Risk Of Retinopathy Of Prematurity Research Articles

Association between VEGF polymorphisms (−460 T/C and +936 C/T) and retinopathy of prematurity risk: A meta-analysis

PurposeVascular endothelial growth factor (VEGF) contributes to the development of retinopathy of prematurity (ROP). A number of studies investigated the association of ROP with VEGF −460 T/C and +936 C/T polymorphisms but the results were conflicting. In order to derive a more precise estimation of the associations, we performed a meta-analysis of the relationship between VEGF −460 T/C and +936 C/T polymorphisms with ROP in all published studies. MethodsA literature search was performed systematically using electronic databases. Published literature from PubMed and other databases was retrieved. The odds ratio (OR) with 95% confidence interval (CI) was used to estimate the pooled effect. Each −460 T/C and +936 C/T polymorphism included four case-control studies including case/control 249/308 and 179/250 respectively. ResultsThrough literature search, we found that both VEGF −460 T/C and +936 C/T polymorphisms were not associated with ROP risk at allelic, co-dominant, dominant and recessive models. ConclusionsThis meta-analysis suggests that the VEGF −460 T/C and +936 C/T polymorphism might contribute to genetic susceptibility of ROP. The association between VEGF −460 T/C and +936 C/T polymorphism and ROP risk awaits further investigation.

Incidence of Retinopathy of Prematurity and Its Association with Oxygen Therapy in Preterm Low Birth Weight Babies

Introduction: The objectives of this study were to study the incidence and risk factors of retinopathy of prematurity (ROP) among preterm low birth weight babies and its association with oxygen therapy.Material and Methods: During one year study period, 50 neonates, who had fulfilled the inclusion criteria (born at gestational age ≤ 35 wks), were included in the present study. They were examined by indirect ophthalmoscopy by an ophthalmologist in NICU or ophthalmology outdoor. Staging of ROP was done according to the International classification. Data obtained from this study were entered in Microsoft Excel and subsequently analysed in SPSS version 20.0.Results: Among study population, 12 neonates (24%) showed evidence of retinopathy of prematurity, and Stage 2 ROP was most common (41.7%) within this group. Those neonates who had born ≤28 wks gestational age, showed more incidence (75%) of ROP. There was significant association between ROP and prematurity, low birth weight, mechanical ventilation, duration and concentration of oxygen therapy.Conclusion: Apart from prematurity and low birth weight, oxygen therapy also carries significant risk for ROP. Thus, judicious use of oxygen in premature babies can reduce incidence of ROP significantly.J Nepal Paediatr Soc 2015;35(3):247-252

Effects of Red Blood Cell Transfusions on the Risk of Developing Complications or Death: An Observational Study of a Cohort of Very Low Birth Weight Infants.

Background The aim of this study was to evaluate the association between red blood cell (RBC) transfusions on the risk of death, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. Study Design and Methods This is an observational study. Data were entered prospectively into the study database at the time of the first transfusion. Clinical characteristics, adverse events, and outcomes of the patients transfused in the first 28 days of life were compared with the population of VLBW infants not transfused during the same period. The association among birth weight, gestational age, comorbidities, and the number of transfusions was estimated with a Poisson regression model. The association between the composite outcome and the occurrence of death, ROP, or BPD separately considered and a set of covariates was estimated with a logistic regression model. Results We enrolled 641 VLBW infants, 42% of whom were transfused. Transfusions were associated with the risk of developing the composite outcome, independently from other conditions; this risk correlated with several transfusions ≥ 3 (odds ratio: 5.88, 95% confidence interval: 2.74-12.6). ROP and BPD were associated with several transfusions ≥ 3. Conclusion We observed an association between RBC transfusions and the composite risk of death or ROP, BPD, and NEC.

Early Erythropoietin Administration does not Increase the Risk of Retinopathy in Preterm Infants

Erythropoietin (EPO) administration prevents anemia of prematurity and may be associated with a significant increase in the risk of retinopathy of prematurity (ROP) in preterm infants. Nonetheless, early EPO treatment may prevent damage following retinal neovascularization. The aim of this meta-analysis was to elucidate whether EPO administration increases the risk of ROP. We searched MEDLINE, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials with no language restrictions. Randomized controlled trials that reported the association between EPO treatment in preterm infants and ROP were eligible. All of the included studies were stratified into two groups according to the age of initiation of EPO treatment: before 8days of age (early EPO), and 8-28days of age (late EPO). Thirteen studies were identified that included a total of 1999 preterm infants. EPO administration did not increase the risk of ROP of any stage or Stage ≥3 (any relative risk: 0.99, 95% confidence interval: 0.84-1.16, p=0.89; Stage ≥3 relative risk: 1.34, 95% confidence interval: 0.90-1.99, p=0.15). This trend remained unchanged in both the early and late EPO groups. There did not seem to be any evidence of publication bias for outcomes as the funnel plots were symmetrical. EPO administration did not significantly increase the risk of ROP of any stage reported or Stage ≥3. Further clinical trials investigating the impact of EPO on ROP in premature infants should include all confounding factors to clarify this important issue.

