Retinopathy Of Prematurity Screening Research Articles

Retinopathy of prematurity screening: prevalence and risk factors of ophthalmic complications in non-treated preterm infants.

Retinopathy of prematurity (ROP) is a vision-threatening disease of premature infants. Practice guidelines recommend that all infants screened for ROP receive follow-up eye examinations to screen for ophthalmic complications.1 The purpose of this study was to identify risk factors for the development of strabismus, amblyopia, high refractive error, and cataracts among ROP-screened, non-treated infants. Retrospective single-centre study of ROP-screened, non-treated premature infants with ophthalmic follow-up. Clinical variables were screened for association with ocular findings at follow-up. Multivariable logistic regression was used to determine the risk factors associated with ocular findings. 309 patients were seen for follow-up at 0.97 (0.69) [mean (SD)] years after neonatal intensive care unit (NICU) discharge. Strabismus was predicted by occipitofrontal circumference (OFC) z-score at NICU discharge (OR 0.61; 95% CI [0.42, 0.88]; p = 0.008), intraventricular haemorrhage (IVH) grade III or IV (OR 3.18; 95% CI [1.18, 8.54]; p = 0.02), and exclusive formula feeding at NICU discharge (OR 2.20; 95% CI [1.07, 4.53]; p = 0.03). Significant predictors of amblyopia were OFC z-score at discharge (OR 0.55; 95% CI [0.31, 0.96]; p = 0.03) and necrotising enterocolitis (NEC) (OR 6.94; 95% CI [1.38, 35.00]; p = 0.02). NEC was a significant risk factor for high refractive error (OR 7.27; 95% CI [1.39, 37.94]; p = 0.02). Among premature infants screened but not treated for ROP, severe IVH, NEC, low OFC z-score, and exclusive formula feeding at NICU discharge were risk factors for ocular morbidity. These findings affirm the value of ophthalmic follow-up for all ROP-screened infants, particularly those with the identified risk factors.

Effect of Breast Milk Feeding on Retinopathy of Prematurity in Neonates Less than 1800 Grams: A Cohort

Introduction Human milk has many antioxidants like Docosahexaenoic acid (DHA), inositol, and vitamin E that combat oxidative stress deregulating VEGF which is implicated in the pathogenesis of retinopathy of prematurity (ROP). Thus, it is biologically plausible that human milk is protective towards ROP. Aim and objective The study aimed to find the association between ROP and breast milk feeding. Methodology The prospective cohort study was carried out for 18 months at the Newborn unit, SJH. In our study, mothers were asked to maintain a feeding diary (type of milk fed) and history was taken from the mother regularly. Each neonate was later assigned a feeding category including exclusively breast milk fed, more than 50% breast milk fed, more than 50% top milk-fed, and exclusively top milk fed. At four weeks of age, all these neonates were called to undergo screening for ROP. In the case of immature retina, neonates were followed up for repeat fundus exams and results were included in the study. Result A study on 521 neonates between birth weight of 1–1.8 kgs found that predominant breast milk feeding reduces the chance of any stage ROP (needing repeat screening or intervention). The total incidence of any stage ROP in this study was noted to be 16.2% where 4.1% of total neonates from the predominantly breastfed group as compared to 37.8% from the predominantly top-fed group developed any stage ROP. Conclusion Breast milk feeding has a significant benefit in reducing any stage ROP and ROP needing intervention, thus it has the potential to prevent a significant cause of childhood blindness. What is already known – Breast milk feeding may be protective towards ROP What the study adds – Breast milk feeding is independently protective towards ROP

Intranasal dexmedetomidine reduces pain scores in preterm infants during retinopathy of prematurity screening.

