ROP screening. It is recommended as a position of choice during ROP screening.

Postnatal administration of systemic steroids increases severity of retinopathy in premature infants

Postnatal systemic steroids are known to increase the risk of developing retinopathy of prematurity (ROP). However, whether the total dosage and type of postnatal systemic steroids are related to the development and severity of ROP in premature infants remains unclear. This study was conducted to identify the risk factors for ROP and investigate the relationship between photocoagulation (PC)-demanding severe ROP and the postnatal dosage of any type of systemic steroids. A total of 75 infants born at <28 weeks of postmenstrual age (PMA) were enrolled. The number of PC procedures for ROP was evaluated as the objective variable. This study analyzed the following independent variables: gestational age; birth weight; sex; Apgar scores; duration of mechanical ventilation; duration of nasal intermittent positive pressure ventilation; mean saturation and mean oxygen concentration administration until 36 weeks of PMA; total accumulation dosage of hydrocortisone, dexamethasone, and systemic steroids; dosage number of times of erythropoietin; total dosage of red cell concentrates (RCC); incidence of necrotizing enterocolitis (NEC) and focal intestinal perforation; sepsis; bronchopulmonary dysplasia (BPD); and intraventricular hemorrhage (IVH). Logistic regression was used to estimate the relative risk (odds ratio (OR)) associated with risk factors for PC-demanding severe ROP. Compared with infants in the non-PC group, PC-treated infants had younger gestational age, longer mechanical ventilation periods, and higher dosage of systemic steroids and dexamethasone. Multivariate logistic regression analysis revealed total dosage of systemic steroids as the only risk factor for PC-demanding severe ROP. Based on receiver operating characteristic (ROC) curve analysis, a cutoff value of 8.95mg/kg of postnatal systemic steroid administration was identified as a useful marker to predict PC-demanding severe ROP. By focusing on the method of systemic steroid administration and avoiding excessive doses for infants born at <28 weeks of PMA, preventing the development of severe ROP is possible.

Macular Hole as a Complication Following Laser Photocoagulation for Retinopathy of Prematurity.

Complications after laser photocoagulation for retinopathy of prematurity (ROP) are rare but do occur. To the best of our knowledge, we report a previously unreported case of a unilateral macular hole that developed after resolution of an exudative retinal detachment that resulted from laser photocoagulation for ROP. Confluent laser patterns in ROP in infants who have previously received intravitreal anti-vascular endothelial growth factor may result in adverse outcomes such as exudative retinal detachments. Even more rarely, a macular hole may develop. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:510-512.].

Retinopathy of Prematurity: Advances in the Screening and Treatment of Retinopathy of Prematurity Using a Single Center Approach

To focus on the longitudinal evaluation of high-risk infants for the development of retinopathy of prematurity (ROP) at a single tertiary neonatal intensive care unit (NICU), and to evaluate evolving demographics of ROP and the transition of treatment-warranted disease. Retrospective cohort study. A consecutive retrospective review was performed of all infants screened for ROP between 1990 and 2019 at the Jackson Memorial Hospital neonatal intensive care unit. All inborn infants meeting a birth criteria of <32 weeks' gestational age (GA) or a birthweight (BW) of 1500 g were included. Longitudinal demographic, diagnostic, and treatment data were reported. Between January 1, 1990, and June 20, 2019, a total of 25,567 examinations were performed and 7436 patients were included. Longitudinal trends over 3 decades demonstrated a decreasing incidence of ROP (P < .05). Although the mean BW and GA increased over 3 decades, patients with ROP demonstrated lower BW and GA over time (P < .05). The prevalence of micro-premature infants (as defined by BW <750 g) continues to rise over time. Micro-preemies demonstrated increasing severity of zone and stage grading, plus disease, and propensity to require treatment (P < .05). The rate of progression of ROP to stage 4 and 5 disease has decreased over time, and there has been an associated increased adoption of intravitreal bevacizumab as primary and salvage therapy. Understanding the evolution of ROP infants and treatment over time is critical in identifying high-risk infants and in reducing the incidence of severe-stage ROP. Micro-prematurity is one of the significant risk factors for treatment-warranted ROP that continues to increase as neonatal care improves. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Comparison of Color Doppler Imaging Criteria for the Ophthalmic Artery and Central Retinal Artery in Infants with Retinopathy of Prematurity with and Without Plus Disease

