Risk Factor For Severe Retinopathy Of Prematurity Research Articles

Retinopathy of prematurity among infants admitted to two neonatal intensive care units in Ethiopia

ObjectiveThis study was conducted to determine the prevalence and risk factors for retinopathy of prematurity (ROP) in two neonatal intensive care units (NICUs) in Addis Ababa, Ethiopia.Methods and analysisA prospective...

Association between Artificial Reproductive Technology and Retinopathy of Prematurity

BACKGROUND: Infertility is an increasingly common health problem which affects approximately 10% of the women in reproductive age. Artificial reproductive technology (ART), which is the modern solution to infertility, unfortunately has been linked to increased prevalence of prematurity and low birth weight (BW) in the newborn. That’s why ART infants make up a considerable portion of the retinopathy of prematurity (ROP) screening burden, which is likely to increase, as ART becomes increasingly available and utilized.
 AIM: The aim of the study was to assess the association between ART and the development of ROP.
 MATERIALS AND METHODS: Retrospective analysis of preterm infants screened for ROP at the Neonatal Intensive Care Unit in the University Hospital â€oeProf. Dr. Stoyan Kirkovich” Stara Zagora, Bulgaria, by single factor and multifactor logistic regression models.
 RESULTS: During a 4-year period (2016–2019), 419 infants, meeting the screening criteria, were admitted in the ward. Out of them, 265 were conceived naturally and 154 through ART. Thirty-two (7.6%) children required laser treatment for ROP, among which 15 (46.87%) were conceived naturally and 17 (53.12%) by ART. Multifactor analyses proves BW (odds ratio [OR] 0.99; confidence interval [CI], 0.98–0.99; p = 0.008) and gestational age (GA) (OR 0.296; 95% CI 0.09–0.88; p = 0.029) as significant risk factors for severe ROP, requiring treatment.
 CONCLUSION: ART is a risk factor for ROP due to its association with lower BW and GA of the newborn infants, rather than directly increasing the possibility for it. Nevertheless, there is a pronounced trend for more severe ROP to develop in ART children, when compared to naturally conceive in the same weight group.

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

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

Maternal diabetes mellitus as an independent risk factor for clinically significant retinopathy of prematurity severity in neonates less than 1500g

BackgroundRetinopathy of prematurity (ROP) is a significant morbidity in preterm babies. Multiple risk factors for severe ROP have been extensively studied, however, only a few studies have included maternal diabetes mellitus (MDM) in their assessment. ROP and diabetic retinopathy are both retinal vascular diseases in which there is leakage and/or neovascularization from damaged retinal vessels. Diabetes may affect ROP development; however, there are conflicting results on the association between MDM and ROP.ObjectiveTo determine if MDM is an independent risk factor for clinically significant ROP (ROP > Stage II) in neonates weighing less than 1500g.Design/MethodWe conducted a retrospective cohort study of neonates weighing <1500g who were delivered or transferred into our institution from 2007 through 2017. Logistic regression was used to analyze the association between severe ROP and MDM. The risks for the different stages of ROP from MDM were compared using chi-square linear trend test.ResultsWe extracted 883 paired maternal-neonatal data. The mean (standard deviation) gestational age and birthweight were 28.5 (2.9) weeks and 1052.7 (300.9) grams, respectively. Of the 883 mothers, 72 (8.2%) had DM. The incidence of ROP and severe ROP was 42.4% (374/883) and 6.5% (57/883) respectively. The odds ratio comparing MDM and severe ROP was 3.47 [95% CI: 1.51–7.96]; p<0.01). Compared to Stage I, the risk of MDM in infants with ROP increased from 1.49 in Stage II ROP to 2.59 in Stages III&IV. Severe ROP was associated with infant steroid use (OR: 5.92 [95% CI: 2.83–12.38]; p <0.01), sepsis (OR: 2.13 [95% CI: 1.09–4.14]; p = 0.03) chorioamnionitis (OR: 1.90 [95% CI: 1.03–3.50]; p = 0.04), and maternal steroid use (OR: 0.51 [95% CI: 0.32–0.79]; p<0.01).ConclusionMaternal diabetes is associated with ROP and the strength of association increased with increasing severity of ROP.