This study aimed to investigate the effectiveness of intranasal dexmedetomidine in reducing pain scores during retinopathy of prematurity (ROP) screening examinations in preterm infants. Infants born at ≤32 weeks of gestational age, undergoing routine ROP examinations in the neonatal intensive care unit, were included in the study and divided into two groups: the standard protocol group (n = 43) and the dexmedetomidine group (n = 56), over a 1-year period. Both groups received standard procedural preparation including swaddling, oral dextrose, and topical anesthesia with proparacaine. The dexmedetomidine group additionally received intranasal dexmedetomidine at a dose of 1 mcg/kg before the procedure. Pain scores (PIPP score), heart rate, respiratory rate, blood pressure, and oxygen saturation were compared at baseline, 1-min, and 5-min during the procedure. There were no significant differences between the groups regarding descriptive and pre-procedure characteristics. In the dexmedetomidine group, the median (25-75p) PIPP score, heart rate, systolic blood pressure and mean (±SD) respiratory rate measured at the 1st minute of the procedure were significantly lower than those in the standard group [PIPP score 10 (8-13) vs. 14 (10-16), p < 0.001; heart rate 165 (153-176) beats/min vs. 182 (17-190) beats/min, p < 0.001; respiratory rate 60 (±7) breaths/min vs. 65(±9) breaths/min, p = 0.002; systolic blood pressure 78 (70-92) mmHg vs. 87 (78-96) mmHg, p = 0.024; respectively] whereas the saturation value was significantly higher (88% (81-95) vs. 84% (70-92), p = 0.036; respectively). By the 5th minute of the procedure, the median (25-75p) PIPP score [4 (2-6) vs. 6 (4-10), p < 0.001], heart rate [148 (143-166) beats/min vs. 162 (152-180) beats/min, p = 0.001] and respiratory rate [56 (54-58) breaths/min vs. 58 (54-62) breaths/min, p = 0.034] were significantly lower, and the saturation level was significantly higher [96% (94-97) vs. 93% (91-96), p = 0.003] in the dexmedetomidine group. Additionally, the frequency of adverse effects was significantly lower in the dexmedetomidine group compared to the standard protocol group (11% vs. 47%, p = 0.001). Administering intranasal dexmedetomidine before ROP screening examinations was associated with a decrease in pain scores among preterm infants. This suggests its potential as an effective and well-tolerated method for pain management during ROP screenings.

Anatomical outcome of laser treatment alone in aggressive retinopathy of prematurity.

The purpose is to study the anatomical outcome of eyes in aggressive retinopathy of prematurity (AROP), treated with laser photocoagulation alone and to evaluate factors affecting outcomes. Records of consecutive babies diagnosed with AROP, undergoing laser photocoagulation treatment in rural tertiary care centers from October 2016 to January 2021 were reviewed retrospectively. Anatomical outcome at 6 months follow-up was grouped as good in eyes with complete regression and poor in those who developed retinal detachment (stage IV a, IV b, and V). Both groups were compared with respect to the period of gestation, birth weight (BW), age at screening, age at treatment, zone of disease, presence of retinal fibrovascular proliferation (FVP), tunica vasculosa lentis, preretinal bleed, need for supplement laser, and associated systemic risk factors. Of the total of 2468 babies screened, 124 (5.02%) were diagnosed with severe retinopathy of prematurity (ROP), of which 54 (43.5%) lasered AROP babies were analyzed. Mean BW and gestation period of the AROP cohort were 1.43 kg and 31.1 weeks, respectively. Eighty-six eyes (79.6%) had good outcomes with laser photocoagulation alone. Posterior location of disease, presence of FVP, neonatal sepsis, shock, and late screening for ROP were found to be factors associated with poor outcomes. Adequate and timely treatment with laser photocoagulation in AROP can achieve good treatment outcomes in a significant proportion of babies. Although a combined approach using laser, anti-vascular endothelial growth factor and early vitrectomy is better, laser remains a viable treatment option in AROP, especially with limited resources and high risk of loss to follow-up.

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.

