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Yagi H, Boeck M, Nian S, Neilsen K, Wang C, Lee J, Zeng Y, Grumbine M, Sweet IR, Kasai T, Negishi K, Singh SA, Aikawa M, Hellström A, Smith LEH, Fu Z. Mitochondrial control of hypoxia-induced pathological retinal angiogenesis. Angiogenesis 2024:10.1007/s10456-024-09940-w. [PMID: 39096357 DOI: 10.1007/s10456-024-09940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE Pathological retinal neovascularization is vision-threatening. In mouse oxygen-induced retinopathy (OIR) we sought to define mitochondrial respiration changes longitudinally during hyperoxia-induced vessel loss and hypoxia-induced neovascularization, and to test interventions addressing those changes to prevent neovascularization. METHODS OIR was induced in C57BL/6J mice and retinal vasculature was examined at maximum neovessel formation. We assessed total proteome changes and the ratio of mitochondrial to nuclear DNA copy numbers (mtDNA/nDNA) of OIR vs. control retinas, and mitochondrial oxygen consumption rates (OCR) in ex vivo OIR vs. control retinas (BaroFuse). Pyruvate vs. vehicle control was supplemented to OIR mice either prior to or during neovessel formation. RESULTS In OIR vs. control retinas, global proteomics showed decreased retinal mitochondrial respiration at peak neovascularization. OCR and mtDNA/nDNA were also decreased at peak neovascularization suggesting impaired mitochondrial respiration. In vivo pyruvate administration during but not prior to neovessel formation (in line with mitochondrial activity time course) suppressed NV. CONCLUSIONS Mitochondrial energetics were suppressed during retinal NV in OIR. Appropriately timed supplementation of pyruvate may be a novel approach in neovascular retinal diseases.
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Affiliation(s)
- Hitomi Yagi
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Myriam Boeck
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Shen Nian
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA
- Department of Pathology, Xi'an Medical University, Xi'an, 710021, Shaanxi Province, China
| | - Katherine Neilsen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA
| | - Chaomei Wang
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA
| | - Jeff Lee
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA
| | - Yan Zeng
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA
| | | | - Ian R Sweet
- University of Washington Medicine Diabetes Institute, University of Washington, Seattle, WA, 98109, USA
| | - Taku Kasai
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Sasha A Singh
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Masanori Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Lois E H Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA.
| | - Zhongjie Fu
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 3 Blackfan Circle, CLS 18, Boston, MA, 02115, USA.
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Tang W, Zhang Y, Zhang H, Li K, Zhao Z, Ma H, Jiang X, Jia Z, Ma Q. Progress in the study of association between hematological indicators and retinopathy of prematurity (Review). Biomed Rep 2024; 21:111. [PMID: 38912168 PMCID: PMC11190637 DOI: 10.3892/br.2024.1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/10/2024] [Indexed: 06/25/2024] Open
Abstract
Retinopathy of prematurity (ROP) is a retinopathy caused by abnormal proliferation of blood vessels in premature infants. It can lead to retinal detachment and, in severe cases, blindness, rendering ROP a critical condition. Advances in neonatal medicine have improved survival rates of low birth weight and low gestational age infants. However, this progress has also led to a rise in incidence of ROP. Currently, premature birth, low birth weight and high postpartum oxygen levels are independent risk factors for ROP. Other factors include mode of delivery, multiple births, anemia, blood transfusion, maternal pregnancy factors, neonatal bronchopulmonary dysplasia, use of surfactants, arterial ductus arteriosus and necrotizing enterocolitis. Laboratory indicators in premature infants such as platelet count, levels of blood glucose, inflammatory cells, lipid and hemoglobin and blood transfusion may also be associated with ROP. However, the etiology and pathogenesis of ROP are not fully understood. A number of factors may influence the onset and progression of ROP, including decreased platelet counts, decreased hemoglobin levels, increased white blood cell counts, increased blood glucose levels, and disorders of lipid metabolism. The present study reviewed the effects of platelet count, hemoglobin, blood glucose, inflammatory cells and factors, blood lipids, and plasma metabolic pathways on ROP.