Background: Color Doppler imaging (CDI) is a non-aggressive and safe technique for the clinical management of retinal diseases. Recently, the number of infants with retinopathy of prematurity (ROP) has increased due to the incidence of premature births. Objectives: This study aimed to compare the CDI criteria for the ophthalmic artery (OA) and central retinal artery (CRA) in ROP infants with and without plus disease. Patients and Methods: In this case-control study, 42 premature infants (21 infants with plus disease and 21 infants without plus disease) underwent CDI. The arterial CDI parameters, including end-diastolic velocity (EDV), pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV), were measured in these patients. After collecting the data, t-test and chi-square tests were used for data analysis. P &lt; 0.05 was considered to be statistically significant. Results: The mean EDV of CRA in patients with and without plus disease was 4.35 ± 1.00 and 5.27 ± 1.02 cm/sec, respectively (P = 0.005). The mean PSV of CRA in patients with and without plus disease was 15.65 ± 3.35 and 18.39 ± 4.39 cm/sec, respectively (P = 0.029). However, no significant difference was found between the two groups in terms of PSV or EDV of OA (P &gt; 0.05). Also, no significant difference was observed between the two groups considering the RI and PI of CRA and OA (P &gt; 0.05). Conclusion: According to the findings of this study, CDI criteria, such as EDV and PSV of CRA, were significantly lower in infants with plus disease as compared to those without plus disease. Since detecting the early stages of plus disease is a challenge for ophthalmologists, assessment of these criteria can be helpful for differentiation of these two subgroups of patients. However, further studies with a larger sample size are needed to determine the cutoff value.

Comparison of Mean Platelet Counts in Preterm Infants with and without Retinopathy of Prematurity.

Platelets are a primary source of pro- and anti-angiogenic cytokines. However, the evidence of their role in retinopathy of prematurity (ROP) is controversial. This retrospective study aimed to compare mean weekly platelet counts between infants with and without ROP over the first 6 weeks of life. A total of 93 infants matched by gestational age and birth weight were recruited (31 with ROP, 62 without ROP). Weekly mean platelet counts and other related risk factors were documented. The repeated measure analysis of variance (ANOVA) and the repeated measure analysis of covariance (ANCOVA) were used to compare mean platelet counts over time between the two groups, with and without adjusting for confounders. We found significant differences in the weekly mean platelet counts of infants with and without ROP over the first 6 weeks of life (p = 0.002). These differences disappeared after adjusting for covariates (p = 0.489). Lower mean platelet counts in ROP infants are not directly related to ROP, but rather to the presence of other risk factors for ROP, such as culture-proven sepsis, blood transfusion and bronchopulmonary dysplasia.

High rate and large intercentre variability in retreatment of retinopathy of prematurity in infants born

ObjectivePrematurity is a major risk factor for retinopathy of prematurity (ROP). We aimed to elucidate ROP prevalence, treatment and retreatment in infants born before 24 gestational age (GA) weeks in...

Artificial Intelligence for ROP Screening and to Assess Quality of Care: Progress and Challenges.

