Retinopathy Of Prematurity In Preterm Infants Research Articles

Bilirubinemia and retinopathy of prematurity in infants ≤ 29 weeks' gestational age.

Bilirubin is a known antioxidant. We hypothesized that the degree of bilirubinemia is inversely associated with oxidative stress-mediated retinopathy of prematurity (ROP). A prospective study was performed to determine if bilirubinemia is associated with ROP in infants ≤ 29 wks' gestational age and birth weights ≤ 1000 g. Total serum bilirubin (TSB) levels were measured at least twice daily during the first week and at least daily during the second week to determine peak and mean TSB levels. The outcomes were the incidence and severity of ROP. Of 193 infants studied, 110 developed ROP: 53 had mild (stage 1 in zone 2 or 3); 31 had moderate (stage 2 in zone 2 or 3); and 26 had severe ROP ( ≥ stage 3 in any zone or any stage in zone 1). Mean TSB levels were associated with the severity (adjusted odds ratio [AOR] 0.68, 95% confidence interval [CI]:0.47-0.98, p = 0.04), but not with the incidence of ROP (AOR 0.81, 95% CI:0.52-1.27, p = 0.3). Peak TSB levels were also associated with the severity (AOR 0.71, 95% CI:0.52-0.96, p = 0.02), but not with the incidence of ROP (AOR 0.71, 95% CI:0.48-1.01, p = 0.07). Bilirubinemia may be protective against severity of ROP. Retinopathy of prematurity (ROP) is a disease mediated by oxidative stress. Increasing antioxidant status may decrease the incidence and severity of ROP. Bilirubin is a known antioxidant; however, findings from observational studies evaluating the role of bilirubinemia against the incidence and/or severity of ROP in premature infants are conflicting. Our findings from this prospective study suggests that bilirubinemia may be protective against the severity of ROP.

Pre-term Familial Exudative Vitreoretinopathy: A Novel Nonsense LRP5 Mutation.

This case report details the diagnosis and management of a pre-term infant with aggressive bilateral retinal pathology. A 4-week-old preterm baby girl, born at 28 weeks and 6 days to consanguineous parents, was referred for suspected aggressive posterior retinopathy of prematurity (ROP). She had a family history of bilateral retinal detachments and intellectual disability in an older sister. Clinical assessment included retinal examination, fluorescein angiography, optical coherence tomography, dual-energy X-ray absorptiometry (DEXA), and genetic testing. The genetic testing involved sequence analysis and copy number variation analysis of 25 genes related to vitreoretinopathy. Retinal examination and fluorescein angiography revealed extensive non-perfusion and telangiectatic vessels in both eyes, and a macula-involving tractional retinal detachment in the left eye. Despite treatment with intravitreal bevacizumab and laser photocoagulation, they progressed to total retinal detachment and no light perception in both eyes. Genetic testing revealed a pathogenic homozygous nonsense mutation in the LRP5 gene (c.3259C>T, p.(Gln1087*)), a mutation not previously reported in association with familial exudative vitreoretinopathy (FEVR). At 10 months of age, DEXA demonstrated normal bone density, diverging from the typical presentation of osteoporosis pseudoglioma syndrome associated with LRP5 mutations. This case describes a novel mutation in a complex retinal disease and underscores the necessity of considering pre-term FEVR in the differential diagnosis of atypical or aggressive ROP in preterm infants. The overlap in clinical features between ROP and FEVR highlights the complexity of diagnosis and management and the importance of genetic testing in preterm infants with retinal vascular abnormalities.

Deep Learning Models and Fusion Classification Technique for Accurate Diagnosis of Retinopathy of Prematurity in Preterm Newborn

