Incidence and risk factors for retinopathy of prematurity in multiple gestations: a Chinese population study

Risk factors for the time to development of retinopathy of prematurity in premature infants in Iran: a machine learning approach

BACKGROUND

Retinopathy of prematurity (ROP), is a preventable leading cause of blindness in infants and is a condition in which the immature retina experiences abnormal blood vessel growth. The development of ROP is multifactorial; nevertheless, the risk factors are controversial. This study aimed to identify risk factors of time to development of ROP in Iran.

METHODS

This historical cohort study utilized data from the hospital records of all newborns referred to the ROP department of Farabi Hospital (from 2017 to 2021) and the NICU records of infants referred from Mahdieh Hospital to Farabi Hospital. Preterm infants with birth weight (BW) ≤ 2000 g or gestational age (GA) < 34 wk, as well as selected infants with an unstable clinical course, as determined by their pediatricians or neonatologists, with BW > 2000 g or GA ≥ 34 wk. The outcome variable was the time to development of ROP (in weeks). Random survival forest was used to analyze the data.

RESULTS

A total of 338 cases, including 676 eyes, were evaluated. The mean GA and BW of the study group were 31.59 ± 2.39 weeks and 1656.72 ± 453.80 g, respectively. According to the criteria of minimal depth and variable importance, the most significant predictors of the time to development of ROP were duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of Total Parenteral Nutrition (TPN), mother age, birth order, number of surfactant administration, and on time screening. The concordance index for predicting survival of the fitted model was 0.878.

CONCLUSION

Our findings indicated that the duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of TPN, mother age, birth order, number of surfactant administrations, and on time screening are potential risk factors of prognosis of ROP. The associations between identified risk factors were mostly nonlinear. Therefore, it is recommended to consider the nature of these relationships in managing treatment and designing early interventions.

Comparative analysis of risk factors for retinopathy of prematurity in single and multiple birth neonates

AIM

To conduct a comparative analysis of risk factors for retinopathy of prematurity (ROP) in single- and multiple-born neonates.

METHODS

In a retrospective evaluation of 521 premature neonates, encompassing singletons, twins, and triplets born at or before 34 weeks of gestational age with a birthweight of less than 2000 g and who completed the ROP screening program, between 2020 and 2023, in outpatient referral ROP screening clinic affiliated by Shiraz University of Medical Sciences, were included. Neonates with the eligibility criteria were enrolled in the screening program from 28 days old age and followed up to discharge or treatment based on national ROP screening guideline. Data on ROP severity, outcome, treatment modality, and risk factors, including gestational age (GA), birth weight (BW), sex, duration of neonatal intensive care unit (NICU) admission, oxygen supplementation, mechanical ventilation, blood transfusion, method of delivery, and maternal and neonatal comorbidities, were extracted and compared between premature neonates from singleton and multiple births.

RESULTS

The analysis of the ROP severity distribution revealed 238 neonates (45.7%) with low-risk (type 2 prethreshold ROP or less severe) ROP and 16 (3.1%) with high-risk (type I prethreshold ROP or more severe) ROP who underwent treatment. According to the comparative analysis of risk factors in neonates with ROP requiring treatment, multiple birth neonates exhibited significantly greater GA (27.50 ± 3.27 vs. 30.00 ± 2.00 vs. 31.14 ± 0.38 weeks, p = 0.032 for singletons, twins and triplets, respectively); greater BW (861.67 ± 274.62 vs. 1233.33 ± 347.75 vs. 1537.14 ± 208.86 g, p = 0.002); and shorter duration of NICU admission (60.17 ± 21.36 vs. 34.00 ± 12.17 vs. 12.00 ± 6.32 days, p = 0.001) and oxygen supplementation (47.33 ± 16.57 vs. 36.00 ± 8.49 vs. 4.60 ± 2.41 days, p = 0.001). There was no significant difference between single-born neonates and multiple-born neonates regarding the prevalence of other risk factors. Multiple-born neonates with no ROP and low risk ROP showed significantly lower GA and BW compared to singletons (p < 0.001).