Frequency and risk factors of retinopathy of prematurity among preterm neonates in a tertiary care hospital of Bangladesh

Background: Retinopathy of prematurity (ROP), a leading cause of childhood blindness, occurs in premature babies. Several factors like perinatal infection, inflammation, hypoxia, hypercapnia, higher oxygen support etc. have been attributed to the cause. Identifying the potentially modifiable risk factors will contribute to making preventive strategy. Objective: To identify the frequency and risk factors of ROP in premature babies. Methodology: This prospective observational study was conducted in the Department of Neonatology of BSMMU after approval from the institutional review board over a period of twelve months. Infants born &lt;35 completed weeks, weighing &lt;2000 g admitted in NICU are included in this study. After enrollment, screening for ROP was done at 20 days for the baby -gestational age of ≤ 30 weeks or birth weight ≤ 1200 g and at 30 days for the baby- gestational age ≤ 35 weeks or birth weight ≤ 2000g. ROP screening test was done by a pediatric ophthalmologist with indirect Ophthalmoscope. The outcome measures were the frequency and risk factors of ROP. Results: Between 2021 and 2022, 154 infants born ≤ 35 weeks gestation, weighing ≤ 2000 g were screened for ROP. Among the studied cases 30 (19.5%) patients had ROP. Among the 30 patients, 16 (53.33%) had AP-ROP, 3 (10%) had plus disease and 3 (10%) had stage IV (6.67%) ROP. Among the newborns diagnosed with ROP, 23 (76.67%) required treatments. Among them, Inj. Avastin was given to 18 (78.26%) patients, 5 (21.7%) needed Laser therapy but none of them required surgery. Univariate analysis showed risk of ROP was significantly higher in lower gestational age and lower birth weight group. Frequency of sepsis, duration of oxygen support, need for CPAP, hospital stay, and Intraventricular hemorrhage (IVH) were significantly higher among ROP group. Antenatal corticosteroid significantly lowered the risk of ROP. Multivariate analysis also showed that antenatal corticosteroid had protective effect against ROP and prematurity, lower birth weight, sepsis, longer duration of oxygen therapy, and longer duration of hospital stay increased the risk of ROP. Conclusions: This prospective observational study showed frequency of ROP was 19.5%. Prematurity, lower birth weight, lack of antenatal-corticosteroid, sepsis, longer duration of oxygen support, and longer hospital stay are some potential risk factors of developing ROP

Retinopathy of prematurity: prevalence, screening and treatment

Retinopathy of prematurity (ROP) is a serious ocular condition arising from improper blood vessel development in the retina, predominantly affecting infants born prematurely or with a birth weight under 1500 g. A global estimate from 2010 indicated that approximately 184,700 infants developed ROP, with around 50,000 progressing to severe stages, yet only 42% received treatment. This article undertakes a thorough review, commencing on 07th November 2023, leveraging databases like Pubmed and Cochrane to synthesize current knowledge and emerging trends in ROP prevalence, screening methodologies, and treatment options. Screening involves repeated eye exams and innovative tools to identify high-risk infants early on. Treatment approaches, encompassing cryotherapy, laser therapy, and anti-VEGF (vascular endothelial growth factor) medications, are tailored to the severity of ROP. Rigorous follow-up assessments are pivotal for tracking progress and ensuring the welfare of infants undergoing ROP interventions. This comprehensive exploration seeks to enhance awareness and understanding of ROP's global prevalence, screening protocols, and evolving treatments, ultimately contributing to informed decision-making and the advancement of best practices in the early identification and management of ROP among premature infants.

Knowledge, awareness and attitudes towards retinopathy of prematurity among Jordanian pediatricians: a cross sectional descriptive study