اعتلال الشبكية الخداجي (ROP) هو السبب الأكثر شيوعًا لعمى الأطفال الذي لا رجعة فيه، ويعتمد تشخيصه وعلاجه على الدرجات الذاتية بناءً على سمات الأوعية الدموية في شبكية العين. ومع ذلك، فإن هذه الطريقة شاقة وعرضة للخطأ، لذا فإن الأساليب الآلية مرغوبة لمزيد من الدقة والإنتاجية. تهدف هذه الدراسة إلى تطوير نهج قائم على التعلم العميق للتشخيص الدقيق لمرض اعتلال الشبكية الخداجي الزائد عند الأطفال الخدج باستخدام نماذج التعلم التحويلية وتقنية تصنيف الاندماج. زودنا مركز الأمل للعيون في العيادة الخاصة في بغداد، العراق، بـ 2776 صورة لقاعدة فحص مرضى اعتلال الشبكية الخداجي بين عامي 2015 و2020، واستخدمنا هذه الصور لتدريب ثلاثة نماذج للشبكات العصبية التلافيفية العميقة (ResNet50 وDensenet161 وEfficientNetB5). تم استخدام نهج مصنف الاندماج لدمج النماذج الثلاثة من أجل تشخيص شامل ودقيق. تتميز النماذج الثلاثة بمعدلات دقة نسبية تبلغ 69.78٪ و80.57٪ و81.29٪ في تصنيفاتها الخاصة. ومع ذلك، زادت الدقة الإجمالية إلى 90.28 في المائة عند استخدام مصنف الاندماج. هذا يدل على أن الطريقة المقترحة مفيدة لتحديد اعتلال الشبكية الخداجي عند الخدج. تشير نتائج الدراسة إلى أن الطريقة المقترحة لديها القدرة على تعزيز الدقة والسرعة التي يتم بها تشخيص اعتلال الشبكية الخداجي بشكل كبير، مما قد يؤدي بدوره إلى الكشف المبكر عن المرض وعلاجه وتقليل احتمالية الإصابة بعمى الأطفال.

The association between serum 25-hydroxyvitamin D levels and retinopathy of prematurity in preterm infants.

This study aimed to investigate the correlation between serum 25-hydroxyvitamin D (25(OH)D) levels and retinopathy of prematurity (ROP) in premature infants one month after birth. Preterm infants (gestational age <32 weeks) admitted to the Affiliated Hospital of Qingdao University from 2017 to 2022 were divided into ROP and non-ROP groups based on ROP occurrence any stage. Serum 25(OH)D levels and clinical data were compared between the two groups at 1 month after birth, and the relationship between vitamin D levels and ROP was analyzed. Among the 217 premature infants included, 55 (25.35%) were in the ROP group, and 162 (74.65%) were in the non-ROP group. The ROP group had lower gestational age and birth weight, longer invasive ventilation (IV), non-invasive ventilation (NIV), and oxygen therapy times compared to the non-ROP group. Apgar scores, cesarean delivery, and antenatal steroids ratios were lower in the ROP group, while sepsis and pulmonary surfactant utilization ratios were higher (all p < 0.05). Significant differences in serum 25-(OH)D levels were observed among children in the non-ROP group (14.20 ± 5.07 ng/ml), ROP treated group (7.891 ± 1.878 ng/ml), and untreated group (12.168 ± 4.354 ng/ml) (p < 0.001). Multivariate regression analysis identified antenatal steroids as protective factors and lower birth weight, serum 25-(OH)D levels, long-term invasive mechanical ventilation, and sepsis as independent risk factors for ROP in premature infants. Vitamin D, lower birth weight, long-term invasive mechanical ventilation, and sepsis were associated with incidence of ROP in preterm infants. Vitamin D was associated with the severity of ROP, emphasizing the importance of prudent vitamin D supplementation and regular monitoring of serum 25-(OH)D levels.

Preterm Retinopathy of Prematurity and risk factors from a tertiary health care unit: A descriptive study

Abstract Introduction: Retinopathy Of Prematurity (ROP), is the major preventable blindness in infants. A study was conducted to find the risk factors of ROP in premature infants with gestational age (GA) &lt; 36 weeks. Methods: It was a descriptive study conducted in Kakatiya Medical College, Hanumakonda. Babies with major congenital, chromosomal anomalies were excluded. One hour before screening, a drop of Tropicamide was instilled for every 10 – 15 minutes for 4 times followed by a drop of Phenylephrine just before examination. ROP screening was carried out by a senior ophthalmologist in NICU. First, the anterior segment was examined. This was followed by sequential examination of all clock hours of the peripheral retina and findings were recorded. Association between variables was analysed by using Chi-Square test. P &lt; 0.05 was considered to be statistically significant. Results: ROP was detected in 31.4%; statistically there was no significant difference between gender. Apnoea, hyperbilirubinemia, anaemia, respiratory distress were found to be the risk factors for ROP; statistically there was significant difference, respectively. Conclusion: Preventing prematurity is the best way to reduce ROP. Proper coordination between obstetrician, neonatologist and ophthalmologist can help to reduce the incidence.

