Risk Factors For Retinopathy Of Prematurity Research Articles

The incidence and risk factors of retinopathy of prematurity in South Korea: A nationwide cohort study.

Retinopathy of prematurity (ROP) is a major treatable cause of childhood blindness. Thus, epidemiological investigations are necessary for detecting and preventing ROP. Determining risk factors for ROP are also essential to improve screening methods. Therefore, we aimed to investigate the incidence and risk factors of ROP in Korea. The National Health Insurance Service (NHIS) covers almost all Koreans. Furthermore, the National Health Screening Program for Infants and Children (NHSPIC) is a government-run, health-screening program for children aged < 6 years. We used the NHIS-Infants and Children's Health Screening cohort database to evaluate the incidence of preterm infants and ROP. The database contains data on 84,005 participants, drawn from 5% of the NHSPIC survey on participants born annually during 2008 to 2012. Sociodemographic factors and systemic diseases were assessed as potential risk factors for ROP. We identified 2615 premature infants (3.11%); 846 of them had ROP (cumulative incidence: 32.4%). Although preterm births increased annually in 2008 to 2012, the ROP incidence in preterm infants did not increase by the birth year. Twenty patients (2.4%) with ROP underwent laser photocoagulation or surgery. Extremely low birth weight was a high risk factor (odds ratio [OR] = 49.86, P < .001). Moreover, chorioamnionitis (OR = 2.77, P = .028), respiratory distress syndrome (OR = 4.09, P < .001), apnea (OR = 1.59, P = .008), anemia (OR = 2.41, P < .001), and intraventricular hemorrhage (OR = 2.34, P < .001) were found to be risk factors for ROP. In conclusion, the incidence of premature babies increased between 2008 and 2012. However, the overall incidence of ROP among premature infants remained unchanged by birth year. Our findings revealed the roles of birth weight, respiratory conditions, anemia, and intraventricular hemorrhage in ROP.

Nutritional interventions to prevent retinopathy of prematurity.

Very preterm infants are at high risk of growth failure. Poor weight gain is a prominent risk factor for retinopathy of prematurity (ROP) and optimizing nutrition could potentially promote growth and reduce ROP. Most infants at risk of ROP need parenteral nutrition initially and studies of enhanced parenteral provision of lipids and amino acids have suggested a beneficial effect on ROP. Higher amino acid intake was associated with lower incidence of hyperglycemia, a risk factor for ROP. For very preterm infants, providing unpasteurized fortified raw maternal breast milk appears to have a dose-dependent preventive effect on ROP. These infants become deficient in arachidonic acid (ArA)and docosahexaenoic acid(DHA) after birth when the maternal supply is lost. Earlier studies have investigated the impact of omega-3 fatty acids on ROP with mixed results. In a recent study, early enteral supplementation of ArA 100 mg/kg/d and DHA 50 mg/kg/d until term equivalent age reduced the incidence of severe ROP by 50%. IMPACT: Previous reviews of nutritional interventions to prevent morbidities in preterm infants have mainly addressed bronchopulmonary dysplasia, brain lesions and neurodevelopmental outcome. This review focusses on ROP. Neonatal enteral supplementation with arachidonic acid and docosahexaenoic acid, at levels similar to the fetal accretion rate, has been found to reduce severe ROP by 50% in randomized controlled trials.

Risk Factors for Retinopathy of Prematurity in Preterm Infants in Kerman, Iran.

Retinopathy of prematurity (ROP) is the main cause of blindness in premature infants. Despite developments in neonatal care and management guidelines, ROP is becoming increasingly prevalent worldwide. Hence, the identification of risk factors for ROP is critical to diminish the burden of the disease. This cross-sectional study included all infants with gestational age 36 weeks referred to the ophthalmology clinic at Shafa hospital, Kerman, Iran from 2014 to 2015. Ophthalmologic examinations were performed followed by demographic and ophthalmic data collection and analysis. A total of 579 preterm neonates were screened including 325 boys and 254 girls. The incidence of ROP was 17.96%. Mean birth weight (BW) and gestational age (GA) were 1668.0 grams and 31.2 weeks, respectively. The results indicated that BW, GA, duration of hospitalization and oxygen therapy were significantly related to the development of ROP, however, after multivariate logistic regression analysis, only BW and duration of hospitalization remained significant. There were no significant associations between gender, type of delivery, or assisted reproductive technologies, and ROP (P = 0.461, 0.461, and 0.826, respectively). BW and duration of hospitalization were significant risk factors for ROP in the current study. BW was also strongly associated with the need for therapy.

