Current concepts in retinopathy of prematurity

Multiple pregnancies and its relationship with the development of retinopathy of prematurity (ROP)

Background

The influence of multiple gestation on the occurrence of retinopathy of prematurity (ROP) is still not completely understood.

Objectives

To verify the incidence of any stage of ROP and threshold ROP in singletons and in multiple gestation among preterm infants.

Methods

This was an institutional, prospective, and descriptive cohort study, which included preterm newborns with birth weight (BW) of 1500 g or less and/or gestational age (GA) of 32 weeks or less, as admitted to the neonatal units at Laranjeiras and Amparo Hospitals in Rio de Janeiro, Brazil, between January 2001 and July 2005, and whom remained hospitalized for at least 28 days. There were no exclusion criteria. Patients were divided into two groups: Group 1 included multiples; and Group 2 consisted of singletons.

Results

A total of 159 infants that remained in neonatal unit care for at least 28 days were included in this study. Group 1 comprised 56 (35%) multiples; and Group 2 comprised 103 (65%) singletons. Mean BW was 1072 g ± 272 and 1089 g ± 282 in Groups 1 and 2, respectively (analysis of variance [ANOVA] P > 0.05). Mean GA among multiple gestation (Group 1) was 29 weeks ± 2.1; and 29 weeks ± 2.4 among singletons (Group 2) (ANOVA P > 0.05). Days in oxygen therapy ranged from 0 to 188 days. Median among Group 1 was 15 days, while median in Group 2 was 10 days (Kruskal–Wallis P > 0.05). Any stage ROP was detected in 66 (41.5%) of the whole cohort comprising 159 babies. Among the 56 multiples, 30 (53.6%) achieved any stage ROP, and among 103 singletons, 36 (35%) achieved any stage ROP (Chi-square test P < 0.05). Threshold ROP occurred in 12 (7.5%) of the 159 patients included. Three (5.3%) patients from Group 1 and nine (8.7%) patients in Group 2 reached threshold ROP needing laser treatment (Fisher’s exact test P > 0.05).

Conclusion

This study showed higher frequency of any stage of ROP in twins and triplets but not regarding threshold disease. Because of the relatively small number of patients in this sample, other studies are necessary to determine if gemelarity plays a role in the occurrence of ROP.

Arterial oxygen fluctuation and retinopathy of prematurity in very-low-birth-weight infants

OBJECTIVE

To determine the influence of arterial oxygen fluctuation on development of threshold ROP.

STUDY DESIGN

Retrospective study of 231 infants, < or =1500 g birth weight, who were admitted to Arkansas Children's Hospital NICU from January 1993 to June 1995. Fluctuation in partial pressure of dissolved arterial oxygen (PaO(2)) was expressed as coefficient of variation (CoV) for each infant. We investigated the relationship between CoV at three intervals and the risk of developing threshold ROP.

RESULTS

The odds ratio (OR) of developing threshold ROP versus prethreshold ROP or less associated with a 10% increase in the CoV during the first 5 days of oxygen therapy was 1.44, and during the first 10 days was 1.51. When analysis was restricted to infants receiving 30 days of therapy, the OR during the first 5 days of therapy was 1.67, during the first 10 days was 1.82, and during days 11-30 was 1.68.

CONCLUSIONS

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

Educational intervention strategies for children with visual impairments with emphasis on retinopathy of prematurity

Young children with retinopathy of prematurity have many intervention needs. This article discusses the possible causes of retinopathy of prematurity and possible educational problems experienced by these children. In addition, possible intervention strategies are suggested in the areas of language development, social interaction, self-help skills, orientation and mobility, and educational technology as they relate to the needs of young children with retinopathy of prematurity.

Control of cerebral and ocular blood flow autoregulation in neonates

Several factors have been implicated in the regulation of cerebral and ocular vasomotor tone in the newborn: the interrelationship between prostanoids, NO, and other vasoactive mediators remains a subject of interest and active investigation. Pharmacologic modulation may provide new treatment modalities for diseases of the newborn that are mostly hemodynamic and vascular in nature.