The Effects of Early Enteral and Parental Nutrition on Retinopathy of Prematurity: A Systematic Review.

The management of preterm newborns must consider the severe problem of retinopathy of prematurity (ROP). A systematic review has been conducted to effectively acknowledge how enteral and parenteral early nutrition affect the growth and progression of ROP. The study summarizes recent findings from various sources to give insight into the relationship between dietary practices and ROP risks. When untreated, retinopathy of prematurity (ROP) may cause severe vision loss or blindness in premature newborns. The latter two phases of ROP progression are the most serious. A child's early nutrition, both orally and intravenously, significantly impacts the severity and progression of ROP. This systematic review aims to examine the evidence linking early nutrition to ROP in premature infants. The study used Embase, Scopus, and PubMed to conduct our search. ROP, premature newborns, and nutrition were keywords used to find relevant papers. Nine research studies made it through the screening process and offered important information on the impact of diet on ROP. These studies support the idea that poor nutrition is a driving force behind the onset of ROP. The risk of ROP has been associated with postnatal development, hyperglycemia, polyunsaturated fatty acid levels, and the presence of breast milk. The outlook for ROP has also been discovered to be affected by the length of time the patient has received parenteral feeding. The incidence and severity of ROP may be mitigated by providing better nutrition to premature newborns. This comprehensive study concludes that early nutrition, both enteral and parenteral, substantially influences the development and progression of ROP in premature newborns. The significance of nutrition in newborn care is highlighted by the possibility that improved dietary methods might aid in preventing and treating this vision-threatening illness.

Childhood blindness from surge of advanced stage retinopathy of prematurity in premature infants during the COVID-19 pandemic: a case series

Background Retinopathy of prematurity (ROP) is a proliferative disease of the ocular retinal vasculature in premature infants, being a leading cause of preventable childhood blindness. The COVID-19 pandemic serves as an additional barrier to access to care and referral, potentially leading to more cases of advanced stage ROP. Although surgery can be done, ROP at this stage is highly associated with poor functional outcome irrespective of surgery. This case series aims to report advanced stage (stage 5) ROP in premature infants during the COVID-19 pandemic. MethodsA retrospective case series of medical records of paediatric patients with ROP was performed at Cipto Mangunkusumo National Referral Hospital between March 1, 2020 and December 31, 2021. This case series included new patients that presented to our clinic from March 2020 to December 2021 with stage 5 ROP. ResultsA total of 19 eyes of 10 patients with stage 5 ROP were included in this study. Mean chronologic age at presentation to our referral centre was 7.0 4.0 months. Upon presentation, all had stage 5 ROP with negative blink reflex to light, and none of the eyes in this cohort underwent surgical intervention. Mean gestational age was 30.3 3.2 weeks and mean birth weight was 1,276.7 366.4 g. ConclusionThere was an observable surge of stage 5 ROP at our referral centre with irreversible blindness. This highlights the need for proper ROP screening in all hospitals in Indonesia to prevent delay in detection and care of advanced stage ROP.

Early Hyperglycemia Is Associated with Increased Incidence of Severe Retinopathy of Prematurity in Extremely Low Birth Weight Infants.