Role of the brain-sparing effect on retinopathy of prematurity in newborns with fetal growth restriction

Introduction This study aimed to investigate the role of the brain-sparing effect (BSE) on retinopathy of prematurity (ROP) in fetal growth restriction (FGR). Methods In this retrospective study, 127 pregnant women were divided into two groups considering the cerebroplacental ratio (CPR): FGR with abnormal CPR group (n = 74) and the appropriate for gestational age with normal Doppler group (n = 53). CPR was computed using the pulsatility index (PI) and resistance index (RI) to quantitate the waveforms [middle cerebral artery (MCA) PI/umbilical artery (UA) PI and MCA RI/UA RI: a result <1 was taken into account as abnormal]. ROP screening results of newborns were recorded from electronic files. Results After adjusting for co-variants, BSE was not related to ROP (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 0.23–4.95). Gestational age at delivery <30 weeks (aOR, 2.55; 95% CI, 1.04–6.93) and birth weight <1500 g (aOR, 5.15; 95% CI, 1.15–25.2) were independently associated with ROP. Preeclampsia, emergency cesarean section birth, or forty-eight hours completion after the first steroid administration were not associated with ROP. Conclusions Gestational age at delivery <30 weeks and birth weight <1500g are independent risk factors for ROP in FGR whereas the BSE is not a risk factor.

Characteristics of Premature Retinopathy Patients who underwent surgery at dr. Kariadi General Hospital Semarang

Abstract&#x0D; Introduction &amp; Objectives : Introduction: Retinopathy of prematurity (ROP) represents a leading cause of childhood blindness. The management of ROP can be challenging in preterm babies, those with very low birth weight and multiple risk factors. The characteristic and risk factors of ROP is essential to acknowledge. Objective: To describe the characteristic of patients with ROP who underwent surgery in Dr. Kariadi Hospital and to identify the risk factors of the disease&#x0D; Methods : A retrospective study held from the medical record of patients with diagnosis ROP from January 2020-January 2023 in Dr. Kariadi Hospital, Semarang. The clinical characteristics: sex, gestation age, birth weight, maternal risk factors, neonatal risk factors, and ROP Stage. Type of surgery: laser, intravitreal injection, vitrectomy were also collected.&#x0D; Results : There were 19 ROP patients with 8 (42.1%) gestational age between 29-30 weeks, 8 (42.1%) birth weight 1000-1500gr, 7 (36.8%) had maternal risk: hypertension, 12 (63), 15%) of patients with ROP stage 3, 8 (42,1%) had a combined management of laser surgery and intravitreal injection. Among all the patients at risk had at least one neonatal risk factor with history of oxygenation being the most common (100%).&#x0D; Conclusion : Characteristics of ROP patients underwent surgery at Dr. Kariadi General Hospital are mostly patients with gestational age between 29-30 weeks and have the most oxygenation history factors. The most common type of surgical procedure performed is a combination of laser and intravitreal injection.

Genetic Variants of the Beta-Adrenergic Receptor Pathways as Both Risk and Protective Factors for Retinopathy of Prematurity

PurposeThere is strong evidence that genetic factors influence retinopathy of prematurity (ROP), a neovascular eye disease. It has been previously suggested that polymorphisms in the genes involved in beta-adrenergic receptor (ADRβ) pathways could protect against ROP. Antagonists for the ADRβ are actively tested in clinical trials for ROP treatment but not without controversy and safety concerns. This study was designed to assess if genetic variations in components of the ADRβ signaling pathways associate with risk of developing ROP. DesignAn observational case-control targeted genetic analysis. MethodsA study was carried out on premature participants with (n=30) or without (n=34) ROP and full-term controls (n=20) which were divided into a discovery cohort and a validation cohort. ROP was defined using International Classification of Retinopathy of Prematurity criteria (ICROP). Targeted sequencing of 20 genes in the ADRβ pathways was performed on the discovery cohort. Polymerase chain reaction (PCR)/restriction enzyme analysis for some of the discovered ROP-associated variants was performed for validation of the results using the validation cohort. ResultsThe discovery cohort revealed 543 bi-allelic variants within 20 genes of the ADRβ pathways. Ten single nucleotide variants (SNVs) in five genes including protein kinase A regulatory subunit 1α (PRKAR1A), rap guanine exchange factor 3 (RAPGEF3), adenylyl cyclase 4 (ADCY4), ADCY7, and ADCY9 were associated with ROP (p<0.05). The most significant SNV was found in PRKAR1A (p=0.001). Multiple variants located in the 3’-untranslated region (3’UTR) of RAPGEF3 were also associated with ROP (p<0.05). PCR/restriction enzyme analysis of the 3’UTR of RAPGEF3 methodologically validated these findings. ConclusionSNVs in PRKAR1A may represent protective factors while SNVs in RAPGEF3 may represent risk factors for ROP. PRKAR1α has previously been implicated in retinal vascular development while the RAPGEF3 product has a role in the maintenance of vascular barrier function, two processes important in ROP. Multicenter validation of these newly discovered risk factors could lead to valuable tools for predicting and preventing the development of severe ROP.