Systemic endogenous erythropoietin and associated disorders in extremely preterm newborns

ObjectiveTo explore the association between concentrations of endogenous erythropoietin (EPO) in blood the first 2 weeks of life and neonatal disorders in extremely low gestational age newborns (ELGANs).DesignProspective cohort study.SettingNeonatal...

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.

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis.

The effectiveness of many interventions aimed at reducing the risk of retinopathy has not been well established. To estimate the effectiveness of nutritional interventions, oxygen saturation targeting, blood transfusion management, and infection prevention on the incidence of retinopathy of prematurity (ROP). A comprehensive search of several databases was conducted, including Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through March 2014. We included studies that evaluated nutritional interventions, management of supplemental oxygen, blood transfusions, or infection reduction and reported the incidence of ROP and mortality in neonates born at <32 weeks. We extracted patient characteristics, interventions, and risk of bias indicators. Outcomes of interest were any stage ROP, severe ROP or ROP requiring treatment, and mortality. We identified 67 studies enrolling 21 819 infants. Lower oxygen saturation targets reduced the risk of developing any stage ROP (relative risk [RR] 0.86, 95% confidence interval [CI], 0.77-0.97) and severe ROP or ROP requiring intervention (RR 0.58, 95% CI, 0.45-0.74) but increased mortality (RR 1.15, 95% CI, 1.04-1.29). Aggressive parenteral nutrition reduced the risk of any stage ROP but not severe ROP. Supplementation of vitamin A, E, or inositol and breast milk feeding were beneficial but only in observational studies. Use of transfusion guidelines, erythropoietin, and antifungal agents were not beneficial. Results of observational studies were not replicated in randomized trials. Interventions were heterogeneous across studies. At the present time, there are no safe interventions supported with high quality evidence to prevent severe ROP.

Sildenafil and retinopathy of prematurity risk in very low birth weight infants

Sildenafil and retinopathy of prematurity risk in very low birth weight infants

Correlation of central visual function and ROP risk factors in prematures with and without acute ROP at the age of 6–13 years: the Giessen long-term ROP study

AimTo correlate light increment sensitivity (LIS) and visual acuity (VA) with birth weight (BW), gestational age (GA) and stage of acute retinopathy of prematurity (ROP) (STG) in premature children at...

The relationship of invasive and non-invasive respiratory therapy to the risk of developing the Retinopathy of Prematurity (ROP)

Methods Retrospective analysis of examination of 217 newborn of the risk group. ( In Russian Federation all children under 35 weeks of gestation age or weighting below 2000 gr lie in the group of risk for ROP). Due to the development of Respiratory Distress Syndrome all children needed respiratory therapy on the first week of living. The patients were divided into 3 groups according to the kind of respiratory therapy received. 1st group ( n-=86) received noninvasive respiratory therapy with Nosal Continuous Airway Pressure, 2nd group (n=69) – noninvasive therapy with Biphasic, and 3rd group (n=62) – invasive respiratory therapy with Artificial Respirating Unit.

Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units.

To identify predictors of severe retinopathy of prematurity (ROP) in a large population-based cohort and to examine risk-adjusted variations across units. Retrospective analysis of Canadian Neonatal Network data on neonates with birth weight <1500 g who were screened for ROP between 2003 and 2010. Characteristics of infants with and without ROP were compared and a risk-adjusted model for severe ROP was developed. Rates of severe ROP were compared between sites. 1163 of 9187 (12.7%) infants developed severe ROP. Lower gestational age, male sex, small for gestational age, patent ductus arteriosus, late onset sepsis, more than two blood transfusions, inotrope use, and outborn status were associated with an increased risk of severe ROP. Severe ROP rates varied significantly between units. Younger, smaller and sicker male infants had higher adjusted risks of severe ROP and rates varied significantly among sites.

Sildenafil and retinopathy of prematurity risk in very low birth weight infants.

ObjectiveTo examine the effect of sildenafil therapy on development of severe retinopathy of prematurity (ROP) requiring surgical intervention in premature infants.Study DesignWe identified premature infants who were discharged from Pediatrix Medical Group neonatal intensive care units from 2003–2012 and who received an ophthalmologic exam. We matched each infant exposed to sildenafil prior to first eye exam to three non-exposed infants using propensity scoring to control for differences in baseline infant characteristics. We evaluated the association between sildenafil exposure and development of severe ROP using conditional logistic regression.ResultOf the 57815 infants meeting inclusion criteria, 88 were exposed to sildenafil. We matched 81/88 (92%) sildenafil-exposed with 243 non-exposed infants. There was no difference in the proportion of infants who developed severe ROP in the sildenafil-exposed vs. non-exposed groups (17/81 [21%] vs. 38/243 [16%], P=0.27). On adjusted analysis, there was no difference in severe ROP in the sildenafil-exposed versus non-exposed infants (odds ratio=1.46, 95% confidence interval=0.76–2.82, P=0.26).ConclusionWe did not observe an association between risk of severe ROP and sildenafil exposure prior to first eye exam in this cohort of premature infants.