Preterm infants have a higher rate of hypoglycemia and hyperglycemia, both of which have been associated with increased neonatal morbidities. The aim of this study was to evaluate the incidence of abnormal glucose homeostasis during the first 72 hours of life and study its association with major morbidities in infants admitted to our neonatal intensive care unit (NICU). This was a retrospective single-center study. We extracted demographic, maternal, and patient information and blood glucose levels for the first 72 hours of life for all infants with birth weight ≤1,000 g admitted to the NICU from January 2017 to December 2019. Continuous data were presented as mean ± standard deviation or as median with interquartile range. Categorical data were presented as frequency and percentage. Student's t-tests and Mann-Whitney U test were used to analyze continuous data and chi-squared test or Fisher's exact test were used to analyze categorical data. Logistic regression analysis was performed to study the relation between hyperglycemia and various morbidities after controlling for gestational age (GA). Statistical significance was set at p < 0.05. Of the 235 infants included in the study, 49% were hypoglycemic at admission to the NICU. Infants that were small for GA and those with history of maternal β-blocker use had a higher incidence of hypoglycemia. Hypoglycemia at admission was not associated with increased mortality or any major morbidities. Seventy-three percent infants who were hypoglycemic or euglycemic at birth developed iatrogenic hyperglycemia during the first 72 hours of life. The incidence of retinopathy of prematurity (ROP) and severe ROP was higher in infants with hyperglycemia on univariate analysis. However, on multivariate analysis, after adjusting for GA, no difference was noted in the incidence of ROP between the two groups. Multivariate analysis could not be performed for severe ROP due to inadequate sample size. Hyperglycemia in the initial 3 days of life is associated with an increased incidence of severe ROP in preterm infants. Neonatologists should aim to maintain euglycemia in these infants to decrease the risk of adverse outcomes. · Preterm infants have a high rate of both hypoglycemia and hyperglycemia.. · Majority of infants who were euglycemic or hypoglycemic at birth develop iatrogenic hyperglycemia.. · Hyperglycemia in the initial 3 days of life is associated with an increased incidence of severe ROP in preterm infants..

Is There a Relationship Between First-Trimester Aneuploidy Screening Serum Biomarker Values and Nuchal Translucency Measurements and the Development of Retinopathy of Prematurity (ROP) in Premature Infants?

Purpose The purpose of this study is the evaluation of serum biomarker and nuchal translucency (NT) values measured during first-trimester aneuploidy screening in terms of the development of retinopathy of prematurity (ROP) in premature infants and investigation of whether the development of ROP is associated with these parameters. Methods In this retrospective cohort study, 3,750 premature infants who underwent ROP screening from 2016 to 2021 were identified from the hospital medical record system. Among 2,130 premature babies screened for first-trimester aneuploidy, 166 babies whose mothers had single pregnancieswere screened by the same methodand showed the same clinical course in both eyes were included in the study. The infants were divided into two groups according to the presence of ROP, and those with ROP were further evaluated in two groups according to the presence of proliferation. The groups were compared in terms of the serum values of human chorionic gonadotropin and pregnancy-associated plasma protein A, among aneuploidy screening biomarkers, and NT measurements. Results There was no significant difference in the evaluated serum biomarker values and NT measurements between the ROP and non-ROP groups or between the proliferative ROP, non-proliferative ROP, and non-ROP groups. Conclusion Our results showed that first-trimester aneuploidy screening serum biomarker values and NT measurements were not associated with the development of ROP in premature infants.

Influence of maternal factors on retinopathy of prematurity: A cross-sectional Study from a tertiary care centre

Retinopathy of prematurity (ROP) is a serious condition affecting premature infants and identifying maternal risk factors is essential for its prevention. This study aimed to identify maternal risk factors associated with ROP in preterm newborns at a tertiary care center.This cross-sectional study was conducted between August 2021 and September 2022 at a tertiary care center. All preterm and low birth weight neonates attending the ROP clinic or admitted to the neonatal intensive care unit (NICU) were included, while term neonates and those weighing ≥2.5 kgs with anterior segment/posterior segment pathology other than ROP were excluded. Data on maternal and neonatal characteristics were obtained and inferential analysis was conducted using the chi-square test and Student’s t-test.Out of 410 preterm newborns included, 109 were diagnosed with ROP, indicating an institutional incidence of 26.58%. Advanced maternal age, low socio-economic status, urinary tract infection, chorioamnionitis, multiple pregnancy, pre-eclampsia, maternal anemia, history of asthma and steroid use during pregnancy were significantly associated with ROP.This study highlights the importance of addressing modifiable maternal risk factors to reduce the incidence of ROP in premature infants. Screening for ROP should be prioritized for neonates born to mothers with these risk factors to improve visual outcomes.

Vitreoretinal biomarkers of retinopathy of prematurity using handheld optical coherence tomography: a review.