Postnatal weight gain and retinopathy of prematurity in preterm infants: a population-based retrospective cohort study

Objective Infants who meet the screening guidelines for retinopathy of prematurity (ROP) based on birth weight and gestational age undergo serial ophthalmological examinations for its detection and treatment. However, <10% of patients require treatment, and less than half develop ROP. Poor postnatal weight gain has been reported to be a strong indicator of ROP development; however, the information regarding this is unclear. Therefore, this study aimed to determine the relationship between postnatal weight gain and ROP development in preterm infants. Methods The data of 675 preterm infants with gestational age ≤32 weeks, who were hospitalized in our neonatal intensive care unit, were obtained retrospectively from file records. The infants’ demographic characteristics, clinical findings, and weekly weight gain (g/kg/day) during the first 8 weeks were recorded. The univariate was used to examine the risk factors for ROP followed by multivariate regression. Results The incidence of ROP in the infants included in the study was 41% (n = 278) and 13.3% (n = 37) of them required treatment. In the infants of the group that developed ROP, the mean birth weight and gestational age were significantly lower than those in the group that did not develop ROP (973 ± 288 and 1301 ± 349 g, p = 0.001 and 28.48 ± 1.95 and 30.08 ± 1.60 weeks, p = 0.001, respectively). As the gestational week and birth weight decreased, ROP development and the risk of ROP-requiring treatment increased. In the infants of the group that developed ROP, the mean weight gain in the postnatal third week was detected as significantly lower compared to those in the group that did not develop ROP (13.9 ± 8.2 and 15.4 ± 6.8 g, p = 0.034). On multiple logistic regression analysis, birth weight (<750 g) (odds ratio [OR], 8.67; 95% confidence interval [CI], 3.99–18.82, p = 0.001), blood transfusion (OR, 2.39; 95% CI, 1.34–4.24, p = 0.003), necrotizing enterocolitis (OR, 4.79; 95% CI, 1.05–26.85, p = 0.045), bronchopulmonary dysplasia (OR, 2.03; 95% CI, 1.22–3.36, p = 0.006), antenatal steroid therapy (OR, 1.60; 95% CI, 1.05–2.43, p = 0.028), surfactant administration (OR, 2.06; 95% CI, 1.32–3.2, p = 0.001) were independent risk factors for ROP development. Conclusion Postnatal weight gain may not be an accurate predictor of ROP development after adjusting for confounding factors. However, the analysis of independent risk factors that influenced the development of ROP revealed a statistically significant effect in cases of low birth weight, blood transfusion, necrotizing enterocolitis, bronchopulmonary dysplasia, and antenatal steroid and surfactant therapies. These findings may help ophthalmologists and neonatologists to pay special attention to this patient group during ROP scanning.

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.

Histological Chorioamnionitis and Funisitis as New Risk Factors for Retinopathy of Prematurity: A Meta-analysis.

The role of placental inflammation in neonatal morbidities is underestimated due to lack of placental examination. This meta-analysis aims to assess the association between histological chorioamnionitis (HCA) with and without funisitis (FUN) and risk of retinopathy of prematurity (ROP). Forty-five studies reporting (unadjusted) data on HCA without FUN and HCA with FUN in neonates with ROP were included. Primary outcomes were any stage ROP and severe ROP. Potential confounders explored were gestational age (GA) at birth, birthweight, maternal steroid use, necrotizing enterocolitis, sepsis (suspected/proven) and mechanical ventilation duration. Neonates with HCA had increased risk for any stage ROP (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.3-2.4) and severe ROP (OR 1.5; 95% CI 1.2-1.8) compared with neonates without HCA. The rates of any stage ROP (OR 1.8; 95% CI 1.4-2.2) and severe ROP (OR 1.4; 95% CI 1.1-1.6) were higher in neonates with FUN compared with neonates without FUN. Multivariate meta-regression analysis suggests that lower GA increases the effect size between FUN and severe ROP. This meta-analysis confirms that presence of HCA and FUN are risk factors for any stage ROP and severe ROP. Structured histological placental examination of HCA and FUN may be a tool to further refine the ROP risk profile. · This systematic review confirms that HCA is a risk factor for ROP.. · This meta-analysis reveals that FUN results in an even higher risk for developing ROP.. · Placental examination of HCA/FUN may be a tool to further refine the ROP risk profile..