CONCLUSION

Multiple gestation neonates may develop high-risk ROP requiring treatment at a greater gestational age and birth weight and at a lower duration of oxygen supplementation and NICU admission compared to the single birth neonates. This pattern prompts a reevaluation of screening criteria, suggesting a potential need to consider multiple birth neonates with lower traditional risk factors in screening programs. This pattern should be further evaluated in larger populations of multiple born premature neonates.

The incidence and risk factors associated with the retinopathy of prematurity in a tertiary hospital using 10-year retrospective data

BACKGROUND

The study aimed to examine the incidence and risk factors associated with retinopathy of prematurity at Phramongkutklao Hospital.

METHODS

A retrospective review was conducted on the medical records of premature infants screened for retinopathy of prematurity between January 2011 and December 2021. The screening examination was performed on infants who met the screening criteria, and retinopathy of prematurity was diagnosed according to the International Classification of Retinopathy of Prematurity. Maternal, obstetric, neonatal, and medical data were retrieved. Logistic regression analysis was used to identify the risk factors associated with retinopathy of prematurity.

RESULTS

A total of 403 premature infants were screened. The mean ± SD birth weight and gestational ages were 1,538 ± 543 grams and 31 ± 3 weeks, respectively. The incidence of any retinopathy of prematurity and stages 2 and 3 were 13.6%, 3.5%, and 10.1%, respectively. Multiple logistic regression analysis demonstrated that gestational age (adjusted odds ratio = 1.98, 95% CI:1.15-3.39), low birth weight (adjusted odds ratio = 0.99, 95% CI: 0.99-1.00), and phototherapy (adjusted odds ratio = 0.41, 95% CI: 0.17-1.00) were significant factors associated with the development of retinopathy of prematurity, after controlling for other confounding factors.

CONCLUSIONS

The incidence of total retinopathy of prematurity cases in this population was 13.6%. Overall, retinopathy of prematurity cases classified as stage 2 equated to 3.5% and stage 3 to 4.1%. Our data suggest that factors associated with retinopathy of prematurity consist of birth weight, gestational age, and phototherapy.

The U.S. National Trend for Retinopathy of Prematurity

OBJECTIVE

The use of supplemental oxygen in premature infants is essential for survival. However, its use has been associated with unintended complications. The restricted use of oxygen is associated with increased mortality and necrotizing enterocolitis (NEC), whereas its liberal use is associated with increased risk for retinopathy of prematurity (ROP). Although there is no clear consensus on the acceptable oxygen saturation range, clinicians have recently become more liberal with the use of oxygen. We aim to assess (1) the national trends for ROP in very low birth weight preterm infants, and (2) the associated trends in mortality, NEC, intraventricular hemorrhage (IVH), and length of hospital stay (LOS).

STUDY DESIGN

We analyzed deidentified patient data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants with gestational age ≤32 weeks and birth weight <1,500 g were included. Trends in ROP, severe ROP, mortality, NEC, IVH, severe IVH, and LOS were analyzed using Jonckheere-Terpstra test.

RESULTS

A total of 818,945 neonates were included in the study. The overall mortality was 16.2% and the prevalence of ROP was 17.5%. There was a significant trend for increased ROP over the years (p < 0.001). Severe ROP was also significantly increased (p < 0.001). This was associated with a significant trend for increased median LOS in survived infants (p < 0.001). Mortality was significantly decreased (p < 0.001), whereas NEC and severe NEC did not change over time (p = 0.222 and p = 0.412, respectively).

CONCLUSION

There is a national trend for increased ROP and severe ROP over the 16 years of the study period. This trend was associated with a significant increase in the LOS in survived infants without change in NEC.

KEY POINTS

· Prevalence of ROP and severe ROP has increased in VLBW infants over the 16-year study period.. · The prevalence of NEC did not change over the same time period.. · Increased ROP and severe ROP were consistent in all three GA and BW subgroups..

The retinal vascular growth rate in babies with retinopathy of prematurity could indicate treatment need

Purpose

To analyze the weekly rate of retinal vascular growth in treatment-naïve babies with various stages of retinopathy of prematurity (ROP) and validate if this could be a predictor of treatment need.