Abstract&#x0D; Background: Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness. This study aims to measure knowledge, awareness and attitudes of Jordanian pediatricians towards ROP screening and treatment protocols, and to identify any barriers concerning referrals to specialized care.&#x0D; Methods: This is a cross-sectional non-interventional descriptive study. A self-administered semi- structured electronic questionnaire was designed to assess the knowledge, attitude and practice patterns of responders and was disseminated via social media and direct contact with pediatricians in governmental and private hospitals from all over the country and collected between June and November of 2022. The questionnaire included questions regarding demographics, level of education, practice details and knowledge regarding ROP.&#x0D; Results: A total of 85 responders from all levels completed the questionnaire. Most of the responders (78 (91.8%)) identified the main risk factors of ROP as low birth weight and gestational age and maintained that timely screening should be performed by an ophthalmologist. Fifty-nine pediatricians (69.4%) were sure that ROP is preventable and 62 (72.9%) identified both laser and anti- vascular endothelial growth factor injections as possible modalities of treatment. Thirty participants (35.3%) faced real limitations reaching ophthalmologists for a reliable ROP consultation. &#x0D; Conclusions: This study demonstrated a high level of awareness of ROP among Jordanian pediatricians of all levels, although some gaps pertaining to the accurate timing of screening still exist. There are identifiable limitations facing Jordanian pediatricians to reach a reliable ophthalmic service to screen and manage referred cases. A unified nation-wide ROP screening protocol with clear access to standardized ophthalmic care is necessary to reduce the challenges facing the screening and management process and by extension, the burden of this preventable disease.

Thrombocytopenia as a Clinical Biomarker of Retinopathy of Prematurity: A Systematic Review

Highlights: This is the first systematic review investigating thrombocytopenia and its association with retinopathy of prematurity The findings suggest that thrombocytopenia could serve as a potential clinical biomarker for screening ROP, considering its quick, affordable, and widespread availability for examination purposes. Abstract Retinopathy of prematurity (ROP) is the leading cause of childhood blindness and occurs due to the underdevelopment of retinal blood vessels in premature infants. Platelets are essential in the regulation of angiogenesis. Hence, thrombocytopenia might aid in the progression of ROP. This systematic review aims to look into the relationship between thrombocytopenia and retinopathy of prematurity. The PubMed and Cochrane Library databases were accessed to include retrospective case-control and cross-sectional studies, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In our review, 9 records were analyzed. All research was done in the period between 2017 and 2022 . Seven studies have reported the prevalence of thrombocytopenia in infants with retinopathy of prematurity (ROP), ranging from 18.37% to 71%. In preterm children without ROP, the occurrence of thrombocytopenia is between 5.71% and 21%. Seven studies have significantly identified thrombocytopenia as a risk factor for ROP, with the Odd Ratio (OR) for thrombocytopenia ranging from 2.8 to 6.69 . Therefore, thrombocytopenia in premature infants could be thought of as a potential clinical biomarker for Type-1 ROP screening. Additionally, this discovery implied that thrombocytopenia can contribute to the pathophysiology of ROP. The crucial platelet count threshold in ROP requires additional investigations.

Non-pharmacological pain relief interventions in preterm neonates undergoing screening for retinopathy of prematurity: a systematic review

ObjectiveThe objective of this review was to determine the efficacy of non-pharmacological interventions for pain management during retinopathy of prematurity (ROP) screening.Methods and analysisElectronic search of Ovid MEDLINE, PubMed, EMBASE,...

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.

Retinopathy of prematurity – developing too soon in babies born too early : A report of three cases

Nigeria has the third largest incidence of premature birth, after India and China. Most babies that will require treatment for retinopathy of prematurity (ROP) have birth weight (BW) less than 1500g and gestational age (GA) less than 32 weeks, with initial eye examination within the first 30 days of life. This report aims to present the findings in three babies with vision threatening ROP that developed at less than 30 days of life. Routine screening for ROP was conducted for three babies. One was born GA 33 weeks, BW 1.6kg, screened for ROP on the 13th day of life, while the other two were a set of twins born at GA of 33 weeks, both BW 1.3kg, screened for ROP first on the 16th day of life. The twins were found to have arborizing vessels at the initial exam, which progressed to stage 3 pre-plus ROP by the 23rd day of life. The 3rd child had stage -3 plus disease at the first screening, warranting immediate LASER therapy. The screening criteria of Nigeria ROP group is BW ≤ 1500g or GA of ≤ 34 weeks, with the first eye examination within the first 30 days of life. These case reports show that larger babies can also develop sight threatening ROP within the first two weeks of life. There is a need for constant review of ROP screening criteria and timing based on locally available data.