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

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.

The impact after 20 years of an early detection program for severe retinopathy of prematurity in a Latin American city.

To evaluate the effects of long-standing early detection program in the incidence and trends of severe retinopathy of prematurity (ROP) in Cali, Colombia. This was a retrospective cohort study of infants included in an ROP prevention, early detection, and prompt treatment program, from January 01, 2002, to December 31, 2021 (20 years). Infants with gestational age (GA) <37 weeks or birth weight (BW) <2000 g and those with known ROP risk factors were screened. The incidence of severe ROP was calculated, and the average annual percent change (AAPC) was estimated through a joinpoint model. 16,580 infants were screened, with an average GA and BW of 31.4 ± 2.8 weeks and 1526.5 ± 56.7 g, respectively. The incidence of severe ROP was 2.69% (446 cases, 95% confidence interval [95%CI]: 2.45%; 2.95%), with an average annual decrease of - 14% (AAPC, 95%CI: -16.3%; -11.6%) from 13.6% in 2002 to 0.7% in 2021. In infants with GA <32 weeks, the incidence was 5.21%. A significant reduction in the risk of ROP was observed with increasing GA and BW (P < 0.05). Among the cases with severe ROP, 6.5% (29/446) had a GA ≥32 weeks with a maximum of 37 weeks; only 0.4% (2/446) of the detected infants had a BW >2000 g. Awareness and screening as part of the early detection program to prevent ROP has shown a significant decline in the incidence of severe ROP over time. Screening infants with GA <32 weeks or BW <2000 g and preterm infants (<37 weeks) with risk factors may be a feasible decision for resource optimization.

Analysis of trends in retinopathy of prematurity over 5 years in a tertiary neonatal intensive care unit.

The aim of the study was to look at the incidence and trend of retinopathy of prematurity (ROP) between 2017 and 2021 in a tertiary neonatal intensive care unit (NICU) in Australia and to compare potential modifiable risk factors of ROP between preterm infants who required treatment for ROP and who did not need treatment. This retrospective study used the data of newborn infants who were <31 weeks gestational age (GA) or birth weight (BW) of <1250 g born between 2017 and 2021 at a tertiary NICU in Australia (n = 261). Univariate analysis using t test for continuous data, Fischer exact test for categorical data and multiple logistic regression analysis were undertaken to identify any significant differences between two groups. A total number of 261 infants were studied. 55.9% of infants developed any type of ROP (146 infants out of 261 infants), type 1 ROP was 5.4% (14 out of 261) and aggressive ROP (AROP) was 3% (8 out of 261). Out of 146 infants who were diagnosed with ROP, 22 (15%) of them required treatment. Mean GA for those who underwent ROP treatment was 25.6 (±1.47) weeks and for those who did not require treatment was 27.6 (±1.95) weeks. The mean BWs for those who needed treatment was 764 (±189.32) g and for those who did not need treatment was 1039 (±306.06) g. The mean duration of invasive ventilation for infants with ROP requiring treatment and those who did not require treatment were 23.95 (±22.41) days and 9.89 (±17.2) days. The total duration of oxygen requirement was 235.54 (±160.5) days and 121.11 (±117.34) days for those who needed treatment and those who did not need treatment respectively. Among infants who required treatment for ROP, 68.18% required blood transfusion whereas among those who did not need treatment, 24.19% required blood transfusion. Lower GA, lower BW, longer duration of invasive ventilation, longer total duration of oxygen requirement and blood transfusion in first 2 weeks of life were significant in preterm infants who required treatment for ROP compared with those who did not.

Thrombocytopenia requiring platelet transfusions is predictive of retinopathy of prematurity in preterm infants.