Methods

Retrospective review of medical charts and retinal images of babies with various stages of ROP. The images were enhanced using red-green image enhancement software. Using the length of the horizontal disc diameter (DD) of each eye, the vessel growth was measured from the disc margin up to the vessel tip in fixed quadrants. The rate of vessel growth was the ratio of vessel length to the number of weeks it took to reach this length. The babies were divided into treatment warranting ROP (group 1), low-risk pre-threshold (type II) ROP (group 2,), and no-ROP (group 3) for analysis. The "no-ROP" group acted as normal control. Group 1 was further subdivided into 1A (threshold ROP), IB (aggressive posterior ROP), 1C (hybrid ROP), and ID (high-risk pre-threshold ROP).

Results

Out of 436 eyes, groups 1, 2, and 3 had 238, 108, and 90 eyes, respectively. The mean rate of vascular outgrowth along with 95% confidence interval (CI) was 0.490 [0.487,0.520], 0.612 [0.599, 0.638], and 0.719 [0.703, 0.740] DD/week, respectively, for babies with "treatment warranting," "low risk pre-threshold" and "no ROP" groups, respectively. In our estimate, more than 80% of eyes with a vessel growth rate of 0.54 DD/week or less required treatment.

Conclusion

A rate of retinal vascular growth less than 0.54 DD/week can be used to determine treatment requirements in babies with ROP.

Quantification of Early Neonatal Oxygen Exposure as a Risk Factor for Retinopathy of Prematurity Requiring Treatment

Purpose

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness related to oxygen exposure in premature infants. Since oxygen monitoring protocols have reduced the incidence of treatment-requiring ROP (TR-ROP), it remains unclear whether oxygen exposure remains a relevant risk factor for incident TR-ROP and aggressive ROP (A-ROP), a severe, rapidly progressing form of ROP. The purpose of this proof-of-concept study was to use electronic health record (EHR) data to evaluate early oxygen exposure as a predictive variable for developing TR-ROP and A-ROP.

Design

Retrospective cohort study.

Participants

Two hundred forty-four infants screened for ROP at a single academic center.

Methods

For each infant, oxygen saturations and fraction of inspired oxygen (FiO₂) were extracted manually from the EHR until 31 weeks postmenstrual age (PMA). Cumulative minimum, maximum, and mean oxygen saturation and FiO₂ were calculated on a weekly basis. Random forest models were trained with 5-fold cross-validation using gestational age (GA) and cumulative minimum FiO₂ at 30 weeks PMA to identify infants who developed TR-ROP. Secondary receiver operating characteristic (ROC) curve analysis of infants with or without A-ROP was performed without cross-validation because of small numbers.

Main Outcome Measures

For each model, cross-validation performance for incident TR-ROP was assessed using area under the ROC curve (AUC) and area under the precision-recall curve (AUPRC) scores. For A-ROP, we calculated AUC and evaluated sensitivity and specificity at a high-sensitivity operating point.

Results

Of the 244 infants included, 33 developed TR-ROP, of which 5 developed A-ROP. For incident TR-ROP, random forest models trained on GA plus cumulative minimum FiO₂ (AUC = 0.93 ± 0.06; AUPRC = 0.76 ± 0.08) were not significantly better than models trained on GA alone (AUC = 0.92 ± 0.06 [P = 0.59]; AUPRC = 0.74 ± 0.12 [P = 0.32]). Models using oxygen alone showed an AUC of 0.80 ± 0.09. ROC analysis for A-ROP found an AUC of 0.92 (95% confidence interval, 0.87–0.96).

Conclusions

Oxygen exposure can be extracted from the EHR and quantified as a risk factor for incident TR-ROP and A-ROP. Extracting quantifiable clinical features from the EHR may be useful for building risk models for multiple diseases and evaluating the complex relationships among oxygen exposure, ROP, and other sequelae of prematurity.

Deep Learning for the Diagnosis of Stage in Retinopathy of Prematurity: Accuracy and Generalizability across Populations and Cameras

PURPOSE

Stage is an important feature to identify in retinal images of infants at risk of retinopathy of prematurity (ROP). The purpose of this study was to implement a convolutional neural network (CNN) for binary detection of stages 1, 2, and 3 in ROP and to evaluate its generalizability across different populations and camera systems.