4 Severity of Retinopathy of Prematurity and Motor Skills Development in Preschoolers

AbstractObjective:Children born preterm are at increased risk of deviation from the typical developmental trajectory. The probability of adverse developmental sequelae is increased in those with history of major perinatal complications. Retinopathy of prematurity (ROP) is a pathological disordered growth of retinal blood vessels occurring in very preterm neonates who require supplemental oxygen. ROP has been linked to intermittent hypoxemic events and blood gas derangements occurring in the Neonatal Intensive Care Unit (NICU), particularly in ventilated infants. Though presence and severity of ROP have been linked to neurodevelopmental impairment, little is known about the relationship between ROP severity and motor development in the preschool age. Because the same hypoxemic events and blood gas changes that lead to severe ROP may also lead to greater developmental deficits in motor control, we hypothesized that ROP severity will be inversely linked to the quality of motor functioning even in NICU graduates without neurological impairments.Participants and Methods:We included 95 preterm (23.6 - 33.6 weeks gestation) preschoolers (49 females, 44 members of twin pairs or triplets). The participants' age ranged from 3.3 - 4.1 years (adjusted for prematurity). ROP screening was conducted during NICU stay and rated from immature retina (0) to grade 4. Motor abilities were assessed with the Peabody Developmental Motor Scales (PDMS-2). Cases with diagnosed perinatal brain pathology (moderate to severe) or cerebral palsy were excluded from analyses.Results:We used linear mixed regression analyses with multiple gestation as a random factor. Severity of ROP was our predictor of interest, whereas socioeconomic status, sex, gestational age, and birth-weight SD served as covariates. Separate analyses were conducted using the PDMS-2 Total Motor, Fine Motor, and Gross Motor Quotients as dependent variables. ROP severity explained a unique portion of the variance in the Total Motor Quotient (F[1, 89] = 5.59, p = .02). Examination of the relationship between ROP severity and motor skill domains yielded a significant association for the Fine Motor Quotient (F[1, 89] = 6.19, p = .015) and a trend for the Gross Motor Quotient (F[1, 89] = 3.64, p = .06).Conclusions:The results of this study reveal that increase in ROP severity is linked to poorer motor skills in preterm-born preschoolers without major disabilities or perinatal diagnosis of moderate to severe brain pathology. This association was evident for both fine and gross motor skills, though only the relationship between ROP severity and the former motor index reached conventional statistical significance. Importantly, ROP severity accounted for a unique portion of the variance in motor performance, over and above the variance explained by other perinatal risk factors. This result is consistent with previous research findings indicating that ROP is linked to the occurrence of multiple, subtle hypoxemic events and 'exposure' to blood gas derangements during NICU stay in very preterm neonates who require respiratory support.

Neurodevelopmental Outcomes in Infants Screened for Retinopathy of Prematurity

Preterm infants screened for retinopathy of prematurity (ROP) are at risk for heterogenous neurodevelopment outcomes that are difficult to predict. To characterize the potential association between socioeconomic and clinical risk factors and neurodevelopmental outcomes in a diverse, multicenter cohort of premature neonates screened for ROP. This was a retrospective cohort study using electronic medical records and US Census Bureau income data. This study was performed at academic (University of California, Los Angeles [UCLA] Mattel Children's Hospital and UCLA Santa Monica Hospital), community (Cedars-Sinai Medical Center), and LA county (Harbor-UCLA Medical Center) neonatal intensive care units. Participants included infants who met American Academy of Pediatrics guidelines for ROP screening and had records from at least 1 Bayley Scales of Infant and Toddler Development (BSID) neurodevelopment assessment between 0 and 36 months of adjusted age. Data analyses were conducted from January 1, 2011, to September 1, 2022. Demographic and clinical information, proxy household income, and health insurance type were collected as risk factors. Neurodevelopmental outcomes in the cognitive, language, and motor domains measured via BSID were the primary outcomes. A total of 706 infants (mean [SD] age, 28.6 [2.4] weeks; 375 male [53.1%]) met inclusion criteria. In a multivariable model, which included adjustments for birth weight, sex, insurance type, intraventricular hemorrhage (IVH), and age at assessment, public health insurance was associated with a 4-fold increased risk of moderate to severe neurodevelopmental impairment (NDI) in cognitive and language domains (cognitive, odds ratio [OR], 3.65; 95% CI, 2.28-5.86; P = 8.1 × 10-8; language, OR, 3.96; 95% CI, 2.61-6.02; P = 1.0 × 10-10) and a 3-fold increased risk in the motor domain (motor, OR, 2.60; 95% CI, 1.59-4.24; P = 1.4 × 10-4). In this adjusted model, clinical factors that were associated with an increased risk of moderate to severe NDI included lower birth weight, diagnosis of IVH, male sex, and older age at time of Bayley assessment. In unadjusted analyses, infants who received either laser or anti-VEGF treatment, compared with infants without treatment-requiring ROP, had lower BSID scores in multiple domains at 0 to 12 months, 12 to 24 months, and 24 to 36 months (DATA). In the multivariable model, treatment type was no longer associated with worse neurodevelopmental outcomes in any domain. Study results suggest an association between public insurance type and NDI in a diverse population screened for ROP, indicating the complexities of neurodevelopment. This study also supports the early neurodevelopmental safety of anti-VEGF treatment, as anti-VEGF therapy was not found to be independently associated with worse NDI in any domain.