Recent studies suggest that some hematological parameters and ratios provided by blood count collected on the first day of life may be predictors for the development of retinopathy of prematurity (ROP). The aims of this study were to assess whether hematological parameters and ratios in blood count collected on the first day of life are associated with ROP. Retrospective data collection from electronic clinical files of inborn preterm infants with a gestational age of less than 30 weeks delivered from January 2008 to December 2022, in a level III Neonatal Intensive Care Unit (NICU). We collected detailed clinical and demographic data on the mother, pregnancy, mode of delivery, resuscitation, in-hospital neonatal morbidity, pathological examination of the placenta, and hematological parameters and ratios provided by blood count collected on the first day of life. We compared neonates with or without ROP and performed a subgroup analysis on patients with ROP≥2. We included 140 preterm infants with ophthalmic examination; 81(57.9%) developed ROP. The need for platelet transfusions (OR=5.28; 95% CI: 1.31-21.21; P=0.019) and bronchopulmonary dysplasia (BPD) (OR=5.12; 95% CI: 1.14-22.98; P=0.033) were independent risk factors for ROP. In the multivariate analysis, no associations were found between any of the hematological parameters or ratios studied and ROP. In our study, hematological parameters and ratios on the first day of life were not associated with the development of ROP. However, thrombocytopenia that required platelet transfusions was associated with ROP development and severity.

Incidence and risk factors of Retinopathy of Prematurity – a prospective observational study

Objective Retinopathy of Prematurity (ROP) is a vasoproliferative retinopathy that affects the developing retinal vessels of premature infants. Identification of risk factors is essential for its early detection and intervention. The study was aimed to assess the incidence of ROP and to determine the risk factors associated with ROP. Methods It was a prospective observational study which included preterm neonates admitted in neonatal intensive care unit of a tertiary care hospital in Chennai,Tamil nadu,India from December 2020 to September 2021. Screening for ROP was performed for all neonates below 34 weeks gestation and between 34 to 36 weeks with risk factors for ROP. Association between risk factors and ROP was determined using chi square test for categorical variables and students t test for continuous variables. A p value less than 0.05 was considered significant. Results Of the 140 neonates screened, 45(32.1%) neonates were diagnosed to have ROP. Among the neonates detected to have ROP there were 24(53.3%) male. 34(75.6%) neonates had a birth weight less than 1.75 kg, 27(60%) neonates had a gestational age less than 34 weeks,22 (48.9%)neonates were born to primi mothers, 25(55.6%) neonates were delivered by normal vaginal delivery. Among the neonatal risk factors studied, sepsis was found to have a significant association with ROP (p=0.02). ). Risk factors like apnoea, respiratory distress syndrome, intraventricular hemorrhage, oxygen therapy and blood transfusion did not have a significant association with ROP. Conclusion The present study revealed an incidence of ROP of 32% and there was significant association with sepsis.

Retinopathy of Prematurity: Incidence and Risk Factor Analysis in Small for Gestational Age Neonates Compared to Appropriate for Gestational Age.

To analyze the incidence of retinopathy of prematurity (ROP) among preterm neonates who were born small for gestational age (SGA) and appropriate for gestational age (AGA). A prospective cohort study among preterm neonates born <34 weeks of gestational age (GA) and <2000 grams birth weight (BW) was conducted. The neonates were divided into AGA and SGA group. Incidence of ROP and risk factors was compared among the groups. 290 neonates were screened [AGA: 240 (82.8%); SGA: 50 (17.2%)]. The mean birth-weight and gestational age were 1510.7 ± 390.64 grams and 31.4 ± 4.8 weeks, respectively. The incidence of ROP in AGA and SGA was 30.2% and 33%, respectively (P = 0.58), whereas the incidence of type 1 ROP in AGA and SGA was 14% and 19% (P = 0.41). Male sex, anemia, oxygen administration, surfactant administration, sepsis, and PIH were independent significant risk factors for ROP on multivariate analysis. This study showed that both AGA and SGA premature infants have similar incidence of ROP. SGA is not an independent risk factor for ROP.

Increased risk of retinopathy of prematurity since increased O2 saturation targets: A multi-centre study.

Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature neonates. The BOOST II, SUPPORT and COT trials recommended increasing O2 saturation targets for pre-term neonates to reduce mortality; however, this is a risk factor for ROP. We aimed to determine whether these targets increased prevalence of ROP among pre-term neonates and higher risk groups. Retrospective cohort study conducted using data from the Australian and New Zealand Neonatal Network. 17 298 neonate cohort born 2012-2018 at <32 weeks' GA and/or <1500 g BW was analysed. Adjusted odds ratios (aORs) were calculated for post-2015 risk of: any ROP; ROP ≥ Stage 2; and treated ROP. Sub-analysis stratified at <28 GA, < 26 weeks' GA, <1500 g BW and <1000 g BW was performed. Risk of any ROP increased in the post-2015 group (aOR = 1.23, 95% confidence interval (CI) = 1.14-1.32), <28 weeks' GA (aOR = 1.31, 95% CI = 1.17-1.46), <26 weeks (aOR = 1.57, 95% CI = 1.28-1.91), <1500 g (aOR = 1.24, 95% CI = 1.14-1.34) and <1000 g (aOR = 1.34, 95% CI = 1.20-1.50). ROP ≥ Stage 2 increased at <28 weeks (aOR = 1.30, 95% CI = 1.16-1.46), <26 weeks (aOR = 1.57, 95% CI = 1.28-1.91), <1500 g (aOR = 1.18, 95% CI = 1.08-1.30), and <1000 g (aOR = 1.26, 95% CI = 1.13-1.42). O2 therapy guidelines since 2015 have resulted in decreased mortality but increased risk of ROP. Individualised NICU adjustments of ROP screening/follow-up methods are necessary to address the clinical burden.

Serum Zinc Levels in Preterm Newborns and its Relation with Retinopathy of Prematurity

Background With the increased survival of preterm babies, retinopathy of prematurity (ROP) has become the leading cause of preventable childhood blindness. It is caused by oxidative damage to the immature retina and zinc may help in the prevention of ROP owing to its antioxidant properties. Objective To measure serum zinc levels in preterm neonates and study its association with the development of ROP. Methods A total of 360 preterm neonates of gestational age between 28 completed weeks to &lt;37 weeks were included in this observational cross-sectional study. Serum zinc levels of the neonates aging &lt;24 hours of life were measured at the time of admission in NICU by spectrophotometry. Taking the reference range of serum zinc levels between 70 to 150 mcg/dL babies were arbitrarily divided into 2 groups (&lt;70 and &gt;70 mcg/dL). ROP screening was done at appropriate postnatal age by indirect ophthalmoscopy. The results were analyzed by the SPSS software version. Results The mean serum zinc level was 114.99±54.47 mcg/dL. The overall prevalence of ROP was 26%; of which, 10% of neonates had severe ROP (≥stage 3). A significant association was found between gestational age and birth weight with ROP. Oxygen supplementation, respiratory distress syndrome, surfactant use, antibiotic use &gt;7 days, and low serum zinc levels (&lt;70 mcg/dL) were significant risk factors on univariate analysis and after multivariate analysis, gestational age, surfactant use, and low serum zinc levels (&lt;70 mcg/dL) came out to be independent risk factors for ROP. Conclusion There was a statistically significant association of low serum zinc levels with the development of ROP and it was independent of other risk factors associated with ROP.

Association between fetal growth-restriction and retinopathy of prematurity using a unique identical twin model.

Research in singletons identified fetal growth restriction (FGR) as a risk factor for retinopathy of prematurity (ROP), but is generally subject to confounding by genetic, obstetric, and maternal factors. We investigated the effect of FGR on ROP in growth-discordant identical twins, thereby controlling for confounding factors. All data of monochorionic (MC) twin pairs with a birth weight discordance ≥20% born in our center between 2010 and 2021 were retrospectively reviewed for the presence of ROP. Potential risk factors for ROP were analyzed. Outcomes were compared between the smaller and larger twin. We included 88 MC twin pairs with growth discordance. In 34% (30/88), both neonates were at risk of ROP. Prevalence of ROP was higher among the smaller twin compared to the larger twin, 30% (9/30) versus 13% (4/30), respectively (OR 2.8, 95% CI: 1.2-6.6). The smaller twin had a longer duration of mechanical ventilation (8 (1-20) versus 2 (1-4) days) and received their first red blood cell transfusion at an earlier postmenstrual age (29.6 (28.1-31.6) versus 30.4 (29.7-32.6) weeks). In this identical twin model, FGR is associated with almost tripled odds of ROP development, suggesting that both unfavorable antenatal growth conditions and adverse neonatal outcomes affect postnatal retinal vascular proliferation. Fetal growth restriction in growth-discordant identical twins is associated with almost tripled odds of developing retinopathy of prematurity in the smaller twin. Since these twins do not only differ in birth weight but also duration of mechanical ventilation and timing of the first red blood cell transfusion, both unfavorable antenatal growth conditions and adverse neonatal outcomes can affect postnatal retinal vascular proliferation. More attention for preventing retinopathy of prematurity is needed in those with fetal growth restriction who received prolonged duration of mechanical ventilation, oxygen supplementation, or a first red blood cell transfusion <32 weeks postmenstrual age.