Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Fang, Jennifer L.; Sorita, Atsushi; Carey, William A.; Colby, Christopher E.; Murad, M. Hassan; Alahdab, Fares

doi:10.1542/peds.2015-3387

Cited by 78 publications

(70 citation statements)

References 98 publications

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“…Genetic and environmental factors are likely to play a role in the degree and duration of hyperoxia necessary to trigger the process, the resultant surge in vascular growth factors and the severity of disease that develops. Balancing oxygen supplementation is key: lower supplementation (85%–89% vs 91%–95%) reduces the risk of sight threatening ROP (risk ratio (RR) of 0.72, 95% CI 0.51 to 1.00) but increases the risk of mortality (RR 1.17, 95% CI 1.03 to 1.32) 38. The role of nutrition, haemoglobin transfusion or erythropoietin (EPO) administration is unclear, though meta-analysis of RCTS of early nutritional supplementation indicates a protective effect (RR 0.22, 95% CI 0.09 to 0.55 and RR 0.67, 95% CI 0.46 to 0.97, respectively) 36 38…”

Section: Retinopathy Of Prematuritymentioning

confidence: 99%

Epidemiology of blindness in children

2017

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An estimated 14 million of the world's children are blind. A blind child is more likely to live in socioeconomic deprivation, to be more frequently hospitalised during childhood and to die in childhood than a child not living with blindness. This update of a previous review on childhood visual impairment focuses on emerging therapies for children with severe visual disability (severe visual impairment and blindness or SVI/BL).For children in higher income countries, cerebral visual impairment and optic nerve anomalies remain the most common causes of SVI/BL, while retinopathy of prematurity (ROP) and cataract are now the most common avoidable causes. The constellation of causes of childhood blindness in lower income settings is shifting from infective and nutritional corneal opacities and congenital anomalies to more resemble the patterns seen in higher income settings. Improvements in maternal and neonatal health and investment in and maintenance of national ophthalmic care infrastructure are the key to reducing the burden of avoidable blindness. New therapeutic targets are emerging for childhood visual disorders, although the safety and efficacy of novel therapies for diseases such as ROP or retinal dystrophies are not yet clear. Population-based epidemiological research, particularly on cerebral visual impairment and optic nerve hypoplasia, is needed in order to improve understanding of risk factors and to inform and support the development of novel therapies for disorders currently considered 'untreatable'.

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Section: Retinopathy Of Prematuritymentioning

confidence: 99%

Epidemiology of blindness in children

2017

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“…However, a meta-analysis concluded that despite the fact that low oxygen concentration has been detected to decline the risk of ROP, it actually increases mortality (RR 1.15, 95% CI, 1.04-1.29) [76].…”

Section: Retinopathy Of Prematurity (Rop)mentioning

confidence: 99%

“…There is a growing body of evidence that no single therapy has proven to be effective and safe in preventing and treating ROP [73,76]. Managing ROP effectively necessitates coordination between physicians from different disciplines, such as neonatologists, obstetricians, and ophthalmologists.…”

Section: Retinopathy Of Prematurity (Rop)mentioning

confidence: 99%

The First Sixty Minutes in Preterm Neonates’ Life: Predicted Morbidities and Interventions

El-Atawi¹

2018

JPNC

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Preterm neonates are more vulnerable to many diseases and complications than full-term infants as most of their biological systems are still underdeveloped. Fortunately, most of these morbidities are preventable as there are many interventions that could be performed in the first 60 minutes of neonatal life to avoid them and their long-term consequences, thus rightfully defining 'the golden hour'. The objective of this article is to review the potential morbidities that neonates might experience and understand their mechanisms, risk factors and its possible outcomes. We also reviewed the possible actions that could be implemented during the golden hour to prevent these morbidities and investigated their effectiveness. Medline and Cochrane database for systematic review were the main two electronic database that we used to search for studies. Studies pertaining to morbidities, such as hypothermia, hypoglycemia, respiratory distress, intraventricular hemorrhage (IVH), Chronic lung disease (CLD) and retinopathy of prematurity (ROP) have been selected according to their full text accessibility for us. Reports related to possible interventions that could be performed to prevent these morbidities have also been involved that include but not only restricted to drying & head coverings, polyethylene occlusive skin wraps, ambient room temperature, pre-warmed incubator, heated humidified gases, heated mattress and skin-to-skin contact for hypothermia; dextrose infusion pump, dextrose burette and oral dextrose for hypoglycemia; indomethacin, ibuprofen, antithrombin and heparin for IVH; surfactant and CPAP for respiratory distress; controlling oxygen saturation for ROP. Keywords: The First Sixty Minutes in Preterm Neonates' Life: Predicted Morbidities and Interventions 2/8Copyright: ©2018 El-Atawi et al. the relation between severe hypothermia (<32°C) and shortand long-term neurodevelopmental outcomes are required. Moderate hypothermia was found to be associated with severe intraventricular hemorrhage, intraventricular leukomalacia, and necrotizing enterocolitis. Yet, these associations should be analyzed carefully since they were based on studies with a wide confidence interval. More studies with larger sample size are warranted to accurately illustrate these associations [5]. Moreover, hypothermia increases oxygen consumption, thus leading to hypoxia and subsequently pulmonary vasoconstriction which, in turn, declines surfactant production and worsens respiratory distress. The presence of comorbidities with hypothermia increases the fatality rate, so adding a higher category to the severity of hypothermia would represent an effective addition to the WHO classification of the severity of hypothermia [8].Large surface area of neonates in relation to their small body weight makes them more vulnerable to hypothermia than fullterm babies. Preterm neonates have a higher transepidermal water loss than term due to their immature epidermal layer [9]. Their premature vasomotor control which acts as a thermoregulatory mec...

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“…Three recent meta-analyses show that any amount of human milk is strongly associated with ROP protection 2–4. One of them demonstrated a significant 60% reduction in severe ROP with increased human milk exposure, while lower oxygen saturation targets were associated with only a 42% reduced risk of severe ROP3; these findings hint that the effectiveness of interventions on oxygen concentrations aimed at reducing the risk of ROP has been over-rated, while the responsibility of formula feeding on ROP pathogenesis has been under-rated.…”

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confidence: 94%