Early detection and correlation of tear fluid inflammatory factors that influence angiogenesis in premature infants with and without retinopathy of prematurity.

To measure the levels of inflammatory factors in tear fluid of pre-term infants with and without retinopathy of prematurity (ROP). The cross-sectional pilot study included 29 pre-term infants undergoing routine ROP screening. Pre-term infants were grouped as those without ROP (no ROP; n = 14) and with ROP (ROP; n = 15). Sterile Schirmer's strips were used to collect the tear fluid from pre-term infants. Inflammatory factors such as interleukin (IL)-6, IL-8, MCP1 (Monocyte Chemoattractant Protein 1; CCL2), RANTES (Regulated on Activation, Normal T Cell Expressed and Secreted; CCL5), and soluble L-selectin (sL-selectin) were measured by cytometric bead array using a flow cytometer. Birth weight (BW) and gestation age (GA) were significantly (P < 0.05) lower in pre-term infants with ROP compared with those without ROP. Higher levels of RANTES (P < 0.05) and IL-8 (P = 0.09) were observed in the tear fluid of pre-term infants with ROP compared with those without ROP. Lower levels of tear fluid IL-6 (P = 0.14) and sL-selectin (P = 0.18) were measured in pre-term infants with ROP compared with those without ROP. IL-8 and RANTES were significantly (P < 0.05) higher in the tear fluid of pre-term infants with stage 3 ROP compared with those without ROP. Tear fluid RANTES level was observed to be inversely associated with GA and BW of pre-term infants with ROP and not in those without ROP. Furthermore, the area under the curve and odds ratio analysis demonstrated the relevance of RANTES/BW (AUC = 0.798; OR-7.2) and RANTES/MCP1 (AUC = 0.824; OR-6.8) ratios in ROP. Distinct changes were observed in the levels of tear inflammatory factors in ROP infants. The status of RANTES in ROP suggests its possible role in pathobiology and warrants further mechanistic studies to harness it in ROP screening and management.

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.

Study protocol of OmegaROP-2 prospective study: expression of placental fatty acid receptors in preterm newborns with retinopathy of prematurity

