Retinopathy Of Prematurity Research Articles

Evaluation of the update on screening for retinopathy of prematurity in a tertiary care center in Türkiye with retrospective cohort

Evaluation of the update on screening for retinopathy of prematurity in a tertiary care center in Türkiye with retrospective cohort

Reducing the Waiting Time for Retinopathy of Prematurity Evaluation—A Quality Improvement Interventional Study

Aim To reduce the waiting time of babies for retinopathy of prematurity (ROP) evaluation at a tertiary care paediatric centre in Rajasthan and check its impact on follow-up. Methods It was a Quality improvement (QI) interventional study in which a QI team was made. A Fishbone root cause analysis after 1 month of observation was done to understand the reasons for the high waiting time for ROP screening in both IPD and OPD. This was followed by three plan-do-study-act (PDSA) cycles: segregation of the IPD & OPD patients by fixing two separate days and hiring a full-time paediatric ophthalmologist; distribution of informative digital/printed leaflets; timely reporting of staff, dilation of pupils, equipment availability and proper examination order. Average waiting time and maximum waiting time were measured before and after the PDSA cycles. Results After the completion of all PDSA cycles: Overall maximum waiting time for OPD and IPD patients was reduced from 130 and 138 minutes to 96 (26.2%) and 97 minutes (29.7%), respectively. The average waiting time for OPD and IPD patients was reduced from 96.2 and 92.4 minutes to 76.5 (20.5%) and 73.4 minutes (20.6%), respectively. The number of patients coming for ROP follow-up also increased. Conclusion The QI initiative using the point of care QI model (POCQI) was quite effective in reducing the maximum and average waiting time of babies undergoing ROP screening. It also increased their follow-up at our centre.

Reactivation of retinopathy of prematurity after ranibizumab treatment

Retinopathy of prematurity (ROP) is one of the most common causes of visual disability in children born prematurely. Intravitreal injection of angiogenesis inhibitors (antivascular endothelial growth factor [VEGF] therapy) is considered one of the conservative methods of treating ROP. Aim: This study aimed to present a clinical case of ROP reactivation after intravitreal injection of the antiVEGF drug ranibizumab (Lucentis). MATERIAL AND METHODS: The course of retinopathy in a premature infant with extremely low birth weight was studied. RESULTS: A patient diagnosed with ROP, a posterior aggressive form of both eyes, received intravitreal injections of an angiogenesis inhibitor at 36 postconceptional weeks. During subsequent follow-up, disease progression was noted, which necessitated repeated ranibizumab administrations to both eyes. Over time, tractional retinal detachment developed in the right eye, and the disease progressed more slowly in the left eye. At the age of 1 year, ROP rapidly progressed to stage 4B in the left eye. Lens vitrectomy was performed sequentially on the right and then on the left eye. At the age of 1.5 years, the patient had coarse preretinal adhesions in the posterior pole of both eyes and had no spatial vision, whereas light perception was preserved. CONCLUSION: Intravitreal ranibizumab administration for posteriorly aggressive ROP does not exclude its reactivation both early and late after administrations. Further improvement in treatment methods for ROP is necessary.

On the issue of the new edition of the international classification of retinopathy of prematurity. Part 2

Retinopathy of prematurity (ROP) is the leading cause of visual disability from early childhood. Foreign researchers and clinicians are focused on studying a new pharmacological method of treatment of active RN using anti-VEGF drugs, which was a reason that prompted updates in the International Classification of Retinopathy of Prematurity (ICROP) in 2021. The second part of the article presents new terms recommended by the Committee for the ICROP: “regression,” which refers to the involution and resolution of the disease, and “reactivation,” which denotes a recurrence of signs in the acute phase. Notably, the latest edition of the ICROP requires a deep understanding and accurate application by domestic specialists treating ROP. This contributes to the standardization of therapeutic and diagnostic processes, therefore, improving the quality of ROP treatment in Russia.

