Retinopathy of Prematurity (Retrolental Fibroplasia) and Oxygen*

Bedrossian, Robert H.; Carmichael, Paul L.; Ritter, Joseph A.

doi:10.1016/0002-9394(54)92034-6

Cited by 46 publications

(9 citation statements)

References 9 publications

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“…[1] No statistical significance was found when comparing oxygen concentration and duration of oxygen received in the two groups. This finding may be due to strict saturation targeting in infants receiving oxygen therapy.…”

Section: Discussionmentioning

confidence: 96%

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Retinopathy of prematurity in a cohort of neonates at Groote Schuur Hospital, Cape Town, South Africa

et al. 2016

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Background. Severe retinopathy of prematurity (ROP) can cause blindness. Before 2016, resource limitations precluded routine screening for ROP at Groote Schuur Hospital (GSH), Cape Town, South Africa. Previous pilot studies at GSH found no patients with ROP requiring treatment; however, improved preterm infant survival may affect the prevalence. Objectives. To determine the prevalence and severity of ROP, describe potential risk factors, and assess the feasibility of ROP screening. Methods. Infants with a birth weight (BW) of <1 251 g or a gestational age (GA) of ≤31 weeks were screened from November 2012 to May 2013. Results. Three hundred and thirteen ROP examinations were performed in 135 of 191 eligible infants. The mean GA and BW were 30.1 weeks (standard deviation (SD) 1.9) and 1 056 g (SD 172), respectively. ROP was diagnosed in 40 infants (29.6%); 8 (5.9%) had severe ROP and 2 (1.5%) received laser treatment. Infants with ROP had a lower mean GA (29.2 weeks (SD 1.6) v. 30.5 weeks (SD 1.9)) (p<0.002) and a lower mean BW (988 g (SD 181) v. 1 085 g (SD 160)) (p=0.001) than those without ROP. Infants weighing <1 000 g had a 2.5 times higher risk than those with a BW of ≥1 000 g of having ROP (95% confidence interval 1. 05 -5.90; p=0.03). Blood transfusions (p<0.002) and late-onset sepsis (p=0.024) were strongly associated with ROP. Screening was completed in 91.1% (123/135) of the infants. Conclusions. The prevalence and severity of ROP have increased at GSH. The strong association between ROP, BW and GA suggests that infants with lower BWs and GAs should be prioritised for screening in our resource-limited setting.

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Section: Discussionmentioning

confidence: 96%

“…[1] Screening and early treatment are important to prevent related morbidity. An increase in ROP has been reported in middle-income countries, as greater numbers of premature infants survive as a result of improved neonatal care, but lack adequately monitored oxygen therapy.…”

Section: Researchmentioning

confidence: 99%

Retinopathy of prematurity in a cohort of neonates at Groote Schuur Hospital, Cape Town, South Africa

et al. 2016

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“…6,35 In addition to glucose status, which has been already discussed above, other factors such as exposure to higher mean airway pressure with prolonged mechanical ventilation, 10,36 inotrope therapy, 10,36,37 and postnatal steroid administration 1,38 as well the presence of a PDA, 39 BPD, 39 sepsis 37 and IVH 10 have been also linked to ROP development. Severity of illness is suspected to have a major role in the development of ROP, and potentially explains some of the significant associated factors.…”

Section: Abnormal Glucose Levels In Elbw Infantsmentioning

confidence: 97%

“…3 Renal glucose excretion and neurological signs have been used as indicators of significant hyperglycemia and hypoglycemia, respectively; however, these findings are often misleading because of other physiological abnormalities. 4,5 Retinopathy of prematurity (ROP) is a vasoproliferative disorder linked to early exposure to relatively high retinal oxygen levels, 6,7 with an incidence of >50% in ELBW infants. 8 Recently, high glucose levels have been associated with an increased ROP incidence in ELBW infants.…”