BackgroundIncomplete vascularization of the retina in preterm infants carries a risk of retinopathy of prematurity (ROP). Progress in neonatal resuscitation in developing countries has led to the survival of an increasing number of premature infants, resulting in an increased rate of ROP and consequently in visual disability. Strategies to reduce ROP involve optimizing oxygen saturation, nutrition, and normalizing factors such as insulin-like growth factor 1 and n-3 long-chain polyunsaturated fatty acids (LC-PUFA). Our previous study, OmegaROP, showed that there is an accumulation or retention of docosahexaenoic acid (DHA) in mothers of infants developing ROP, suggesting abnormalities in the LC-PUFA placental transfer via fatty acid transporting proteins. The present study aims to better understand the LC-PUFA transport dysfunction in the fetoplacental unit during pregnancy and to find a novel target for the prevention of ROP development.MethodsThe study protocol is designed to evaluate the correlation between the expression level of placental fatty acid receptors and ROP occurrence. This ongoing study will include 100 mother-infant dyads: mother-infant dyads born before 29 weeks of gestational age (GA) and mother-infant dyads with full-term pregnancies. Recruitment is planned over a period of 46 months. Maternal and cord blood samples as well as placental tissue samples will be taken following delivery. ROP screening will be performed using wide-field camera imaging according to the International Classification of ROP consensus statement.DiscussionThe results of this study will have a tangible impact on public health. Indeed, if we show a correlation between the expression level of placental omega-3 receptors and the occurrence of ROP, it would be an essential step in discovering novel pathophysiological mechanisms involved in this retinopathy.Trial registrationNCT04819893.

Variations in medical practice of retinopathy of prematurity among 8 Asian countries from an international survey

Advances in perinatal care have led to the increased survival of preterm infants with subsequent neonatal morbidities, such as retinopathy of prematurity (ROP). This study aims to compare the differences of neonatal healthcare systems, resources, and clinical practice concerning ROP in Asia with review of current literature. An on-line survey at the institutional level was sent to the directors of 336 neonatal intensive care units (NICU) in 8 collaborating national neonatal networks through the Asian Neonatal Network Collaboration (AsianNeo). ROP screening was performed in infants born at < 34 weeks in Indonesia and Japan. In South Korea, Malaysia, and Taiwan, most screened for ROP in infants born at < 32 weeks. In all networks, majority of NICUs conducted ROP screening to infants with birth weight < 1500 g. In most NICU’s in-hospital ophthalmologists performed indirect ophthalmoscopy and some were supplemented with digital imaging. Both laser photocoagulation and anti-vascular endothelial growth factor injection are performed for treatment and, vitreous surgeries are conducted less frequently in all countries. Despite limited information collected by the survey, this first study to compare ROP practices implemented in eight Asian countries through AsianNeo will enable an understanding of the differences and facilitate quality improvement by sharing better practices.

Development and validation of an artificial intelligence based screening tool for detection of retinopathy of prematurity in a South Indian population.

The primary objective of this study was to develop and validate an AI algorithm as a screening tool for the detection of retinopathy of prematurity (ROP). Images were collected from infants enrolled in the KIDROP tele-ROP screening program. We developed a deep learning (DL) algorithm with 227,326 wide-field images from multiple camera systems obtained from the KIDROP tele-ROP screening program in India over an 11-year period. 37,477 temporal retina images were utilized with the dataset split into train (n = 25,982, 69.33%), validation (n = 4,006, 10.69%), and an independent test set (n = 7,489, 19.98%). The algorithm consists of a binary classifier that distinguishes between the presence of ROP (Stages 1-3) and the absence of ROP. The image labels were retrieved from the daily registers of the tele-ROP program. They consist of per-eye diagnoses provided by trained ROP graders based on all images captured during the screening session. Infants requiring treatment and a proportion of those not requiring urgent referral had an additional confirmatory diagnosis from an ROP specialist. Of the 7,489 temporal images analyzed in the test set, 2,249 (30.0%) images showed the presence of ROP. The sensitivity and specificity to detect ROP was 91.46% (95% CI: 90.23%-92.59%) and 91.22% (95% CI: 90.42%-91.97%), respectively, while the positive predictive value (PPV) was 81.72% (95% CI: 80.37%-83.00%), negative predictive value (NPV) was 96.14% (95% CI: 95.60%-96.61%) and the AUROC was 0.970. The novel ROP screening algorithm demonstrated high sensitivity and specificity in detecting the presence of ROP. A prospective clinical validation in a real-world tele-ROP platform is under consideration. It has the potential to lower the number of screening sessions required to be conducted by a specialist for a high-risk preterm infant thus significantly improving workflow efficiency.

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.