Serendipitous Discovery of Lipemia Retinalis in a Premature Infant: A Case Report

Introduction Lipemia retinalis (LR) is a rare ocular condition characterized by a creamy white appearance of the retinal vessels, which is indicative of significantly elevated serum triglyceride (TG) levels. This condition is particularly noteworthy in pediatric populations, especially in preterm infants who are at risk for various metabolic disorders. Case Presentation We report a case of LR in a 44-day-old preterm infant identified during routine retinopathy of prematurity (ROP) screening. Unusual retinal findings led to metabolic investigations, revealing elevated TG levels confirming LR. The infant was managed with a dietary regimen including skimmed milk, resulting in a substantial decrease in TG levels and complete resolution of the retinal changes. Conclusion Fundus examination serves as a portal to the systemic health of an individual, enabling rare identification of LR, indicative of underlying dyslipidemia. This case underscores the necessity for comprehensive metabolic screening in preterm infants, particularly during ROP assessments. Furthermore, it emphasizes the effectiveness of dietary interventions in managing LR. The favorable outcomes stress the significance of early detection of LR in pediatric patients and implementing nutritional strategies to enhance metabolic well-being, thereby averting severe hypertriglyceridemia complications.

Evaluation of Foveal Hypoplasia in Children with a History of Retinopathy of Prematurity.

To evaluate the foveal development in patients diagnosed with retinopathy of prematurity (ROP) and to evaluate whether foveal development was affected by treatment in ROP patients. This cross-sectional study included patients with a history of ROP. Foveal development was compared between eyes with spontaneous regression and treated eyes. Additionally, gestational age, birth weight, ROP zone and stage, and postmenstrual gestational age at the time of treatment, were evaluated. The final visual acuity was analyzed according to the foveal hypoplasia (FH) severity. This study included 166 eyes from 83 patients. Foveal development was significantly different among the treatment and spontaneous regression groups, and FH was more severe in the treatment group. The prevalence of normal foveal development was higher in the spontaneous regression group than in the treatment groups. This suggests that ROP treatment may induce morphological alterations during foveal development. Gestational age, postmenstrual age at the time of treatment, ROP stage, and ROP zone were correlated with FH severity. Visual acuity was not affected by mild FH, and 88.5% of the patients had a visual acuity of LogMAR 0. Early stage foveal development is not significantly disrupted in patients with ROP, and patients with ROP show no significant visual disturbance associated with FH. However,eyes treated for ROP either with laser photocoagulation or intravitreal anti-vascular endothelial growth factor demonstrated more severe hypoplasia compared to that with spontaneous regression.

Platelet-Derived Growth Factor Subunit A Strengthens the Neurovascular Unit and Inhibits Retinal Vascular Regression Under Hyperoxic Conditions

Retinopathy of prematurity (ROP) is primarily caused by the exposure of preterm infants with underdeveloped blood vessels to high oxygen concentrations. This damages the astrocytes that promote normal vascular development, leading to avascularity, pathological neovascularization, and retinal detachment, and even blindness as the disease progresses. In this study, the aim was to investigate the differences in the characteristics of astrocytes and blood vessels between wild-type (WT) and genetically modified mice overexpressing platelet-derived growth factor subunit A (PDGF-A) in the retina immediately after high oxygen exposure, a protocol in the oxygen-induced retinopathy (OIR) model of ROP. Our results showed that PDGF-A mice exhibited an increased population of astrocytes and higher vascular density than WT mice and that PDGF-A strengthened the resistance to hyperoxic conditions. In the OIR model, PDGF-A mice had reduced avascular zone areas following hyperoxia exposure. Furthermore, immunostaining for NG2 and CD31 showed that pericytes tended to regress earlier than endothelial cells, particularly at the vessel edges in both WT and transgenic mice, indicating relatively higher susceptibility to hyperoxia-induced damage. These findings suggest that PDGF-A plays a crucial role in stabilizing retinal vessels and may serve as a novel therapeutic target for ROP, highlighting the potential significance of PDGF-A in the pathological mechanisms of retinal diseases.

Novel ultrasound-based classification of retinal funnel patterns in stage 5 retinopathy of prematurity

Novel ultrasound-based classification of retinal funnel patterns in stage 5 retinopathy of prematurity

Elective high frequency oscillatory ventilation versus conventional mechanical ventilation on the chronic lung disease or death in preterm infants administered surfactant: a systematic review and meta-analysis.