DESIGN

Diagnostic validation study of CNN for stage detection.

PARTICIPANTS

Retinal fundus images obtained from preterm infants during routine ROP screenings.

METHODS

Two datasets were used: 5943 fundus images obtained by RetCam camera (Natus Medical, Pleasanton, CA) from 9 North American institutions and 5049 images obtained by 3nethra camera (Forus Health Incorporated, Bengaluru, India) from 4 hospitals in Nepal. Images were labeled based on the presence of stage by 1 to 3 expert graders. Three CNN models were trained using 5-fold cross-validation on datasets from North America alone, Nepal alone, and a combined dataset and were evaluated on 2 held-out test sets consisting of 708 and 247 images from the Nepali and North American datasets, respectively.

MAIN OUTCOME MEASURES

Convolutional neural network performance was evaluated using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), sensitivity, and specificity.

RESULTS

Both the North American- and Nepali-trained models demonstrated high performance on a test set from the same population: AUROC, 0.99; AUPRC, 0.98; sensitivity, 94%; and AUROC, 0.97; AUPRC, 0.91; and sensitivity, 73%; respectively. However, the performance of each model decreased to AUROC of 0.96 and AUPRC of 0.88 (sensitivity, 52%) and AUROC of 0.62 and AUPRC of 0.36 (sensitivity, 44%) when evaluated on a test set from the other population. Compared with the models trained on individual datasets, the model trained on a combined dataset achieved improved performance on each respective test set: sensitivity improved from 94% to 98% on the North American test set and from 73% to 82% on the Nepali test set.

CONCLUSIONS

A CNN can identify accurately the presence of ROP stage in retinal images, but performance depends on the similarity between training and testing populations. We demonstrated that internal and external performance can be improved by increasing the heterogeneity of the training dataset features of the training dataset, in this case by combining images from different populations and cameras.

Can Complete Blood Count Parameters Predict Retinopathy of Prematurity?

Objectives

To predict the risk of retinopathy of prematurity (ROP) development according to routine complete blood count (CBC) parameters.

Materials and Methods

The medical records and CBC results of 150 premature neonates were retrospectively evaluated. As ROP develops 1 month after birth, first month CBC profiles of neonates without ROP (non-ROP), with ROP (ROP group), and those with Type 1, Type 2, and Stage 1+2 ROP were compared. Besides known statistical methods like Student's t-test, logistic regression and classification & regression tree (C&RT) analysis were also done to identify a reliable quantitative predictive parameter.

Results

Mean gestational age and birth weight of the ROP group (n=99) and non-ROP (n=43) group were 29.39±3.43 and 32.05±2.20 weeks and 1382.44±545.30 and 1691.51±360.84 grams, respectively (p<0.001, p<0.001). Average hemoglobin (Hb) (p<0.001), hematocrit (HCT) (p<0.001), erythrocyte (p=0.005), mean corpuscular hemoglobin (MCH) (p=0.020), and MCH concentration (p=0.019) values of the ROP group were lower than those of the non-ROP group. Leukocyte was higher in the ROP group (p=0.018). Hb [odds ratio (OR)=0.668, 95% confidence interval (CI)=0.555-0.804, p<0.001], red cell distribution width (RDW) (OR=1.282, 95% CI=1.012-1.624, p=0.040), leukocyte (OR=1.157, 95% CI=1.053-1.271, p=0.002), and platelet (OR=0.997, 95% CI: 0.994-0.999, p=0.036) values differed significantly between the two groups. Platelet, MCV, and MCH parameters were found to be lower in the Type 1 ROP group compared to the Stage 1+2 ROP group (p<0.005). MCH was the most prominent predictor (cut-off: 34.43 pg) according to the results of C&RT analysis.

Conclusion

As Hb plays an important role in oxygen transport, low levels of Hb and especially MCH may cause increased vascular endothelial growth factor secretion from the hypoxic retina, thereby causing ROP. Therefore, the results of this study are encouraging regarding the use of the abovementioned CBC parameters as a simple screening test to predict ROP.