Association between severe retinopathy of prematurity and postnatal weight gain in very low-birthweight infants at Chiang Mai University Hospital, Thailand

ABSTRACTBackground: Poor postnatal weight gain has been associated with low serum IGF-1, a key factor in the pathogenesis of retinopathy of prematurity (ROP).Aim: To investigate an association between relative weight gain (RWG) and severe ROP in very low-birthweight (VLBW) Thai infants.Methods: The medical records of VLBW infants who were admitted to the neonatal intensive care unit in Chiang Mai University Hospital from June 2014 to December 2016 and screened for ROP were reviewed. RWG and total calorie intake (TCI) in the 2nd, 4rth and 6th week of age were calculated and those with no ROP/mild ROP and severe ROP requiring laser treatment were compared.Results: The study included 139 VLBW infants, 24 (17.3%) of whom had ROP requiring laser treatment. Infants with severe ROP requiring laser treatment had a lower median birthweight (840 vs 1,195 g, p < 0.001) and median gestational age (GA) (27 vs 30 wk, p < 0.001) than those with no ROP/mild ROP. When RWG and TCI were compared, the infants with severe ROP requiring laser treatment had a lower RWG at the 2nd (p < 0.01) and 4th weeks of age (p < 0.05) and had a lower TCI at the 2nd week of age (p < 0.001) than those with no ROP/mild ROP. Multivariate logistic analysis demonstrated that GA <29.5 w (p < 0.01), hypotension (p < 0.05), RWG <2.9 g/kg/d (p < 0.05) and TCI <98.5 kcal/kg/day (p < 0.001) at the 2nd week of age were independent risk factors for severe ROP requiring laser treatment.Conclusions: Poor weight gain and low calorie intake at the 2nd week of age were associated with severe ROP requiring laser treatment in VLBW infants. Monitoring weight gain and calorie intake during this period are essential and may improve the outcome of ROP.Abbreviations: BPD, bronchopulmonary dysplasia; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PDA, patent ductus arteriosus; PRC, packed red cells; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity; RWG, relative weight gain; SGA, small for gestational age; TCI, total calorie intake; VLBW, very low birthweight.

Screening for retinopathy of prematurity by telemedicine in a tertiary level neonatal intensive care unit in France: Review of a six-year period

To analyze the prevalence and risk factors for retinopathy of prematurity (ROP) and severe (treatment-requiring) ROP. A retrospective study was conducted in a level III neonatal unit in Bordeaux, France, from 2009 to 2015. Four hundred and nineteen preterm infants who were screened for ROP exclusively by RetCam were included. ROP of any degree was diagnosed in 27.68% of infants. Stages 1, 2, 3 and 4 ROP was found in 44%, 46%, 9% and 1% of subjects, respectively. No stage 5 ROP was observed. 28/419 infants (6.6%) were treated exclusively with laser photocoagulation. No intravitreal anti-VEGF injections or surgical treatments were performed. No infants born at>31 weeks or with BW>1110g required ROP treatment. On multivariate analysis, risk factors for ROP development were low birth weight, low gestational age at birth, high duration of invasive mechanical ventilation, shock or use of vasopressors. On multivariate analysis, risk factors for severe, treatment-requiring ROP were male gender, gestational age≤27 weeks and Apgar score at 5minutes≤7. In our 6-year series, ROP was successfully identified on screening exclusively by telemedicine, and no surgical treatment was required. This study identifies known ROP risk factors, but the Apgar score at 5minutes as a risk factor for severe ROP requires further studies in order to be confirmed.

The role of the maternal and fetal inflammatory response in retinopathy of prematurity.