Retinopathy of prematurity (ROP) is caused by abnormal retinal vascularization in premature infants that has the potential for severe long-term vision impairment. Recent advancements in handheld optical coherence tomography (OCT) have enabled noninvasive, high-resolution, cross-sectional imaging of the infant eye at the bedside. The use of handheld OCT devices in the diagnosis of ROP in premature infants has furthered our understanding of disease state and progression. This review discusses the known and novel biomarkers of ROP severity in premature infants identified through handheld OCT and potential for future directions.

INCIDENCE AND RISK FACTORS FOR RETINOPATHY OF PREMATURITY IN A LEVEL 3 NICU OF A TEACHING INSTITUTE IN MAHARASHTRA.

Background: Retinopathy of prematurity (ROP) is a serious complication seen in premature babies post treatment which can lead to blindness unless and until it is recognized and treated early. The objective was Objective: to estimate the incidence of ROP in preterm infants in Neonatal Intensive Care Unit (NICU) and to identify the risk factors which predispose to ROP. : ROP prospective screening survey was performed enrolling all premature Materials and Methods babies admitted to the NICU for a period of six months, with a gestational age of 34 weeks or less at birth and a birth weight of 2000gm or less. Those with a BW&gt;2000g or GA&gt;34 weeks with an unstable clinical course were included in the study as per recent IAP guidelines. The incidence of ROP in our study was 18.6%. Among babies with Results: gestational age less than 34 weeks had ROP incidence 31.1 %. No ROP was found in infants those who had weight of ≥ 2000g. Maximum babies had stage 2 ROP; only 1 baby had stage 1 ROP and all regressed spontaneously. Two babies had stage 3 ROP and required laser ablative therapy. Pearson Chi-Square test showed that there was a significant relationship between the occurrence of ROP and gestational age (P = 0.015) and low birth weight (P = 042) and number of days the baby was exposed to oxygen (p=0.0324). The incidence of ROP in our study was 18.6%. Low gestational Conclusion: age, low birth weight, oxygen therapy, were significant risk factors for ROP. Screening for early identification of retinal damage done soon after birth is important to prevent this blindness.

Effect of blood sampling management on reducing blood transfusions in very preterm infants.

Effect of blood sampling management on reducing blood transfusions in very preterm infants.

Characteristic and risk factors of retinopathy of prematurity in Sanglah Hospital Denpasar: 3-years retrospective study

Introduction: Retinopathy of prematurity (ROP) is one of the important causes of blindness in children. ROP is characterized by abnormal retinal neovascularization of premature infants. Purpose: This study aimed to estimate the prevalence of ROP in preterm infants at Sanglah Hospital Bali from 2015-2017 and identify the risk factors predisposing them to ROP. Methods: This was a retrospective study, observational analysis on premature infants diagnosed as ROP at Sanglah Hospital Bali from January 2015 to December 2017, with a gestational age of 30 weeks or less at birth and a birth weight of 1500 grams or less. Infants whose gestational age was &gt;30 weeks or whose birth weight was &gt;1500 grams were also included. The ophthalmological examinations were initiated between the fourth and sixth weeks of chronological age or 34 weeks of corrected age, whichever was earlier, and were repeated weekly or biweekly as per Indonesian guidelines for ROP screening, until full vascularization of the retina reached zone 3. Results: Out of 31 infants diagnosed as ROP, 3 (9.7%) cases developed ROP in one eye, and 28 (90,3%) cases in both eyes. They were classified as 23 (74.2%) cases stage 1, and 8 (25,8%) cases stage 2. None of the studied infants presented ROP at stage 3, 4, or 5. The risk for ROP was not significantly associated with birth weight (OR 0.375; 95% CI 0.030 – 4.635), gestational age (OR 0.897; 95% CI 0.792 – 1.015), sepsis (OR 1.111; 95% CI 0.089 – 13.835), blood transfusion (OR 1.111; 95% CI 0.089 – 13.835), and HMD (OR 1.118; 95% CI 0.977 – 1.443). Conclusions: The data of this study showed that low gestational age, low birth weight, sepsis, oxygen therapy, and blood transfusion may be contribute to the development of ROP, but not significant statistically. Clinicians should be aware of the presence of the additional risk factors when monitoring preterm infants,especially when giving supplemental oxygen therapy.