The goal of retinopathy of prematurity (ROP) screening is to detect the constellation of clinical signs that suggest a high risk of progression to retinal detachment so that urgent treatment can be given. At each screening episode, there are 3 considerations: whether urgent treatment is needed, whether follow-up screening is needed, and whether there is no risk of sight-threatening ROP so that the screening can stop. The decisions are based on a detailed examination of the retina focused on the severity (ie, stage), location (ie, zone), and degree of dilation and tortuosity of retinal blood vessels (ie, plus disease). If ROP is not present, the peripheral retina needs to be assessed to determine the degree of maturity of the retinal vessels; if they are mature or ROP detected earlier is definitely regressing, the screening can stop.Telemedicine with artificial intelligence (AI) image analysis could transform ROP screening, especially in settings with an insufficient supply of ophthalmologists, which can happen either because of absolute workforce shortages or when ophthalmologists choose not to offer ROP screening because of the time burden or fear of litigation. Telemedicine with AI image analysis is particularly appealing for low-resource settings in which greater exposure to risk factors, such as hyperoxia, can lead to a high frequency of treatment-requiring ROP in infants born at a gestational age (GA) of <32 weeks, and severe disease can also develop in more mature infants.1 In these settings, wider screening criteria are required, which increases the screening workload.2In this issue of Pediatrics, Campbell et al3 describe a multicenter screening program in India, the Retinopathy of Prematurity Eradication Save Our Sight program, which was done in collaboration with a United States–based international group, Imaging and Informatics in Retinopathy of Prematurity (iROP). This report describes not only the diagnostic-test accuracy of the deep learning (DL) system developed by this group (iROP DL) but, also, whether the findings can be used as an indicator to assess the quality of neonatal care.iROP DL, which quantifies plus disease, performed well, with 100% sensitivity and a high specificity compared to image grading by 3 ROP experts as the gold standard. Because missing ROP that requires treatment can have serious vision consequences, a high sensitivity is essential. The low positive predictive value is not surprising because of the low prevalence of treatment-requiring ROP.The study findings related to quality of care are particularly interesting. There were highly significant associations between the mean iROP DL score and lower birth weight and whether the unit had adequate equipment to mix and monitor oxygen. A striking finding was that only 3 of the 14 study units had enough of this equipment, which is a frequent and regrettable occurrence in a large number of units in many low- and middle-income countries.There are some important limitations of this study. iROP cannot be used to assess stage or zone, only plus disease. Whether DL and AI image analysis can achieve equally high diagnostic-test accuracy for these other prognostic signs, compared to clinical examination by indirect ophthalmoscopy or image analysis by an ROP expert, remains to be seen. In India and other low-resource settings, data on GA can be unreliable because of low attendance at antenatal care, high rates of intrauterine-growth restriction, and lack of routine prenatal ultrasound. Because GA is an important risk factor for ROP, in this study, more accurate data may have attenuated the association between iROP DL scores and quality of care. The study findings might not be generalizable to other regions. For example, the degree of retinal pigmentation, which can be greater for children born in Africa, could impact the interpretation of images.Several other groups are also working on AI for ROP screening,4–7 and once systems can provide reliable information on all of the signs needed to make a management decision at each screening episode, together with the availability of lower-cost imaging devices, the door is open for a dramatic change in how ROP screening is delivered and by whom.8In 2019, the World Health Organization and United Nations Children’s Fund recommended ROP screening and treatment as standard of care in their “Survive and Thrive” policy.9 The authors correctly indicate that integrated systems will be essential before the benefits of telemedicine and AI image analysis can be fully realized. Studies of the feasibility, acceptability, and cost-effectiveness of this approach would also be required for decision-makers and policy change within countries, with allocation of resources for implementation.

Effects of diode laser photocoagulation treatment on ocular biometric parameters in premature infants with retinopathy of prematurity

To investigate the effects of diode laser treatment on ocular biometric parameters in premature infants with retinopathy of prematurity (ROP). Premature infants who received diode laser treatment for ROP (n=68) and premature infants with spontaneous regressed ROP without treatment (n=50) were performed longitudinal ocular biometric measurements including anterior chamber depth, lens thickness and axial length as follows: 1d prior to laser treatment, and 3, 6, 9, and 12mo after the laser treatment. The mean birth weight, gestational age and initial examination time values were 936.53±302.07 g, 26.66±2.42wk, 36.26±2.73wk in the treatment group and 959.78±260.08 g, 27.28±2.10wk, 36.56±2.54wk in the control group. There was no statistically significant difference in these demographic characteristics of the groups. Anterior chamber depth, lens thickness and axial length demonstrated statistically significant linear increases during the study period in the two groups (P<0.001 for each). There were no statistically significant differences between the two groups in terms of anterior chamber depth after laser treatment. Measurements of the lens thickness at 9th and 12th months (9th month 3.70±0.22 vs 3.60±0.21 mm, P=0.017; 12th month 3.81±0.21 vs 3.69±0.22 mm, P=0.002) and the axial length at 12th month (19.35±0.79 vs 19.13±0.54 mm, P=0.031) after laser treatment were statistically higher in the treatment group. Diode laser retinal photocoagulation treatment in premature infants seems to increase the lens thickness and axial length.