There is a paucity of research on the contribution of placental inflammation to severe retinopathy of prematurity (ROP). A retrospective cohort study (n=1217) was conducted of infants screened for ROP (2006-2016). The outcomes of the study were severe ROP (type 1 or type 2 ROP) and low grade ROP. We categorized the placental pathology as the presence of (i) maternal plus fetal inflammatory response, (ii) maternal inflammatory response only, (iii) fetal inflammatory response only and, (iv) no evidence of a maternal or fetal inflammatory response. The data were analyzed using univariate and multivariate logistic regression analyses (P<.05). In this cohort, the number of infants with the maternal plus fetal inflammatory response, the maternal inflammatory response only, the fetal inflammatory response only, and no maternal or fetal inflammatory response was 305 (25%), 82 (7%), 8 (1%), and 822 (67%), respectively. Adjusted for covariates, the maternal plus fetal inflammatory response was a significant risk factor for severe ROP (AOR=2.6, 95% CI 1.1-5.9, P=.03). None of the categories of placental inflammation were significantly associated with low grade ROP. Placental pathology distinguished by the maternal plus fetal inflammatory response was a significant risk factor for severe ROP. Our study supports a link between intrauterine inflammatory events and the subsequent development of severe ROP.

Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units

BackgroundTo evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition.MethodsA prospective cohort study (TR-ROP) was performed between...

Risk factors of retinopathy of prematurity in a tertiary care hospital in South India

ObjectiveThe objective of this study is to evaluate the risk factors in very low birth weight preterm newborns screened for retinopathy of prematurity (ROP) in a tertiary care hospital and to find the relationship of risk factors to the severity of disease. Very few reports on risk factors of ROP are available from this part of South India. MethodsA prospective screening study was done enrolling 812 preterm babies during the period April 2013 to April 2015 and followed up until maturation of retina or regression of disease. The study population included preterms ≤32 weeks and or ≤1500g at birth admitted in newborn intensive care unit. Nested case control analysis was done in 203 cases with ROP against a control group of 609 babies. Multivariate analysis of binary logistic regression model was performed by taking ROP as dependent variable and independent variables were those which were found significant (p<0.05). ResultsOn multivariate analysis apart from low birth weight and low gestational age, risk factors found statistically significant were apnea (p=0.020), blood transfusion (p=0.001), hyaline membrane disease (p=0.035), phototherapy (p=0.033), ventilator support (p=0.033) and oxygen use more than seven days (p=0.007). Factors significantly associated with severity of ROP were oxygen by continuous positive airway pressure (p=0.02), congenital pneumonia (p=0.001), shock (p=0.02), hyaline membrane disease (p=0.03) and surfactant use (p=0.003). ConclusionCompromised pulmonary function along with oxygen, surfactant therapy and shock are important risk factors for severe ROP. Antenatal risk factors have no significance in the development of ROP.

Oxygen Monitoring Reduces the Risk for Retinopathy of Prematurity in a Mexican Population

Background: Retinopathy of prematurity (ROP), a potentially blinding disease, affects preterm infants. High levels of oxygen saturation are a well-known risk factor for ROP. Objectives: To assess the frequency of ROP type 1 needing treatment after improved oxygen monitoring (2011) in a Mexican preterm population selected for WINROP analyses and to retrospectively revalidate WINROP, an online surveillance system identifying infants at risk of developing ROP type 1. Methods: Preterm infants born with birth weight (BW) <1,750 g and/or at gestational age (GA) ≤34 weeks, screened for ROP in 2012-2014 at the Hospital Civil de Guadalajara, Mexico were included (n = 151). Eighty-five infants with GA <32 weeks qualified for WINROP analyses. GA, BW, maximal ROP stage, ROP treatment and weekly weights were recorded. The results in the present study were compared to those of a previous WINROP study in the same hospital (2005-2010; n = 352). Results: In the present WINROP cohort, 11.8% of the infants born at GA <32 weeks received treatment compared to 51.0% of the infants in the previous WINROP cohort. One infant (3%) born at GA ≥32 weeks received treatment during the present study period compared to 35.6% during the previous period. WINROP displayed 80.0% sensitivity in infants born at GA <32 weeks in the present study compared to 84.7% in the previous study. Conclusions: Uncontrolled oxygen supplementation is the major risk factor for severe ROP in infants born at GA ≥32 weeks. After improved oxygen monitoring, the frequency of ROP treatment was dramatically reduced at the Hospital Civil de Guadalajara, Mexico.