Use of elective high frequency oscillatory ventilation (HFOV) compared with conventional mechanical ventilation (CMV) results in a small reduction in the risk of chronic lung disease (CLD) or death, but the evidence is weak. Our objective was to explore whether elective HFOV was associated with less CLD or death as compared with CMV in preterm infants administered surfactant. We conducted a systematic review and meta-analysis, including 1835 ventilated participants from 11 randomized controlled trials comparing elective HFOV with CMV between February 1993 and February 2014. The primary outcome was the incidence of CLD or death. Compared with CMV, elective HFOV was associated with less CLD or death (relative risk (RR) 0.76, 95% confidence interval (CI) 0.61-0.94, p = 0.01) (p = 0.01, I2 = 55%), CLD (RR 0.71, 95%CI 0.53-0.93, p = 0.01) (p = 0.03, I2 = 50%), and ≥2nd stages of retinopathy of prematurity (RR 0.77, 95%CI 0.62-0.94, p = 0.01) (p = 0.42, I2 = 0%). In the subgroup of > 1 dose of surfactant, compared with CMV, elective HFOV was also related to less CLD or death (RR 0.87, 95%CI 0.77-0.98, p = 0.02) (p = 0.10, I2 = 42%). No differences were found in the incidences of death, grade 3 or 4 of intraventricular hemorrhage, periventricular leukomalacia, airleak and necrotizing enterocolitis between the two groups. Elective HFOV is superior to CMV in reducing the incidence of CLD or death in ventilated preterm infants administered surfactant, especially in the subgroup of >1 dose of surfactant. International Prospective Register of Systematic Reviews: No.: CRD42022301033; URL: https://www.crd.york.ac.uk/PROSPERO/ .

Comment on 'Posterior to the ridge laser in zone 2 stage 3 retinopathy of prematurity with plus disease: Efficacy and safety'.

Comment on 'Posterior to the ridge laser in zone 2 stage 3 retinopathy of prematurity with plus disease: Efficacy and safety'.

Stage 5 retinopathy of prematurity: The silent epidemic blinding our smallest babies.

Stage 5 retinopathy of prematurity: The silent epidemic blinding our smallest babies.

Association of a Count of Inpatient Morbidities with Two-Year Outcomes among Infants Born Extremely Preterm

To determine if number of neonatal morbidities is associated with death or severe neurodevelopmental impairment (sNDI) among infants born extremely preterm who survived to 36 weeks' postmenstrual age (PMA). This is a retrospective cohort analysis of prospectively collected data from 15 NICHD Neonatal Research Network (NRN) centers. Neonatal morbidities and 2-year outcomes were examined for 3794 infants born at 22 to 26 weeks' gestation from 2014 through 2019 who survived to 36 weeks' PMA. Serious brain injury (SBI), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP) had the strongest bivariate associations with death or sNDI: odds ratios (ORs, 95% confidence Interval [CI] )3.96 (3.39 , 4.64), 3.41 (2.94 , 3.95), and 2.66 (2.28 , 3.11), respectively. A morbidity count variable was constructed using these morbidities. The estimated (ORs and 95% CI for death or sNDI with any 1, any 2, or all 3 of these morbidities, adjusted for maternal and infant characteristics and hospital of birth, increased from 2.75 (2.25, 3.37) to 6.10 (4.83, 7.70) to 12.90 (9.07, 18.36), respectively. Corresponding rates of late death or sNDI with none, any 1, any 2, and all 3 morbidities were 12.6%, 30.3%, 51.9%, and 69.9%, respectively. The estimated logistic model produced predictions of death or sNDI with moderate discrimination (C-statistic [95% CI]: 0.765 [0.749, 0.782]) and good calibration (Intercept[CITL]= -0.004, slope=1.026). Among infants born extremely preterm who survived to 36 weeks' PMA, a count of SBI, BPD, and severe ROP predicts death or sNDI.

Authors' Response: Risk factor-based models to predict severe retinopathy of prematurity in preterm Thai infants.

Authors' Response: Risk factor-based models to predict severe retinopathy of prematurity in preterm Thai infants.

Risk of long-term ophthalmological complications in Taiwanese preterm infants: a nationwide cohort study

ObjectivesThe aim was to determine whether different maturity levels and birth weights could change the risk of long-term ophthalmological complications in preterm infants.DesignThis was a cohort study.SettingThis was a nationwide...