Clinical features of premature twin babies with intersibling asymmetry of retinopathy of prematurity severity

OBJECTIVE

To report the clinical features of premature twin babies showing intersibling asymmetry in their severity of retinopathy of prematurity (ROP) and analyze risk factors associated with development of severe ROP between twin siblings with discordant ROP severity.

METHODS

A retrospective study of records of 105 premature twin pairs was conducted. The criteria for discordant ROP with an intersibling difference in ROP severity were as follows: (i) two or more stages of difference in ROP between siblings, (ii) one sibling having treatment-requiring ROP and the other having no ROP or ROP that regressed spontaneously, or (iii) one sibling having aggressive posterior ROP and the other having staged or no ROP. Twin siblings were classified into two groups according to the severity of ROP (no or less ROP and more severe ROP). We examined ocular features in twins having intersibling asymmetry of ROP and analyzed perinatal risk factors for ROP.

RESULTS

Of 105 twin pairs, 32 pairs (30.5%) showed intersibling asymmetry of ROP severity, and 15 pairs (14.3%) showed ROP asymmetry in terms of need for ROP treatment. The development of more severe ROP was associated with longer duration of oxygen supplementation and greater frequency of total blood and packed red blood cell transfusion (p = 0.020, p = 0.045, and p = 0.036, respectively). Longer duration of oxygen supplementation remained a statistically independent risk factor of severe ROP using multivariate logistic regression analysis.

CONCLUSIONS

Ophthalmologists caring for premature infants should be aware of the variable courses and progressions of ROP between twin babies. Longer duration of oxygen supplementation and greater frequency of blood transfusions were associated with higher ROP severity in twins.

Management of aggressive posterior retinopathy of prematurity in oculocutaneous albinism

A male infant, born preterm at 32 weeks of gestation, was referred at 36-week postmenstrual age for retinopathy of prematurity (ROP) screening. He had nystagmus, generalised hypopigmentation of skin, hair and eyes with preaxial polydactyly. The fundus was depigmented with prominently visible choroidal vessels. The retinal vessels were dilated, tortuous at zone 1. There was presence of arcading, shunting of vessels with presence of vitreous haemorrhage in the left eye. A diagnosis of aggressive posterior retinopathy of prematurity (APROP) in association with oculocutaneous albinism (OCA) was made.Half-dose intravitreal bevacizumab was used to treat the vascular condition. After 2 weeks, there was complete regression of APROP with a completely mature retina observed at 4 months post-treatment. Herein, we describe the role of red-free light for screening ROP in infants with OCA; challenges in the management of ROP with laser photocoagulation compared with intravitreal anti-vascular endothelial growth factor therapy.

Different retinopathy of prematurity severity and outcomes in triplets: A case report

In this case report, we discuss the presentation of retinopathy of prematurity in triplets born at 25 + 3 weeks gestational age of whom each had a different birth weight, weight gain and treatment requirements. Triplet A weighed 800 g and his retinopathy of prematurity had resolved with no intervention. Triplet B weighed 630 g at birth and he required bilateral intravitreal ranibizumab injection at 32 + 6 weeks. Triplet C weighed 520 g and required bilateral intravitreal ranibizumab injection at 36 weeks, but after 5 weeks he had recurrence which was treated with bilateral diode laser. Triplet C had the poorest weight gain. The main differences between the triplets are the birth weight and the weight gain. Furthermore, refraction was performed at 10 months; triplet A had a hyperopia of +1.25 spherical equivalent in both eyes, triplet B had mild myopia of −0.25 spherical equivalent and triplet C had a myopia of −3.00 spherical equivalent in the right eye and −2.75 spherical equivalent in the left eye.

Incidence and risk factors of retinopathy of prematurity and utility of the national screening criteria in a tertiary center in Iran

AIM

To determine the incidence and risk factors of retinopathy of prematurity (ROP) and the sensitivity of current screening criteria in a tertiary eye center in Tehran, Iran.