Brain White Matter Maturation and Early Developmental Outcomes in Preterm Infants With Retinopathy of Prematurity.

PurposeTo investigate brain white matter pathways using magnetic resonance diffusion tensor imaging (DTI) and correlate the findings with developmental outcomes at 18 months of corrected age in preterm infants with and without retinopathy of prematurity (ROP).MethodsIn this prospective cohort study, probabilistic maps of the 26 white matter pathways associated with motor, cognitive, visual, and limbic/language functions were generated in 84 preterm infants using DTI obtained at term-equivalent age. The mean fractional anisotropy (FA) and mean diffusivity (MD) values were compared between those with and without ROP. Developmental outcomes were assessed using the third edition of Bayley Scales of Infant and Toddler Development (BSID-III) at 18 months of corrected age. Multiple regression analyses were performed to confirm the association among developmental outcomes, white matter pathways, and ROP or severe ROP after adjusting for potential confounders.ResultsThe white matter pathways were insignificantly associated with ROP or severe ROP. There were no significant differences in the FA and MD values of the pathways between ROP infants treated with and without bevacizumab therapy. Furthermore, there were no significant differences in BSID-III scores between infants with and without ROP or severe ROP. The BSID-III scores at 18 months of age showed a significant association with FA or MD values in several pathways.ConclusionsROP or severe ROP was insignificantly associated with maturation delay of the white matter pathways. Developmental outcomes were similar between preterm infants with and without ROP or severe ROP or between ROP infants with and without intravitreal bevacizumab therapy.

Nationwide incidence and treatment pattern of retinopathy of prematurity in South Korea using the 2007\u20132018 national health insurance claims data

The aim of this study is to investigate the nationwide incidence and treatment pattern of retinopathy of prematurity (ROP) in South Korea. Using the population-based National Health Insurance database (2007–2018), the nationwide incidence of ROP among premature infants with a gestational age (GA) < 37 weeks (GA < 28 weeks, GA28; 28 weeks ≤ GA < 37 weeks; GA28-37) and the percentage of ROP infants who underwent treatment [surgery (vitrectomy, encircling/buckling); retinal ablation (laser photocoagulation, cryotherapy)] were evaluated. We identified 141,964 premature infants, 42,300 of whom had ROP, with a nationwide incidence of 29.8%. The incidence of ROP in GA28 group was 4.3 times higher than in GA28-37 group (63.6% [2240/3522] vs 28.9% [40,060/138,442], p < 0.001). As for the 12-year trends, the incidence of ROP decreased from 39.5% (3308/8366) in 2007 to 23.5% (2943/12,539) in 2018. 3.0% of ROP infants underwent treatment (25.0% in GA28; 1.7% in GA28-37); 0.2% (84/42,300) and 2.9% (1214/42,300) underwent surgery and retinal ablation, respectively. The overall percentage of ROP infants who underwent treatment has decreased from 4.7% in 2007 to 1.8% in 2018. This first Korean nationwide epidemiological study of ROP revealed a decreased incidence of ROP and a decreased percentage of ROP infants undergoing conventional treatment during a 12-year period.

Retinopathy of prematurity: Incidence and perinatal risk factors in a tertiary hospital in Saudi Arabia

Purpose: This study aims to estimate the incidence of retinopathy of prematurity (ROP) and investigate its perinatal and neonatal risk factors in a tertiary hospital in Saudi Arabia. Methodology: This was a retrospective cohort study of premature infants admitted to a neonatal intensive care unit at a tertiary hospital in Jeddah, Saudi Arabia, from January 2016 to December 2017. Participants who met the screening criteria for ROP were included and followed up until spontaneous recovery or laser treatment. Results: A total of 119 infants screened, the incidence of ROP was 21.8% (26/119). A plus disease was diagnosed in 15.4% (4/26) of the ROP infants. For most, 80.7% (21/26) of the ROP regressed spontaneously, and 19.2% (5/26) required a laser intervention. The mean gestational age (GA) of infants diagnosed with ROP was 25.62 ± 1.58 weeks and the median birth weight (BW) 750 (interquartile range: 280) g. Lower GA, lower BW, prolonged oxygen therapy, and mechanical ventilation (MV) were significantly related to ROP disease and severity. Requiring resuscitation at birth, a lower Apgar score at 1-min, poor weight gain proportion at 6 weeks, and requiring a blood transfusion were significantly associated with ROP disease. Conclusion: Compared to other local studies, the incidence of ROP was lower in our population. Lower GA, low BW, prolonged oxygen therapy and MV, and poor weight gain at 6 weeks are well-documented risk factors. We recommend close monitoring of weight gain and oxygen therapy and modifying risk factors in preterm infants to lower the incidence and the severity of ROP.