PRENATAL MATERNAL CHARACTERISTICS ASSOCIATED WITH RETINOPATHY OF PREMATURITY

Determine whether prenatal maternal characteristics such as sociodemographic characteristics, comorbidities, or pregnancy complications affect retinopathy of prematurity (ROP) development. Medical records of 236 mother-infant dyads from our institution were reviewed, only including dyads in which infants were born at 30 weeks gestational age or earlier. The primary outcome measure was the risk of ROP (defined Stage 1 or greater in either eye) and its association with prenatal maternal variables. Maternal Medicaid insurance, smoking during pregnancy, and chorioamnionitis were associated with an increased risk of ROP. For Medicaid insurance and chorioamnionitis, these risks were not appreciably altered by adjustment for potential confounders. These results suggest that several prenatal maternal factors may independently affect the risk of ROP in preterm infants. Validation of our findings could aid in the identification of infants at high risk for ROP based on prenatal clinical features.

GSDMD deficiency ameliorates hyperoxia-induced BPD and ROP in neonatal mice

Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) are among the most common morbidities affecting extremely premature infants who receive oxygen therapy. Many clinical studies indicate that BPD is associated with advanced ROP. However, the mechanistic link between hyperoxia, BPD, and ROP remains to be explored. Gasdermin D (GSDMD) is a key executor of inflammasome-induced pyroptosis and inflammation. Inhibition of GSDMD has been shown to attenuate hyperoxia-induced BPD and brain injury in neonatal mice. The objective of this study was to further define the mechanistic roles of GSDMD in the pathogenesis of hyperoxia-induced BPD and ROP in mouse models. Here we show that global GSDMD knockout (GSDMD-KO) protects against hyperoxia-induced BPD by reducing macrophage infiltration, improving alveolarization and vascular development, and decreasing cell death. In addition, GSDMD deficiency prevented hyperoxia-induced ROP by reducing vasoobliteration and neovascularization, improving thinning of multiple retinal tissue layers, and decreasing microglial activation. RNA sequencing analyses of lungs and retinas showed that similar genes, including those from inflammatory, cell death, tissue remodeling, and tissue and vascular developmental signaling pathways, were induced by hyperoxia and impacted by GSDMD-KO in both models. These data highlight the importance of GSDMD in the pathogenesis of BPD and ROP and suggest that targeting GSDMD may be beneficial in preventing and treating BPD and ROP in premature infants.

Prevalence of retinopathy of prematurity in a urban based tertiary hospital in central India

Background: Retinopathy of prematurity (ROP) is an important cause of preventable blindness in children. It is a serious and underestimated complication of prematurity treatment among preterm and low-birth weight babies and is preventable cause of blindness unless recognized and treated early. Objective: The objective of this study was to estimate the prevalence of ROP in preterm infants and low-birth weight in the Neonatal Intensive Care Unit (NICU) of a tertiary hospital and to increase the awareness of early screening of ROP among parents and doctors. Materials and Methods: A ROP prospective screening survey was performed enrolling all prematures and low-birth-weight Neonates delivered at Index Medical College Hospital &amp; Research Centre from July 2018 to June 2021, with a gestational age of 37 weeks or less at birth and a birth weight of 1700 g or less. One Hundred and Eighty Six(186) preterm infants (i.e.372 eyes) were included for ROP screening .Out of these 186 preterm infants (372eyes), Forty eight (48)preterm infants (i.e.96 eyes) developed Retinopathy of Prematurity. Descriptive statistics included the mean and standard deviation for numerical variables, and the percentage of different categories for categorical variables.

The role of hepatic and renal functions in the development of retinopathy of prematurity: Is proteinuria a new risk factor?

To investigate the association of hepatic and renal parameters with the development of retinopathy of prematurity (ROP) in premature infants with a gestational age ≤ 32weeks. Medical records of 240 preterm infants were reviewed retrospectively, 85 of them were grouped as type 1, type 2 ROP, and control group. The 4th week hepatic and renal function test results of the groups, on the day of their first ROP examinations, were compared for the risk of development of ROP and the development of type 1 ROP. In this study, 12, 35, and 38 infants were enrolled in the type 1, type 2 ROP, and control group, respectively. The average gestational age and birth weight were higher; however, the duration of oxygen treatment was lower in the control group (p < 0.001). The blood glucose level was significantly higher in the type 1 ROP group than in the other groups (p = 0.023). The mean of total serum bilirubin of the type 1 ROP group was significantly lower than those of the type 2 ROP and control group (p = 0.032). Proteinuria was present in 85.7% of preterms with treatment-requiring ROP and proteinuria increased the risk of ROP by 3.9 times (OR with 95% CI 3.9 (1.19-12.75), p = 0.042). We found significantly higher blood glucose and lower total bilirubin level in the type 1 ROP group. Moreover, our findings suggest that proteinuria may not be only a comorbidity factor but also related to a higher frequency of ROP and type 1 ROP in preterm infants.

