Arterial Oxygen Fluctuation and Retinopathy of Prematurity in Very-Low-Birth-Weight Infants

York, James L.; Landers, Susan; Kirby, Russell S.; Arbogast, Patrick G.; Penn, John S.

doi:10.1038/sj.jp.7211040

Cited by 134 publications

(93 citation statements)

References 29 publications

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“…It is possible that fluctuations occurring over much shorter periods of time or in clinical factors not captured by SNAP scores may be more pertinent to progression of ROP. Short periods of hyperoxemia or hypoxemia, for example, may influence the risk for progressive ROP, 10,29 yet would not be reflected in changes of daily SNAP scores.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The strong associations reported between neonatal diagnoses or therapies and subsequent ROP suggest that severe illness, or an unstable fluctuating hospital course in general, are associated with risk for developing severe ROP. [4][5][6][7][8][9][10][11][12][13][14] Standardized illness severity (IS) measurements are widely used to account for variations in neonatal outcomes among hospitals. 15 The Score for Neonatal Acute Physiology (SNAP score) 16 on the first day of life appears associated with development of any ROP 17 and severe ROP.…”

Section: Introductionmentioning

confidence: 99%

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Cumulative illness severity and progression from moderate to severe retinopathy of prematurity

et al. 2007

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Objective: To test cumulative neonatal illness severity (IS) and IS fluctuation as predictors of progression from moderate to severe retinopathy of prematurity (ROP).Study Design: Data from research databases and medical record review were collected for infants from four neonatal intensive care unit (NICUs) admitted between 1995 and 2001 and diagnosed with prethreshold ROP. Cumulative neonatal IS measured using daily Scores for Neonatal Acute Physiology (SNAP) for the first 28 days of life, and IS fluctuation as assessed by summing changes between daily SNAP scores, were tested as predictors of progression to threshold ROP using logistic regression.Result: Infants progressing to threshold (n ¼ 79), compared to those not progressing to threshold (n ¼ 130), had significantly (P<0.05) lower gestational ages (25.2±1.1 versus 25.8±1.4 weeks), higher cumulative neonatal SNAP (255±77 versus 224±63 weeks) and had more severe hospitalizations as indicated by diagnoses and medical management. In regression analysis, gestational age, chronological age and presence of plus disease at first diagnosis of prethreshold were associated with development of threshold. After adjusting for these factors, cumulative neonatal SNAP was significantly associated with progression to threshold. However, addition of cumulative SNAP to the model only increased receiver-operating characteristic curve area from 0.77 to 0.78 (NS). Other factors, including SNAP fluctuation, were not associated with progression to threshold after adjustment using this model. Conclusion:Cumulative neonatal IS, as measured by cumulative SNAP, is an independent risk factor for progression from moderate to severe ROP. However, cumulative IS does not enhance assessment of risk for ROP progression after adjusting for simpler clinical factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cumulative illness severity and progression from moderate to severe retinopathy of prematurity

et al. 2007

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“…Although the precise oxygen saturations to avoid remain unknown, avoiding hyperoxia, and particularly avoiding swings between hyperoxia and hypoxia, in the first few weeks of life has been shown to decrease the severity of ROP Askie and Henderson-Smart, 2000;Tin et al, 2001;Chow et al, 2003;Anderson et al, 2004;York et al, 2004). The relationship between hyperoxia and subsequent neovascularization appears more complex than suggested previously.…”

Section: Implications For Prevention and Treatment Of Ropmentioning

confidence: 97%

Vascular endothelial growth factor in eye disease

Penn

Madan

Caldwell

et al. 2008

Progress in Retinal and Eye Research

636

527

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Collectively, angiogenic ocular conditions represent the leading cause of irreversible vision loss in developed countries. In the U.S., for example, retinopathy of prematurity, diabetic retinopathy and age-related macular degeneration are the principal causes of blindness in the infant, working age and elderly populations, respectively. Evidence suggests that vascular endothelial growth factor (VEGF), a 40 kDa dimeric glycoprotein, promotes angiogenesis in each of these conditions, making it a highly significant therapeutic target. However, VEGF is pleiotropic, affecting a broad spectrum of endothelial, neuronal and glial behaviors, and confounding the validity of anti-VEGF strategies, particularly under chronic disease conditions. In fact, among other functions VEGF can influence cell proliferation, cell migration, proteolysis, cell survival and vessel permeability in a wide variety of biological contexts. This article will describe the roles played by VEGF in the pathogenesis of retinopathy of prematurity, diabetic retinopathy and age-related macular degeneration. The potential disadvantages of inhibiting VEGF will be discussed, as will the rationales for targeting other VEGF-related modulators of angiogenesis.

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“…Two previous studies have shown that the threshold levels of the partial pressure of the arterial carbon dioxide (PaCO 2 ), pH, the fraction of the inspired oxygen (FiO 2 ), and the SpO 2 were more stringent for the intubation group when compared to the CPAP group (Morley et al 2008;Finer et al 2010). Other studies have further suggested that the fluctuations between hyperoxia and hypoxia are more harmful with regard to developing severe ROP (York et al 2004;Di Fiore et al 2010).…”

Section: Discussionmentioning

confidence: 99%

Low Incidence of Sight-Threatening Retinopathy of Prematurity in Infants Born Before 28 Weeks Gestation at a Neonatal Intensive Care Unit in Japan

Aikawa

Noro

2013

Tohoku J. Exp. Med.

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Improvement in neonatal care has led to increased survival rates of very premature infants. Accordingly, there are now more extremely preterm infants who are at risk of developing retinopathy of prematurity (ROP). ROP is a disorder of low birth-weight preterm infants and may lead to blindness. However, the prevalence of ROP varies globally, depending on different neonatal and ophthalmic care. Therefore, we studied the incidence and progression of ROP in extremely preterm infants in Japan. In addition, we investigated the characteristics and the clinical courses of the infants who progressed to sight-threatening ROP. A total of 3,154 infants were born at the Japanese Red Cross Sendai Hospital between 2009 and 2011, including 53 live-born infants born before 28 weeks' gestation. Two extremely preterm infants died before the first ROP examination. Among the survived 51 infants (the birth-weight ranged from 309 to 1,354 g, mean 779 g), 36 infants (70.6%) developed ROP: 18 infants with mild ROP and 18 infants with severe ROP. Eight out of the 51 infants (15.7%) underwent laser treatment. None of the infants born at older than 27 weeks 0 day of gestation required any treatment for ROP. In conclusion, most of extremely preterm infants develop some degree of ROP. However, in the majority of these infants the ROP never progressed beyond mild disease and resolved spontaneously without treatment. Sight-threatening ROP was rare. The present study clarifies the natural history of ROP in extremely preterm infants with active perinatal care.

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Arterial Oxygen Fluctuation and Retinopathy of Prematurity in Very-Low-Birth-Weight Infants

Abstract: Very-low-birth-weight infants experiencing fluctuating PaO(2) are at higher risk of threshold ROP.

Cited by 134 publications

References 29 publications

Cumulative illness severity and progression from moderate to severe retinopathy of prematurity

Cumulative illness severity and progression from moderate to severe retinopathy of prematurity

Vascular endothelial growth factor in eye disease

Low Incidence of Sight-Threatening Retinopathy of Prematurity in Infants Born Before 28 Weeks Gestation at a Neonatal Intensive Care Unit in Japan

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