METHODS

In a cross-sectional observational study, neonates weighing ≤2000 grams at birth or born <34wk gestational age (GA) and all other infants at risk of ROP admitted to the neonatal intensive care unit (NICU) or referred to our ROP clinic were investigated. The incidence of ROP and severe ROP (i.e. patients needing treatment) were determined. The associations between risk factors and the development and severity of ROP were assessed. We also examined the sensitivity of the current national screening guideline in Iran.

RESULTS

Among 207 infants, the incidence of ROP and severe ROP was 33.3% and 11.1%, respectively. Mean GA and birth weight (BW) were significantly lower in ROP vs non-ROP infants (29±2wk vs 33±3wk, P<0.001; 1274±489 g vs 1916±550 g, P<0.001, respectively). Univariate analysis displayed significant association between ROP incidence and GA, BW, NICU admission period, blood transfusion, surfactant usage, sepsis, intraventricular hemorrhage and patent ductus arteriosus (P<0.05 for all). BW [relative risk (RR): 0.857 (0.711-0.873), P<0.001], GA [RR: 0.788 (0.711-0.873), P<0.001] and blood transfusion [RR: 1.888 (0.995-3.583), P=0.052] were independent ROP risk factors. The sensitivity of country-specific screening guidelines was 95.7% and 100% for overall and severe ROP detection, respectively.

CONCLUSION

ROP incidence is relatively high in Iran. Identifying ROP risk factors results in more accurate screening and reduces the risk of irreversible vision loss. The ROP screening criteria utilized in Iran are efficient at the present time.

Refining evidence-based retinopathy of prematurity screening guidelines: The SCREENROP study

Purpose

Retinopathy of prematurity (ROP) is a potentially blinding condition affecting premature infants for which less than 10% of babies undergoing screening require treatment. This study assessed and validated predictors of developing clinically significant ROP (type 2 or worse) and ROP requiring treatment.

Design

Nationwide retrospective cohort study.

Methods

This study included infants born between January 2014 and June 2016, admitted to level 3 neonatal intensive care units across Canada who underwent ROP screening. Data were derived from the Canadian Neonatal Network database. Predefined ≥ 1% risk for clinically significant retinopathy or prematurity and ROP requiring treatment was set as threshold for screening. Thirty-two potential predictors were analyzed, to identify and validate the most important ones for predicting clinically significant ROP. The predictors were determined on a derivation cohort and tested on a validation cohort. Multivariable logistic regression modeling was used for analysis.

Results

Using a sample of 4,888 babies and analyzing 32 potential predictors, capturing babies with ≥1% risk of developing clinically significant ROP equated to screening babies with birth weight (BW) <1,300 g or gestational age (GA) <30 weeks while capturing babies with ≥1% risk of requiring ROP treatment equated to screening babies with BW <1,200 g or GA <29 weeks.

Conclusions

The Canadian ROP screening criteria can be modified to screen babies with BW <1,200 g or GA <30 weeks. Using these criteria, babies requiring treatment would be identified while reducing the number of babies screened unnecessarily.

Automated Analysis for Retinopathy of Prematurity by Deep Neural Networks

Retinopathy of Prematurity (ROP) is a retinal vasproliferative disorder disease principally observed in infants born prematurely with low birth weight. ROP is an important cause of childhood blindness. Although automatic or semi-automatic diagnosis of ROP has been conducted, most previous studies have focused on "plus" disease, which is indicated by abnormalities of retinal vasculature. Few studies have reported methods for identifying the "stage" of the ROP disease. Deep neural networks have achieved impressive results in many computer vision and medical image analysis problems, raising expectations that it might be a promising tool in the automatic diagnosis of ROP. In this paper, convolutional neural networks with a novel architecture are proposed to recognize the existence and severity of ROP disease per-examination. The severity of ROP is divided into mild and severe cases according to the disease progression. The proposed architecture consists of two sub-networks connected by a feature aggregate operator. The first sub-network is designed to extract high-level features from images of the fundus. These features from different images in an examination are fused by the aggregate operator, then used as the input for the second sub-network to predict its class. A large data set imaged by RetCam 3 is used to train and evaluate the model. The high classification accuracy in the experiment demonstrates the effectiveness of the proposed architecture for recognizing the ROP disease.