Retinopathy of prematurity in infants without fetal growth restriction is decreased with the progression of acute histologic chorioamnionitis: New observation as a protective factor against retinopathy of prematurity

IntroductionIGF-1 deficiency in prenatal period is known to be a definite pathophysiology of retinopathy of prematurity(ROP), which is more frequent in infants with fetal growth restriction(FGR). Of note, recent reports demonstrated intra-amniotic inflammation(IAI) closely linked to acute histologic chorioamnionitis(acute-HCA) is associated with a decrease in intact-form of IGFBP-1, ultimately rising the probability of an increase in IGF-1. Therefore, we hypothesized ROP in preterm-infants without FGR would be decreased with the progression of acute-HCA. MethodsThe frequency of ROP was examined in 85 singleton preterm-infants(24.5weeks ≤ gestational-age[GA] at delivery<30weeks) due to either preterm-labor and intact-membranes(PTL) or preterm premature rupture of membranes(preterm-PROM) without FGR(birth-weight<5th percentile for GA). Patients were divided according to the progression of inflammation in extra-placental membranes(EPM) and the progression of inflammation in chorionic-vessel(CV) and umbilical-cord(UC). Results1) ROP was present in 40%(34/85) of study-population; 2) Of note, there was a significant stepwise-decrease in ROP with the progression of inflammation in EPM(inflammation-free EPM vs. inflammation restricted to CD vs. amnionitis; 55.6%[15/27]vs.39.5%[17/43]vs.13.3%[2/15]) and the progression of inflammation in CV and UC(inflammation-free CV and UC vs. inflammation restricted to CV and umbilical vessels vs. inflammation in Wharton's jelly[WJ]; 49.2%[29/59]vs.25.0%[3/12]vs.14.3%[2/14])(each-for P < 0.05, Chi-square test and each-for P < 0.01, linear-by-linear association); 3) Multiple logistic-regression analysis demonstrated amnionitis(Odds-Ratio 0.120, 95%Confidence-Interval 0.022–0.654, P = 0.014) and inflammation in WJ(Odds-Ratio 0.124, 95%Confidence-Interval 0.022–0.694, P = 0.018) were independent protective-factors against ROP. DiscussionROP in preterm-infants due to PTL or preterm-PROM without FGR is decreased with the progression of acute-HCA. This finding may be an evidence to suggest the progression of acute-HCA is closely associated with reducing the pathophysiology of ROP.

Thresholds of glycemia, insulin therapy, and risk for severe retinopathy in premature infants: A cohort study.