Investigation of the rates of retinopathy of prematurity and other diseases in infants born late preterm: is routine ROP examination required?

The objective of this study was to ascertain the prevalence of ROP and other ocular diseases in late preterm infants and to evaluate the necessity of routine ROP examination in a tertiary hospital in Turkey. This retrospective cohort study included late preterm infants treated in the neonatal intensive care unit (NICU) and referred to the ROP outpatient clinic. Those who were discharged or died before the first screening and those who did not complete all screening sessions were excluded. The data set comprised demographic information, gestational age, birth weight, stages of ROP, treatments, and the presence of other ocular comorbidities. The study cohort comprised 600 late preterm infants, with a median gestational age of 35 weeks and a mean birth weight of 2392 ± 451 g. Of the infants included in the study, 3.3% developed ROP, with one infant requiring treatment. Furthermore, 4.8% of the subjects exhibited additional ocular comorbidities. The results indicated a statistically significant correlation between lower birth weight and gestational age with an increased prevalence of ROP and other ocular pathologies. ROP incidence in late preterm infants is relatively low, although comorbidities are notable. Infants born late preterm with lower birth weight and gestational age are at greater risk for ROP and additional pathologies. It is recommended that routine screening for ROP be conducted in order to ensure that ROP and other ocular conditions are diagnosed and treated in a timely manner, thus preventing severe visual impairments.

Semiautomated measures of foveal immaturity from handheld swept-source optical coherence tomography are associated with retinopathy of prematurity severity

Background/aimsHandheld swept-source optical coherence tomography (SS-OCT) was previously used to measure foveal maturity through semiautomated methods in awake premature infants. This study assesses the relationship between foveal maturity and retinopathy...

Hour of Life at Enteral Feeding Initiation and Associated Clinical Morbidity in Extremely Low-Birth-Weight Infants

Background/Objectives: Identifying nutritional interventions in extremely low-birth-weight (ELBW) infants (<1000 g) that are associated with favorable clinical outcomes is important. Delayed enteral feeding initiation (>3 days) has been associated with increased odds of developing morbidity. Therefore, the aim of this study is to evaluate the relationship between hour of life at enteral feeding initiation and associated clinical outcomes. Methods: An IRB-approved retrospective chart review evaluated ELBW infants. Birth acuity was evaluated using CRIB II scoring and incidence of various morbidities (bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP)) and mortality was assessed after adjustment. p < 0.05 was statistically significant. Results: A total of 27/61 (44.3%) initiated enteral feeding <12 h of life. CRIB II scores were lower in infants with earlier enteral feeding initiation. There were no statistical differences in NEC, SIP, or death between categories of hour of life at enteral feeding initiation. After adjusting for CRIB II scores, enteral feeding initiation ≥12 h of life was associated with more days receiving oxygen >21% inspired air (β = 32.7; p = 0.040), approximately 7-fold higher odds of developing moderate/severe BPD (95% CI 1.2.8–38.28; p = 0.025), and 9-fold higher odds of being discharged home while receiving oxygen therapy (95% CI 1.03–79.81; p = 0.047). Conclusions: Timing of enteral feeding initiation may be delayed in ELBW infants with higher clinical acuity, yet later initiation by hour of life is associated with worsened clinical respiratory outcomes. Early initiation within the first 12 h of life is feasible and was not associated with gastrointestinal morbidity in this single-center cohort of ELBW infants.

"Umbilical Artery Doppler in Severe Small for Gestational Age: Prognostic Insights for Short and Long-Term Neurodevelopment"