Artificial Reproductive Technology - A Risk Factor for Retinopathy of Prematurity

BACKGROUND:

Retinopathy of Prematurity (ROP) is a potentially blinding vasoproliferative disease in premature babies. The presentation and course of ROP are determined by a complex interaction of a series of risk factors, including artificial reproductive technology (ART).

AIM:

To analyse and combine the information relating ART as an independent risk factor for retinopathy of prematurity.

METHODS AND MATERIAL:

The article is systematic review and meta-analysis using RevMan 5. Pubmed, Scopus and Medline were searched for articles from 1990 to 2018.

RESULTS:

Studies suggest that ROP is observed more frequently in ART children. They are more likely to be premature and of low birth weight than those conceived naturally. Results vary from just a tendency to a five-fold increase in risk to develop ROP in ART babies. At the same time, they might develop ROP later, and more mature newborns might be affected.

CONCLUSION:

The data relating ART as a risk factor for ROP is inconclusive, but most studies show at least a tendency. The ART newborns need to be considered as a risk group for ROP and observed with greater suspicion. Even more mature ART newborns might need to be screened in order not to miss any significant pathology.

Risk Factors for Retinopathy of Prematurity in Premature Born Children

INTRODUCTION

Retinopathy of Prematurity (ROP) represent disease of the eye in premature born children which affects immature blood vessels of the retina during their development. The emergence of retinopathy of prematurity depends on the interaction of multiple factors, such as: gestational age, low birth weight, hypoxia, duration of oxygen supplementation, respiratory distress syndrome, twin pregnancy, anemia, blood transfusions, sepsis, intraventricular hemorrhage, hypotension, hypothermia, etc. If remain unrecognized and untreated it can cause severe visual impairment and blindness in children, but can also be prevented with timely screening.

GOALS

To establish the number of patients with development of retinopathy of prematurity active forms in the observed time period and examine which risk factors have most significant impact on its origin.

MATERIAL AND METHODS

In a clinical, retrospective study we observed a total of 80 premature born children in the period from January to May 2015 with regard to listed risk factors identified for eye examination.

RESULTS

From a total of 80 premature newborns sample included 48.8% male and 51.2% female children. The active form of ROP developed in 6.2% of cases, while in 93.8% of cases there was a spontaneous resolution. Patients who developed active form of ROP have significantly younger gestational age (26.4±1.5 weeks) and lower birth weight (874±181 grams), lower Apgar score in the first and fifth minute and were longer on oxygen therapy (20±3.4 days).

CONCLUSION

Of the potential risk factors that could affect the development of ROP active form following factors have a statistically significant influence: early gestational age, low birth weight, lower Apgar score and prolonged oxygen therapy (p <0.05).

Prediction of severe retinopathy of prematurity using the WINROP algorithm in a cohort from Malopolska. A retrospective, single-center study

INTRODUCTION

Retinopathy of prematurity (ROP) is one of the leading avoidable causes of blindness in childhood in developed countries. Accurate diagnosis and treatment are essential for preventing the loss of vision. WINROP (https://www.winrop.com) is an online monitoring system which predicts the risk for ROP requiring treatment based on gestational age, birth weight, and body weight gain.

AIM

To validate diagnostic accuracy of the WINROP algorithm for the detection of severe ROP in a single centre cohort of Polish, high-risk preterm infant population.

MATERIAL AND METHODS

Medical records of neonates born before 32 weeks of gestation admitted to the third level neonatal centre in a 2-year retrospective investigation 79 patients were included in the study: their gestational age, birth weight and body weight gain were set in the WINROP system. The algorithm evaluated the risk for ROP divided into low or high-risk of disease and identified infants with high risk of developing severe ROP (type 1 ROP).

RESULTS

Out of 79 patients 37 received a high-risk alarm, of whom 22 developed severe ROP. Low-risk alarm was triggered in 42 infants; five of them developed type 1 ROP. The sensitivity of the WINROP was found to be 81.5% (95% CI 61.9-93.7), specificity 71.2% (95% CI 56.9-82.9), negative predictive value (NPV) 88.1% (95% CI 76.7-94.3), and positive predictive value (PPV) 59.5 (95% CI 48.1-69.9), respectively. The accuracy of the test significantly increased after combined WINROP and surfactant therapy as an additional factor - sensitivity 96.3% (95% CI 81.0-99.9), specificity 63.5% (95% CI 49.0-76.4), NPV 97.1% (95% CI 82.3-99.6), and PPV 57.8 (95% CI 48.7-66.4).