Hyperglycemia in preterm infants may be associated with severe retinopathy of prematurity (ROP) and other morbidities. However, it is uncertain which concentration of blood glucose is associated with increased risk of tissue damage, with little consensus on the cutoff level to treat hyperglycemia. The objective of our study was to examine the association between hyperglycemia and severe ROP in premature infants. In 2 independent, monocentric cohorts of preterm infants born at <30 weeks' gestation (Nantes University Hospital, 2006-2016, primary, and Lyon-HFME University Hospital, 2009-2017, validation), we first analyzed the association between severe (stage 3 or higher) ROP and 2 markers of glucose exposure between birth and day 21-maximum value of glycemia (MaxGly1-21) and mean of daily maximum values of glycemia (MeanMaxGly1-21)-using logistic regression models. In both the primary (n = 863 infants, mean gestational age 27.5 ± 1.4 weeks, boys 52.5%; 38 with severe ROP; 54,083 glucose measurements) and the validation cohort (n = 316 infants, mean gestational age 27.4 ± 1.4 weeks, boys 51.3%), MaxGly1-21 and MeanMaxGly1-21 were significantly associated with an increased risk of severe ROP: odds ratio (OR) 1.21 (95% CI 1.14-1.27, p < 0.001) and OR 1.70 (95% CI 1.48-1.94, p < 0.001), respectively, in the primary cohort and OR 1.17 (95% CI 1.05-1.32, p = 0.008) and OR 1.53 (95% CI 1.20-1.95, p < 0.001), respectively, in the validation cohort. These associations remained significant after adjustment for confounders in both cohorts. Second, we identified optimal cutoff values of duration of exposure above each concentration of glycemia between 7 and 13 mmol/l using receiver operating characteristic curve analyses in the primary cohort. Optimal cutoff values for predicting stage 3 or higher ROP were 9, 6, 5, 3, 2, 2, and 1 days above a glycemic threshold of 7, 8, 9, 10, 11, 12, and 13 mmol/l, respectively. Severe exposure was defined as at least 1 exposure above 1 of the optimal cutoffs. Severe ROP was significantly more common in infants with severe exposure in both the primary (10.9% versus 0.6%, p < 0.001) and validation (5.2% versus 0.9%, p = 0.030) cohorts. Finally, we analyzed the association between insulin therapy and severe ROP in a national population-based prospectively recruited cohort (EPIPAGE-2, 2011, n = 1,441, mean gestational age 27.3 ± 1.4, boys 52.5%) using propensity score weighting. Insulin use was significantly associated with severe ROP in overall cohort crude analyses (OR 2.51 [95% CI 1.13-5.58], p = 0.024). Adjustment for inverse propensity score (gestational age, sex, birth weight percentile, multiple birth, spontaneous preterm birth, main pregnancy complications, surfactant therapy, duration of oxygen exposure between birth and day 28, digestive state at day 7, caloric intake at day 7, and highest glycemia during the first week) and duration of oxygen therapy had a large but not significant effect on the association between insulin treatment and severe ROP (OR 0.40 [95% CI 0.13-1.24], p = 0.106). Limitations of this study include its observational nature and, despite the large number of patients included compared to earlier similar studies, the lack of power to analyze the association between insulin use and retinopathy. In this study, we observed that exposure to high glucose concentration is an independent risk factor for severe ROP, and we identified cutoff levels that are significantly associated with increased risk. The clinical impact of avoiding exceeding these thresholds to prevent ROP deserves further evaluation.

Cluster Analysis of Early Postnatal Biochemical Markers May Predict Development of Retinopathy of Prematurity.

PurposeGrowth factors and inflammatory and angiogenetic proteins are involved in the development of retinopathy of prematurity (ROP). However, no early biochemical markers are in clinical use to predict ROP. By performing cluster analysis of multiple biomarkers, we aimed to determine patient groups with high and low risk for developing ROP.MethodsIn total, 202 protein markers in plasma were quantified by proximity extension assay from 35 extremely preterm infants on day 2 of life. Infants were sorted in groups by automated two-dimensional hierarchical clustering of all biomarkers. ROP was classified as stages I to III with or without surgical treatment. Predictive biomarkers were evaluated by analysis of variance and detected differences by two-sided paired t-test with Bonferroni corrections for multiple comparisons.ResultsDifferences in 39 biochemical markers divided infants without ROP into two control groups (control 1, n = 7; control 2, n = 5; P < 0.05). Sixty-six biochemical markers defined differences between the control groups (n = 13) and all ROP infants (n = 23; P < 0.05). PARK7, VIM, MPO, CD69, and NEMO were markedly increased in control 1 compared to all ROP infants (P < 0.001). Lower TNFRSF4 and higher HER2 and GAL appeared in infants with ROP as compared to control 1 and/or 2 (P < 0.05, respectively).ConclusionsOur data suggest that early elevated levels of PARK7, VIM, MPO, CD69, and NEMO may be associated with lower risk of developing ROP. Lower levels of TNFRSF4 with higher levels of HER2 and GAL may predict ROP development.Translational RelevanceCluster analysis of early postnatal biomarkers may help to identify infants with low or high risk of developing ROP.

Ретинопатия недоношенных у детей со сроком гестации менее 27 недель

Ретинопатия недоношенных у детей со сроком гестации менее 27 недель