Reduced utility of serum IGF-1 levels in predicting retinopathy of prematurity reflects maternal ethnicity

AimsTo validate known risk factors and identify a threshold level for serum insulin-like growth factor 1 (IGF-1) in the development of severe retinopathy of prematurity (ROP) in an ethnically diverse...

Preventing bioenergetic failure in the preterm infant

The failure to match postnatal nutritional requirements to support growth and well-being in the extremely preterm infant has been a long-standing challenge with slow progress. Several large prospective cohorts over...

Babies at risk for retinopathy of prematurity in Ghana

Developing retinopathy of prematurity (ROP) detection and treatment programs in a region with emerging expertise in care of premature infants is a complex and multifaceted task. We sought to determine the need for such a program in Accra, Ghana.

Trisomy 21 and Risk of Retinopathy of Prematurity.

Trisomy 21 is known to decrease the risk of several (nonocular) angiogenic-mediated diseases. The objective of this study was to determine whether trisomy 21 can also be shown to be significantly protective against ocular angiogenic-mediated disorders such as retinopathy of prematurity (ROP). A retrospective analysis of deidentified data from the Pediatrix BabySteps Clinical Warehouse. This large repository of neonatal data is approved for use in research studies by the Western Institutional Review Board. The study population consisted of 99,080 infants with very low birth weights (BWs; BW <1500 g), born between 1996 and 2013, cared for at >300 US NICUs, and who had been discharged alive from hospital. Statistical significance for unadjusted comparisons between groups was determined with Pearson's χ(2) test or Student's t test. Logistic regression models were used to calculate the odds of ROP (of any stage) and advanced ROP (stage 3 or greater) for infants with trisomy 21 compared with all other infants. The prevalence of trisomy 21 was 0.3% in the study population (321 of 99,080). After adjustment for BW, gestational age, oxygen exposure, and other potential confounders, there was an odds ratio of 0.6 (95% confidence interval: 0.5-0.8) for ROP in infants with trisomy 21compared with other infants and an odds ratio of 0.4 (95% confidence interval: 0.1-0.9) for advanced-stage ROP. Trisomy 21 significantly decreases the odds for ROP in very low BW infant survivors. This study unmasks a potentially identifiable genetic component to ROP risk, paving the way for the development of a laboratory-based ROP screening tool.

Validated System for Centralized Grading of Retinopathy of Prematurity: Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study.

Measurable competence derived from comprehensive and advanced training in grading digital images is critical in studies using a reading center to evaluate retinal fundus images from infants at risk for retinopathy of prematurity (ROP). Details of certification for nonphysician trained readers (TRs) have not yet been described. To describe a centralized system for grading ROP digital images by TRs in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study. Multicenter observational cohort study conducted from July 1, 2010, to June 30, 2014. The TRs were trained by experienced ROP specialists and certified to detect ROP morphology in digital retinal images under supervision of an ophthalmologist reading center director. An ROP reading center was developed with standard hardware, secure Internet access, and customized image viewing software with an electronic grading form. A detailed protocol for grading was developed. Based on results of TR gradings, a computerized algorithm determined whether referral-warranted ROP (RW-ROP; defined as presence of plus disease, zone I ROP, and stage 3 or worse ROP) was present in digital images from infants with birth weight less than 1251 g enrolled from May 25, 2011, through October 31, 2013. Independent double grading was done by the TRs with adjudication of discrepant fields performed by the reading center director. Digital retinal images. Intragrader and intergrader variability and monitoring for temporal drift. Four TRs underwent rigorous training and certification. A total of 5520 image sets were double graded, with 24.5% requiring adjudication for at least 1 component of RW-ROP. For individual RW-ROP components, the adjudication rate was 3.9% for plus disease, 12.4% for zone I ROP, and 16.9% for stage 3 or worse ROP. The weighted κ for intergrader agreement (n = 80 image sets) was 0.72 (95% CI, 0.52-0.93) for RW-ROP, 0.57 (95% CI, 0.37-0.77) for plus disease, 0.43 (95% CI, 0.24-0.63) for zone I ROP, and 0.67 (95% CI, 0.47-0.88) for stage 3 or worse ROP. The weighted κ for grade-regrade agreement was 0.77 (95% CI, 0.57-0.97) for RW-ROP, 0.87 (95% CI, 0.67-1.00) for plus disease, 0.70 (95% CI, 0.51-0.90) for zone I ROP, and 0.77 (95% CI, 0.57-0.97) for stage 3 or worse ROP. These data suggest that the e-ROP system for training and certifying nonphysicians to grade ROP images under the supervision of a reading center director reliably detects potentially serious ROP with good intragrader and intergrader consistency and minimal temporal drift.