CONCLUSIONS

The WINROP algorithm sensitivity from the Polish cohort was not as high as that reported in developed countries. However, combined with additional factors (e.g. surfactant treatment) it can be useful for identifying the risk groups of sight-threatening ROP. The accuracy of the WINROP algorithm should be validated in a large multi-center prospective study in a Polish population of preterm infants.

Relationship between serum 25-hydroxy vitamin D levels and retinopathy of prematurity

Aim To evaluate the relationship between serum 25-hydroxy vitamin D, 25 (OH) D, levels and retinopathy of prematurity. Methods and Results Serum 25 (OH) D levels were measured in 97 very low birth weight infants, prior to vitamin D supplementation. The development of retinopathy of prematurity and its treatment requirement were evaluated. At follow-up, retinopathy of prematurity developed in 71 (73.2%) infants. Serum 25 (OH) D levels were significantly lower in infants with retinopathy of prematurity than ones without retinopathy of prematurity ( P < 0.001). The infants who required treatment had lower 25 (OH) D levels compared with the infants who did not required treatment (7.1 ± 5.2 ng/ml vs. 11.9 ± 6.5 ng/ml; P = 0.003). Multivariate analysis showed that lower serum 25 (OH) D levels may be a risk factor for retinopathy of prematurity development [OR: 1.14, 95% CI (1.02-1.27), P = 0.02]. Conclusion Lower 25 (OH) D levels in the first days of life may be related to retinopathy of prematurity development and treatment requirement in premature infants.

Artificial placenta: Analysis of recent progress

The artificial placenta (AP) has for many decades captured the imagination of scientists and authors with popular fiction including The Matrix and Aldous Huxley's "Brave New World", depicting a human surviving ex-utero in an artificial uterine environment (AUE). For scientists this has fascinated as a way forward for extremely preterm infants (EPIs) born less than 28 weeks of gestation. Early successes with mechanical ventilation (MV) for infants born above 28 weeks of gestation meant that AP research lost momentum. More recently, the gestational age limit for survival now borders on 23 weeks and corresponds to the biological milestone of lung development marked by the early canalicular stage of lung morphogenesis. The so called greyzone of 23-25 weeks represents a steep increase in mortality with decreasing gestational age and current options in neonatal care are on the fringes of efficacy for this population. A shift in thinking recognizes the vitality of EPIs as a fetus rather than a 37-40 week neonate and this has reinvigorated the concept of the AP. This review will discuss the scale of extreme preterm birth with special reference to previable infants born in the greyzone. Recent AP studies using sheep models are compared, technical obstacles discussed and future research themes identified.

Risk of recurrence of retinopathy of prematurity after initial intravitreal ranibizumab therapy

We report our experience with the use of intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP). A retrospective review was performed on 138 consecutive infants screened at a single centre over 18 months. Intravitreal ranibizumab was offered in selected cases requiring treatment, such as aggressive posterior ROP or poor mydriasis. 2 eyes of 1 infant received intravitreal ranibizumab alone and 8 eyes of 5 infants received combined intravitreal ranibizumab and laser therapy. 3 out of 8 eyes treated initially with intravitreal ranibizumab monotherapy had persistent disease requiring laser therapy, and 3 out of 5 eyes with initial regression suffered disease recurrence at a mean of 7.6 weeks post-injection. 2 eyes treated first with laser followed by intravitreal ranibizumab had disease regression without recurrence. Our cohort demonstrate a significant rate of persistent disease and recurrence in ROP eyes treated initially with intravitreal ranibizumab monotherapy, which is greater and earlier than that reported for intravitreal bevacizumab in the BEAT-ROP study. Intravitreal ranibizumab may be useful as an initial treatment in selected cases of ROP when laser therapy as first line is suboptimal. However, close monitoring is important and adjunctive laser therapy may subsequently be needed in a majority of cases.