Oral Ibuprofen Versus Oral Paracetamol in Pain Management During Screening for Retinopathy of Prematurity

Screening examinations for retinopathy of prematurity (ROP) are critical to reduce ROP-related vision loss; however, the procedure is painful and uncomfortable, and topical anesthetics do not completely suppress the pain responses. The number of safe and effective pharmacological options to reduce pain during eye examinations for ROP screening in preterm infants is limited. This study compared the efficacy of oral ibuprofen and oral paracetamol in reducing pain during screening for ROP in preterm infants. This prospective observational study was conducted at a tertiary-care neonatal intensive care unit. Forty-four preterm infants with gestational age of 32 weeks and less undergoing ROP screening were included. Each enrolled infant received either oral ibuprofen 10 mg/kg (n = 22) or oral paracetamol 10 mg/kg (n = 22) 1 hour before eye examination. The primary outcome measure was pain assessed by the Neonatal Pain, Agitation, and Sedation Scale (N-PASS). Secondary outcome measures were tachycardia, bradycardia, desaturations, and crying time. The groups were similar for gestational age, birth weight, and postnatal age at examination (P > .05). The mean N-PASS scores were not significantly different between the oral ibuprofen and oral paracetamol groups (8.64 ± 1.57 vs 8.50 ± 1.71, respectively, P = .605). Moreover, no significant intergroup differences were observed in the crying time and the incidence of tachycardia/bradycardia and desaturation (P > .05). Ibuprofen or paracetamol administered orally before ROP screening in preterm infants had similar analgesic effects and did not significantly alleviate pain during eye examination.

Effect of Enteral Long-Chain Polyunsaturated Fatty Acids on Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

Background: Long-chain polyunsaturated fatty acids (LCPUFA) are critical for the maturation of the brain and retina. Retinopathy of prematurity (ROP) is a preventable cause of blindness in preterm infants. LCPUFA have anti-inflammatory, antioxidant, and antiangiogenesis effects. Supplementation of enteral LCPUFA might mitigate the incidence of ROP in these infants. Available limited randomized studies showed promising results. We aimed to assess the effect of enteral supplementation of LCPUFA on ROP in preterm infants. Methods: We followed PRISMA guidelines and searched MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Embase, and Cochrane Registry from 1990 to 2021 for the studies that examined the effects of enteral LCPUFA and ROP in preterm infants. We included the studies that satisfied the predefined inclusion criteria. RevMan 5.3 software derived the forest plot of pooled relative risk. We assessed the quality of all the included studies using GRADE recommendations. Results: Nine studies were eligible for the meta-analysis involving 2,482 infants. Of the nine RCTs, six studies provided LCPUFA (DHA/AA) as a separate intervention in different concentrations, and three studies provided formula milk enriched with LCPUFA. In addition, five studies recruited infants below 32 weeks of gestational age. Supplementation of LCPUFA did not reduce the incidence of severe ROP (RR 0.71, 95% CI: 0.50–1.01, 5 studies, 1,822 infants) with very low CoE or any ROP (RR 0.95, 95% CI: 0.73–1.12, 6 studies, 1,177 infants) with very low CoE or ROP requiring treatment (RR 0.92, 95% CI: 0.62–1.38, 4 studies, 1,395 infants) with very low CoE. Regarding safety outcomes, enteral LCPUFA did not increase the risk of necrotizing enterocolitis or mortality. Discussion/Conclusion: Supplementation of enteral LCPUFA to preterm infants did not reduce ROP incidence; however, there was a trend toward benefit in mitigating severe form of ROP. More well-designed, large, randomized controlled studies are warranted.