Association between postnatal weight gain and severe retinopathy of prematurity in preterm babies with very low birth weight

Objective To analyze the association of postnatal weight gain proportion of very low birth weight (BW) preterm babies and the onset of severe retinopathy of prematurity, and investigate the optimal cut-off points and predictive ability of postnatal weight gain (WG) proportion for the onset of retinopathy of prematurity (ROP). Methods A retrospective cohort study. 257 preterm infants underwent screening whose weight was less than 1500 g were enrolled in this study. Risk factors include BW, gestational age (GA), history of oxygen inhalation, need for blood transfusions, Apgar score in 1 to 10 minutes, embryo number, delivery mode, in vitro fertilization infants, and WG proportion within 6 weeks after birth and other systemic diseases were recorded. Their correlation with severe ROP is analyzed. Clinical outcomes were divided into severe ROP group (patients who suffered from ROP and required treatment) and mild and no ROP group (patients who suffered from ROP but do not require treatment and patient without ROP). The severe ROP group included 18 patients and mild and no ROP group included 239 patients. Multiple logistic regression and receiver operating characteristic (ROC) curve were used to determine if the WG proportion was independently related to severe ROP development and if it was capable of predicting severe ROP. This study determines the predict value by comparing the area under the ROC curve (AUC) of independent risk factors. Results GA (t=-4.835, P<0.001), BW(t=-5.192, P<0.001), history of oxygen inhalation (χ2=6.001, P=0.009), proportion of infants who had oxygen inhalation for more than 10 days(χ2=10.019, P=0.002), postnatal WG proportion at 1 week(t=-3.663, P<0.001), postnatal WG proportion at 2 weeks(t=-3.425, P=0.001) had significant difference between two groups. Multiple logistic regression analysis revealed that GA(β=-0.858, P=0.008), BW(β=-0.005, P=0.010), postnatal WG proportion at 2 weeks (β=-8.745, P=0.035)were correlated to severe ROP significantly. And their area under the ROC were 0.836[95% confidence interval (CI): 0.752 - 0.920], 0.826 (95%CI: 0.947 - 0.903), 0.744 (95%CI: 0.598 - 0.891) respectively. The optimal cut-off points of GA, BW, and postnatal WG proportion at 2 weeks were 28.41 weeks, 1241.96 g, 12.80% respectively. Conclusion Low WG proportion at 2 weeks of very low BW preterm babies is an important and independent risk factor for severe ROP and has certain predictive value of the onset of severe ROP. Key words: Retinopathy of prematurity/etiology; Birth weight/growth and development; Weight gain/growth and development; Forecasting

Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants

ObjectivesPoor weight gain during the first weeks of life in preterm infants is closely associated with the risk of developing the retinopathy of prematurity (ROP) and insufficient nutrition might be...

Incidence and Main Risk Factors for Severe Retinopathy of Prematurity in Infants Weighing Less Than 1000 Grams in Brazil

This study evaluated the incidence and risk factors for severe retinopathy of prematurity (ROP) in babies <1000 g at Porto Alegre, Brazil. Prospective cohort study including premature children with birth weight ≤1000 g was conducted. Main outcome was the occurrence of severe ROP needing treatment. A total of 157 infants were included. Severe ROP occurred in 20 infants (12.7%). Nineteen patients were treated by laser photocoagulation. Main risk factors for severe ROP were gestational age (P = 0.029), infant's weight measured at sixth week of life (P < 0.001) and number of days of oxygen therapy under mechanical ventilation (P < 0.001). After logistic regression, infant's weight at sixth week of life and number of days in mechanical ventilation were associated to severe ROP. We reported the incidence of 12.7% of severe ROP among babies born ≤ 1000 g in our institution. Laser photocoagulation was effective to stabilize the disease among 19 treated patients.

