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Retinopathy of prematurity (retrolental fibroplasia): old and new
facts.Helv
Paediatr Acta. 1982;37(5):413-20
Retinopathy of
prematurity (ROP) is found in 10% of patients in neonatological units.
Most often, there is spontaneous restitution. Rarely, severe degrees
develop (retrolental fibroplasia); occasionally, infants become blind
even nowadays. The etiological role of oxygen is undisputed.
Additional factors, however, are also found with significant frequency
in the history of infants with ROP. These are elevated pCO2-values, an
acidotic pH, and blood transfusions. These three parameters lead to
increased availability of oxygen for the tissue. Data from animal
experiments confirm this effect. The statistical significance of these
factors is clear, whereas their clinical significance has not yet been
proved. Probably, the most effective prophylactic measure for
preventing severe degrees of ROP is the repeated examination of
newborns presenting defined risks by especially trained
ophthalmologists.
Retinopathy of prematurity and risk factors: a prospective cohort
study.BMC Pediatr.
2005 Jun 28;5(1):18
BACKGROUND:
Increased survival of extremely low birth infants due to advances in
antenatal and neonatal care has resulted in a population of infants at
high risk of developing retinopathy of prematurity (ROP). Therapeutic
interventions include the use of antenatal and postnatal steroids
however, their effects on the severity of ROP is in dispute. In
addition, it has not been investigated whether severe ROP is due to
therapeutic interventions or due to the severity of illness. The aim
of the present study was to assess the association between the
incidence of severe retinopathy of prematurity (greater than stage 2 -
International classification of ROP) and mechanical ventilation,
oxygen therapy, gestational age, antenatal and postnatal steroids in
extremely low birth weight infants. METHODS: Neonates admitted to the
neonatal intensive care unit in Lansing, Michigan, during 1993-2000
were followed to determine factors influencing the development of
severe retinopathy of prematurity. Ophthalmologic examinations were
started at 6 weeks and followed until resolution. We used logistic
regression to estimate the relative risk (odds ratio) associated with
risk factors of ROP. RESULTS: Of the neonates with <or= 1500 g birth
weight, admitted to the neonatal intensive care unit, 85% (616/725)
survived. Severe retinopathy of prematurity was detected in 7.8% of
576 neonates who had eye examinations. Neonates of lower gestational
age (<or= 25 weeks and 26-28 weeks) had an increased odds ratio of
8.49 and 3.19 for the development of severe retinopathy of prematurity,
respectively, compared to those 29 weeks and older. Late postnatal
steroid treatment starting after 3 weeks of life showed 2.9-fold
increased odds ratio, in particular administration for two weeks and
more (OR: 4.09, 95% CI: 1.52-11.03). With increasing antenatal
steroids courses the risk of severe retinopathy of prematurity
decreased, however, it was not significant. Lower gestational age,
dependence on ventilation, and use of postnatal steroids were
intertwined. Simultaneous presence of these factors seems to indicate
severe disease status. CONCLUSION: Prolonged and late postnatal
steroids treatment in very low birth weight infants may pose an
increased risk for the development of severe retinopathy of
prematurity; however, use of postnatal steroids may also be a marker
for severity of illness. Further studies need to focus on biologic
markers in the pathogenesis of retinopathy of prematurity and to
better understand the influence of therapies.
Risk factors of
retinopathy of prematurity in infants 32 to 36 weeks gestational age.Z
Geburtshilfe Neonatol. 2003 Jan-Feb;207(1):24-8.
INTRODUCTION: In
our study we determined possible risk factors for retinopathy of
prematurity (ROP) in infants 32 to 36 completed weeks of gestational
age based on a regional German neonatal database. We examined
especially whether or not oxygen therapy over more than 3 days is
related to a higher risk of ROP. MATERIALS: We identified 7172
ophthalmologically examined infants, 32 to 36 completed weeks
gestational age, born from 1990 to 1996. ROP was diagnosed in 195 (2.7
%). We examined the following variables as risk factors for ROP in
infants receiving oxygen for less than 4 days: gestational age, sex,
blood pH of 7.0 or less, body temperature of 36 degrees C or less,
phototherapy, blood pO2 of 35 mm Hg or less, small-for-gestational
age, sepsis, ventilation after birth, and blood transfusion. RESULTS:
Sex, blood pH of 7.0 or less, blood pO2 of 35 mm Hg or less, sepsis,
phototherapy, and small-for-gestational age were not associated with a
significant risk of ROP. A gestational age of 32 weeks compared to a
gestational age of 36 weeks was associated with an increased risk of
ROP (odds ratio, 2.95; 95 % confidence interval, 2.18 to 4.01).
Ventilation after birth (adjusted OR, 2.29; 95 % CI, 1.70 to 3.15) and
blood transfusion (adjusted OR, 5.28; 95 % CI, 3.80 to 7.23) increased
the risk of ROP regardless of gestational age. Oxygen therapy for more
than 3 days was not associated with an increased risk of ROP (OR,
1.06; 95 % CI, 0.67 to 1.70). CONCLUSION: In neonates delivered
between 32 and 36 weeks of gestation, the duration of oxygen
supplementation should not necessitate an ophthalmological
examination. A vigorous restriction of blood transfusions could reduce
the incidence of ROP.
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