Section: Introductionmentioning

confidence: 99%

Contribution of early glycemic status in the development of severe retinopathy of prematurity in a cohort of ELBW infants

et al. 2011

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Objective: The objective of this study is to investigate the relationship between glycemic status and severe retinopathy of prematurity (ROP).Study Design: This is a retrospective cohort study of 114 infants <1000 g admitted to a level IV neonatal intensive care unit within 48 h of life. A cumulative, time-weighted glucose level (TWGL) derived from plotting glucose values over time was included in logistic regression analysis to identify predictors for severe ROP.Result: Infants had 26.6 ± 2 weeks gestational age and had a birth weight of 782±136 g. TWGL during first 10 and 30 days of life were greater in the severe ROP group (P<0.01). Unlike single events of glucose levels X150 mg dl À1 , 10 days TWGL X100 mg dl À1 (odds ratio (OR) 5.2, P<0.02) and 30 days TWGL X118 mg dl À1 (OR 5.7, P<0.02) were predictors for severe ROP (univariate). Multivariate regression confirmed 30 days TWGL X118 mg dl À1 (OR 9.4 to 10) and gram-positive sepsis (OR 4.1 to 5) as predictors for severe ROP (P<0.05). Conclusion:High overall glycemic status is associated with the development of severe ROP.

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“…Nearly 190,000 preterm neonates develop some stage of ROP and around 20,000 of them become blind each year [2]. The first epidemic of ROP was in the 1950s [3,4]. High oxygen supplementation was the major reason during this epidemic, and hyperoxia was the major factor.…”

Section: Introductionmentioning

confidence: 99%

Retinopathy of Prematurity: Therapeutic Strategies Based on Pathophysiology

Cayabyab¹,

Ramanathan²

2016

Neonatology

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Retinopathy of prematurity (ROP) continues to be a major preventable cause of blindness and visual handicaps globally. With improved perinatal care, improved survival of moderately preterm infants, and limited resources for oxygen delivery and monitoring, more mature preterm infants are developing severe ROP in developing countries. The pathophysiology of ROP is characterized by two phases. Phase I ROP is due to vaso-obliteration beginning immediately after birth secondary to a marked decrease in vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1). Phase II begins around 33 weeks' postmenstrual age (PMA). During this phase, VEGF levels increase, especially if there is retinal hypoxia with increasing retinal metabolism and demand for oxygen leading to abnormal vasoproliferation. Since the original description of ROP in 1942 by Terry et al. [Am J Ophthalmol 1942;25:203-204], four epidemics of ROP have been observed. Prevention or early treatment of ROP involves careful titration of oxygen saturation by pulse oximeter (SpO₂). Optimal SpO₂ target remains elusive. Most of the large trials have focused on either a low SpO₂ (85-89%) or a high SpO₂ (91-95%) from the first day of birth to 36 weeks' PMA. Although the incidence of severe ROP and bronchopulmonary dysplasia decreased significantly, predischarge mortality was higher in these studies. Use of graded SpO₂ during the 2 different phases of ROP (early, low SpO₂ during phase I vs. late, high SpO₂ during phase II) may be the best approach to prevent this disabling condition. Further trials should focus on this strategy. Other biological agents that are currently being studied include IGF-1 with IGF-binding protein-3 (rhIGF-1 + rhIGFBP-3) and propranolol. For advanced stages of ROP, laser ablation of avascular retina, early treatment of ROP (ETROP) protocol, intravitreal injection of anti-VEGF antibodies (e.g. bevacizumab) and vitrectomy are used to protect central vision and prevent retinal detachment. Long-term complications such as refractory errors, recurrence of ROP and risk of retinal detachment require continued follow-up with an ophthalmologist through adolescence and beyond. Optimal nutrition including adequate intake of omega-3 polyunsaturated fatty acids and decreasing infection/inflammation to promote normal vascularization are important strategies. Screening guidelines for ROP based on local incidence of ROP in different regions of the world are very important. Oxygen therapy is clearly a modifiable risk factor to decrease ROP that needs further study. Understanding the two phases of ROP will help to identify appropriate therapeutic strategies and improve visual outcomes in many preterm infants globally.

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Retinopathy of Prematurity (Retrolental Fibroplasia) and Oxygen*

Cited by 46 publications

References 9 publications

Retinopathy of prematurity in a cohort of neonates at Groote Schuur Hospital, Cape Town, South Africa

Retinopathy of prematurity in a cohort of neonates at Groote Schuur Hospital, Cape Town, South Africa

Contribution of early glycemic status in the development of severe retinopathy of prematurity in a cohort of ELBW infants

Retinopathy of Prematurity: Therapeutic Strategies Based on Pathophysiology

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