Screening for Retinopathy of Prematurity in a Large Tertiary Neonatal Intensive Care Unit in Turkey: Frequency and Risk Factors

Purpose: We aimed to determine applicable guidelines for screening of retinopathy of prematurity (ROP), and evaluate the contribution of risk factors for severe ROP.Methods: A prospective cohort study of neonates with a gestational age (GA) < 34 weeks or birth weight < 2000g who were admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary level hospital was conducted. The study group was classified into three groups according to eye examination findings as no ROP, mild ROP and severe ROP.Results: Of the 700 neonates screened, the frequencies of ROP for any stage and severe ROP were 32.7% and 3.1%, respectively. Laser photocoagulation was needed in 9.6% of neonates with ROP. None of the neonates with a GA ≥ 31 weeks required treatment. Any ROP was detected in 199 (53.6%) of the babies < 32 weeks (n = 371), 22 (5.9%) of whom were treated with laser photocoagulation. Independent risk factors for severe ROP in babies < 32 weeks GA were birth weight, duration of mechanical ventilation and patent ductus arteriosus (PDA).Conclusion: This is the largest prospective cohort study including infants younger than 34 weeks GA from Turkey. Our data which belongs to the last 1-year period shows lower incidence of severe ROP when compared to previous reports from Turkey. According to our data, screening babies smaller than 32 weeks GA or 1500g birth weight seems reasonable. In the presence of long duration of mechanical ventilation and PDA, screening should be intensified.

P1-537 Retinopathy of prematurity and neonatal risk factors: a retrospective cohort study

IntroductionRecent technological advances in neonatology have increased the survival rate of very low birth weight infants, which has led to a correspondingly increased incidence of retinopathy of prematurity (ROP).ObjectiveTo identify...

Is ethnicity a risk factor for severe retinopathy of prematurity?

ObjectiveTo assess the risk of severe retinopathy of prematurity (ROP) requiring treatment in different ethnic groups.DesignRetrospective observational study on ROP screening and treatment. It involved a cross-sectional review of all...

Weight gain measured at 6 weeks after birth as a predictor for severe retinopathy of prematurity: study with 317 very low birth weight preterm babies

Recent studies suggest that postnatal weight gain can play an important role in the development of retinopathy of prematurity (ROP). To analyze the low weight gain (WG) from birth to 6 weeks of life to predict the development of severe retinopathy of prematurity (ROP) among very low birth weight preterm babies (VLBW). A prospective cohort study included 317 newborns with birth weight (BW) <or=1,500 g and gestational age (GA) <or=32 weeks. The main outcome was the development of severe ROP (defined as threshold ROP and higher stages of ROP). In all patients, the proportion of the WG was defined as the preterm weight measured at 6 weeks of life minus the BW divided by the BW. Seventeen risk factors for ROP were studied by univariate analysis. Chi-square test and Student's t-test were used to compare no-ROP/mild ROP patients and severe ROP patients. Logistic regression and receiver operating characteristic (ROC) curve were used to determine if the WG proportion was independently related to severe ROP development and if it was capable of predicting severe ROP. Ophthalmological examinations started between the fourth and sixth week of life, and were repeated until the 45th week of postmenstrual age. Weight gain proportion was always calculated at completed 6 weeks of life. Mean GA and mean BW of the whole cohort were 29.6 weeks (+/-1.9) and 1,124 grams (+/-239.5) respectively. After logistic regression, the low WG proportion under 51.2% from the BW, measured at 6 weeks of life, showed OR 3.007 (95%CI: 1.195-7.566; P = 0.019), for severe ROP, when adjusted for BW and for any stage intraventricular hemorrhage. Area under the ROC curve was 0.63 (95%CI: 0.495-0.761; P = 0.037). For the discriminative cutoff of 51.2% of the WG proportion, sensitivity and specificity values were 66.3% and 62.6% respectively. Positive and negative predictive values were 10.2% and 94.7% respectively. Low WG by six weeks of life is an important and independent risk factor for severe ROP and is capable to predict the development of severe ROP in most patients that needed treatment.