Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

Abstract

Aims To analyse the incidence and risk factors for retinopathy of prematurity (ROP) and survival rates among extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants. Methods A prospective cohort study of 352 infants admitted at a teaching hospital, Hospital de Clinicas de Porto Alegre, Brazil, between October 2002 and December 2006, was screened for ROP. The ELBW group comprised infants whose birth weight (BW) was p1000 g and the VLBW group comprised those infants whose BW were 41000 g and p1500 g. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Results Of the 352 neonates screened, 88 were ELBW babies. Survival rates among ELBW and VLBW were 47.8 and 88.7%, respectively. ROP affected 48.9% of ELBW infants and 18.2% of VLBW babies. Threshold disease occurred in 21 patients, 15 of whom were born weighing o1000 g. Only 2.3% of the neonates born with more than 1000 g developed treatable disease. Univariate analysis showed that gestational age (GA), BW, use of indomethacin and erythropoietin, blood transfusions, and intraventricular haemorrhage were associated with ROP. After logistic regression, the most important adjusted risk factors were BW (OR: 1.002;95% CI: 1.001-1.003; P ¼ 0.003), GA (OR: 1.254;95% CI: 1.082-1.455; P ¼ 0.003), and use of erythropoietin (OR: 2.486;95% CI: 1.182-5.231; P ¼ 0.016). ConclusionThis study showed reduced survival rates, high incidence of ROP, and a greater need of treatment among ELBW infants as compared to VLBW babies admitted in this institution.

Score for Neonatal Acute Physiology and Perinatal Extension II as a Predictor of Retinopathy of Prematurity: Study in 304 Very-Low-Birth-Weight Preterm Infants

“…In Brazil, these scoring systems have become increasingly important considering survival rates, especially among VLBW and extremely low-BW preterm babies (babies with BW <1,000 g), because the Brazilian survival rates are lower than those reported in industrialized countries [11, 12]. …”

“…According to the Brazilian guidelines for ROP screening, we also included in this study all babies with BW >1,501 g but with GA ≤32 weeks at birth (estimated by the New Ballard method for newborns with obstetric GA up to 34 weeks) [10, 11]. Pupils were dilated with tropicamide 0.5% and phenylephrine 2.5% eyedrops, instilled 1 h before examination.…”

Chorioamnionitis as a Risk Factor for Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

“…It has been shown in a number of studies that extreme prematurity plus multiple hits of perinatal inflammation appear to be involved in ROP etiology and progression [26,39]. Again, lower GA and birth weight are associated with increased oxygen therapy, which is an independent risk factor for development of ROP [80]. In a recent meta-analysis by Saugstad and Aune [81], it was found that a lower oxygen saturation targeting by pulse oximetry reduced severe ROP by 50%, i.e.…”

Prevalência e fatores de risco para a retinopatia da prematuridade: estudo com 450 pré-termos de muito baixo peso

“…Embora esses importantes estudos brasileiros, baseados em dados de unidades neonatais isoladas, sejam da década passada e, portanto, anteriores à publicação das diretrizes brasileiras para a detecção da ROP, a prevalência da doença em nossa instituição foi inferior ao relatado por aqueles autores. Em estudo anteriormente publicado (19) , verificamos a prevalência de 48,9% de ROP em qualquer estadiamento, quando analisamos apenas os pré-termos com PN <1.000 gramas, e que essa prevalência fica reduzida a apenas 18,2% de ROP em qualquer estadiamento, se considerarmos somente os pacientes com PN >1.000 gramas. Estudo recente, publicado por Bonotto et al (20) , em 2007, mostrou dados sobre 286 prematuros atendidos no período entre 1992 e 1999, na cidade de Joinville em Santa Catarina.…”