Polymorphisms of Vascular Endothelial Growth Factor and Retinopathy of Prematurity.

Retinopathy of prematurity (ROP) is a major problem among preterm survivors of neonatal intensive care. Neovascularization of the retina is prominent in the proliferative stages of ROP and is under the control of factors such as vascular endothelial growth factor (VEGF). The authors investigated the association of ROP with VEGF genetic polymorphisms and clinical (maternal, perinatal, neonatal) risk factors among preterm infants admitted to the neonatal intensive care unit. The frequencies of VEGF 634 C/G and VEGF 936 C/T polymorphisms were determined in DNA from 102 preterm infants by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The frequency of the VEGF 634 CG genotype was significantly higher, whereas the frequency of the VEGF 634 CC genotype was significantly lower among neonates with ROP. The frequencies of the VEGF 634 GG, VEGF 936 CC, and VEGF 936 CT genotypes were similar in both groups. The distribution of VEGF 634 G allele was significantly different between the two groups. By logistic regression analysis, low birth weight, presence of maternal disease, respiratory distress syndrome, hypotension, and VEGF 634 CG genotype remained significant risk factors for the development of ROP. The results support the hypothesis that the carrier state of VEGF 634 C/G polymorphism has an impact on the risk of ROP in infants. A broader study may suggest that this marker could be used as an indicator in the screening for ROP.

G530(P) To give oxygen or not? are we adhering to local guidelines on administering targeted oxygen therapy to our neonatal population?

Context This “spot audit” was carried out in a level 3 neonatal unit. Problem Supplementary oxygen therapy is a vitial to the vulnerable neonate. We know that in excess, oxygen can be toxic, contributing to retinopathy of prematurity (ROP). The recent BOOST 2 study has made clinicians rethink what our oxygen saturation limits should be. However, given the increased mortality in those with lower saturation limits, the exact limit remains controversial. The aim of this “spot audit” was simply to determine whether we were adhering to our local guidelines regarding oxygen saturation targeting. Assessment of problem and analysis of its causes This audit was carried out on a weekly basis. The initial few weeks, before any change, ensured that we obtained baseline numbers. The staff were aware that the audit project was being carried out. We quickly identified that there was a need to intervene and a discussion was had with ward sisters. We identified that nurses were key to ensuring that the limits on the saturation monitors were set correctly. Intervention We realised that verbal communication/education alone would be insufficient to increase our compliance. A visual aid, or quick reference card, was developed. This briefly summarised our protocol, i.e. what the saturation limits should be for neonates, based on their risk of ROP. This was produced in a size which ensured that it could be attached to the saturation monitors. Study design A initial prospective audit was carried out over a period of 8 weeks. information regarding risk of ROP and whether or not stauration limits were achieved was collected on a proforma. When possible, I would then refer to the neonates case notes and/or speak to nursing staff caring for them to determine why the monitors may have been set differently to protocol, i.e. medical decision or in error. 2 years after the initial audit, we’ve reaudited the same thing to determine if compliance has been maintained. Strategy for change Initially discussions were had with the ward sister regarding the audit project, but it became apparent that there was a lack of awareness of our local protocol. The quick reference card was produced on a home computer. Medical physics (who ensure up keep of our saturation monitors) were given additional copies of the visual aid. I presented the inital results at a local quality improvement evening. Measurement of improvement Percentages were used to demonstrate compliance. This ensured that all staff could easily interpret the results obtained. During the initial four weeks of the audit, our compliance with our local guideline, regarding oxygen saturation targets within the neonatal population, ranged from 43–70%. After the introduction of the quick reference card, our compliance was 79–94%. We re-audited this recently and our compliance is sustained at 92%. In the majority of cases, the reasons for non compliance included no quick reference card on the saturation monitor! Effects of changes Our change has increased compliance with local guidelines and ensures that oxygen therapy is being targeted appropriately in the majority of cases. It has also increased staffs awareness of the importance of targeted oxygen therapy. Lessons learnt This simple regular audit process can be applied within any healthcare setting. The simplicity of the concept makes it easily reproducibile. Furthermore, it helped identify a key, often overlooked, problem within our unit, and attempted to address it. Message for others We have demonstrated how simple auditing can result in sustained improvement in neonatal care by targeting our oxygen saturations more effectively in compliance with our local guideline.

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...