IntroductionWe evaluated the impact of absent end-diastolic flow in the umbilical artery (UA-AEDF) in severe small for gestational age (SGA) cases. MethodsThis retrospective cohort study focused on fetuses with severe SGA (defined as birth weight ≤ 2.5 SD). Clinical measurements and neonatal outcomes were compared between the UA-AEDF and non-UA-AEDF groups. ResultsFifty-four patients were categorized into UA-AEDF (15 patients) and non-UA-AEDF (39 patients) groups. Regarding neonatal short-term prognosis, the UA-AEDF group showed higher rates of respiratory distress syndrome (RDS), late circulatory dysfunction, late metabolic acidosis, and retinopathy of prematurity (ROP) requiring laser treatment than the non-UA-AEDF group. However, within 32 weeks of gestation, the complication rates between the two groups were not significantly different. In the 32 weeks before delivery, the overall developmental quotient (DQ) scores of children in the UA-AEDF group were lower than those in the non-UAAEDF group. Specifically, within the UA-AEDF group, the mean DQ scores at 1.5 years of corrected age was significantly lower prior to 32 weeks of gestation than in the other groups. DiscussionThis study demonstrated that UA-AEDF in severely SGA infants before 32 weeks of gestation may be associated with poor long-term prognosis, comparable to preterm infants. Conversely, in non-UA-AEDF cases, the frequency of poor long-term prognosis, involving DQ, remained consistent before and after 32 weeks of gestation. This study highlights the potential significance of UA-AEDF in predicting neurodevelopmental outcomes in severe SGA infants; thus, incorporating UA Doppler findings into clinical protocols for severe SGA cases is helpful.

Computer-aided diagnosis of early-stage Retinopathy of Prematurity in neonatal fundus images using artificial intelligence

Retinopathy of Prematurity (ROP) is a retinal disorder affecting preterm babies, which can lead to permanent blindness without treatment. Early-stage ROP diagnosis is vital in providing optimal therapy for the neonates. The proposed study predicts early-stage ROP from neonatal fundus images using Machine Learning (ML) classifiers and Convolutional Neural Networks (CNN) based pre-trained networks. The characteristic demarcation lines and ridges in early stage ROP are segmented utilising a novel Swin U-Net. 2000 Scale Invariant Feature Transform (SIFT) descriptors were extracted from the segmented ridges and are dimensionally reduced to 50 features using Principal Component Analysis (PCA). Seven ROP-specific features, including six Gray Level Co-occurrence Matrix (GLCM) and ridge length features, are extracted from the segmented image and are fused with the PCA reduced 50 SIFT features. Finally, three ML classifiers, such as Support Vector Machine (SVM), Random Forest (RF), andk- Nearest Neighbor (k-NN), are used to classify the 50 features to predict the early-stage ROP from Normal images. On the other hand, the raw retinal images are classified directly into normal and early-stage ROP using six pre-trained classifiers, namely ResNet50, ShuffleNet V2, EfficientNet, MobileNet, VGG16, and DarkNet19. It is seen that the ResNet50 network outperformed all other networks in predicting early-stage ROP with 89.5% accuracy, 87.5% sensitivity, 91.5% specificity, 91.1% precision, 88% NPV and an Area Under the Curve (AUC) of 0.92. Swin U-Net Convolutional Neural Networks (CNN) segmented the ridges and demarcation lines with an accuracy of 89.7% with 80.5% precision, 92.6% recall, 75.76% IoU, and 0.86 as the Dice coefficient. The SVM classifier using the 57 features from the segmented images achieved a classification accuracy of 88.75%, sensitivity of 90%, specificity of 87.5%, and an AUC of 0.91. The system can be utilised as a point-of-care diagnostic tool for ROP diagnosis of neonates in remote areas.

Post-procedure pain in preterm neonates undergoing retinopathy of prematurity (ROP) screening: a prospective cohort study.

To evaluate the pain intensity in preterm infants during 48 h post retinopathy of prematurity (ROP) screening by binocular fundoscopy. Prospective cohort study. Level-III-NICU in India. 83Neonates undergoing first ROP screening. Pain assessment using the premature infant pain profile-revised (PIPP-R) score at baseline and 5 min, 30 min, 6 h, 24 h, and 48 h post-procedure. The mean gestation and birth weight was 29.8 (2.3) weeks and 1256 (344)g respectively. The median (IQR) PIPP-R score at baseline was 0 which significantly increased to 10.5 (8,12.5) 5 min (immediately) after the procedure. At 30 min and 6 h, scores were 7 (5,8) and 4.5 (3,5.5) respectively. After 24 h and 48 h, it decreased to 3 (0,5) and 0 (0,4.5) respectively. Nearly 59% (95%CI:40%-83%) of neonates had severe pain (PIPP-R score > 12) immediately after procedure. A majority of neonates experience severe pain immediately after ROP screening, and mild-moderate pain continues for 6 h. Hence, an additional pharmacological agent should be considered for reducing neonatal pain.