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Affiliation(s)
- Wenwen Tang
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Yin Zhang
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Haifang Zhang
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Kejun Li
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Zhihua Zhao
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Huijie Ma
- Department of Physiology, Hebei Medical University, Shijiazhuang, Hebei 050017, P.R. China
| | - Xinli Jiang
- Department of Ophthalmology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Zhiyang Jia
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Qingmin Ma
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
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Hellström A, Smith LEH, Hård AL. ROP: 80 Years after Its Detection - Where Do We Stand and How Long Will We Continue to Laser? Neonatology 2024:1-8. [PMID: 38776885 DOI: 10.1159/000538907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Retinopathy of prematurity (ROP), a potentially blinding disease, is increasing worldwide because of the increased survival of extremely preterm and preterm infants born where oxygen monitoring and ROP screening programs are insufficient. Repeated retinal examinations are stressful for infants, and laser photocoagulation treatment for sight-threatening ROP is destructive. The use of anti-VEGF agents instead of lasers is widespread but requires a long-term follow-up because of late recurrence of the disease. In addition, the optimal anti-VEGF agent dosage and long-term systemic effects require further study. SUMMARY Interventions preventing ROP would be far preferable, and systemic interventions might promote better development of the brain and other organs. Interventions such as improved oxygen control, provision of fresh maternal milk, supplementation with arachidonic acid and docosahexaenoic acid, and fetal hemoglobin preservation by reducing blood sample volumes may help prevent ROP and reduce the need for treatment. Free readily available online tools to predict severe ROP may reduce unnecessary eye examinations and select, for screening, those at a high risk of needing treatment. KEY MESSAGES Treatment warranting ROP is a sign of impaired neurovascular development in the central nervous system. Preventative measures to improve the outcomes are available. Screening can be refined using tools that can predict severe ROP. Laser treatment and anti-VEGF agents are valuable treatment modalities that may complement each other in recurrent ROP.
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Affiliation(s)
- Ann Hellström
- Department of Clinical Neuroscience, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lois E H Smith
- The Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna-Lena Hård
- Department of Clinical Neuroscience, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
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Nayyar M, Sood M, Panwar PK. Profile and risk factors of sight-threatening retinopathy of prematurity: Experience from SNCU in North India. Oman J Ophthalmol 2024; 17:224-233. [PMID: 39132111 PMCID: PMC11309536 DOI: 10.4103/ojo.ojo_167_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/06/2024] [Accepted: 04/30/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND This research aimed to identify the clinical profile and risk factors of retinopathy of prematurity (ROP) among "at-risk" newborns treated at a sick newborn care unit (SNCU) located at high altitude in North India, with the intention of contributing to formulate regional and national ROP screening guidelines. MATERIALS AND METHODS In a prospective observational study from 2021 to 2022, outborn and inborn babies eligible for ROP screening were screened. RESULTS Total 39/122 screened neonates had laser for Type 1 ROP, and 22/39 (56.4%) had aggressive ROP (AROP). The average birth weight (BW) was 1803.87 g, and the average gestational age was 34 weeks. Respiratory distress, bronchopulmonary dysplasia, sepsis, and apnea were present in 57.3%, 13%, 52.5%, and 25.4%, respectively. Sight-threatening ROP was present in 50% below 28+6 weeks, 27% between 29 and 30+6 weeks, 52% between 31 and 33+6 weeks, and 15% with gestation >34 weeks. Two babies with Type 1 ROP weighed >2 kg and one had AROP. Upon regression analysis, BW <1500 g, gestation <32 weeks, oxygen >48 h, clinical sepsis, total SNCU stay >14 days, continuous positive airway pressure support with oxygen >50%, and >10 days to achieve full feeds were associated with severe ROP. Caffeine to treat apnea and kangaroo mother care reduced ROP. None had short-term unfavorable outcome. CONCLUSION With similar infrastructure and work force shortage in most SNCUs, these findings can be generalized. The burden of Type 1 and AROP is increasing, as seen in higher gestation and BWs. This needs revision of ROP screening criteria at local and national level. It is crucial to emphasize on the importance of pediatrician and ophthalmologist collaboration, early ROP screening, diagnosis, and treatment to stop disease progression to severe ROP.
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Affiliation(s)
- Mannat Nayyar
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Mangla Sood
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Praveen Kumar Panwar
- Department of Opthalmology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Oruz O, Dervişoğulları MS, Öktem ME, İncekaş C. Predictive role of systemic immune-inflammation index and neutrophil/lymphocyte ratio values in infants with retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06493-y. [PMID: 38656423 DOI: 10.1007/s00417-024-06493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To search the relationship between serum neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) values with the development of retinopathy of prematurity (ROP) and the requirement for laser treatment. METHODS This retrospective cohort study was carried out with 195 preterm infants between 2012 and 2023. The NLR, PLR, LMR, and SII values were calculated on both the first day and at the end of the first month after birth. The association between development of ROP and other risk factors were analyzed using univariate analysis and multivariate logistic regression analysis. RESULTS Of patients, 92 infants were diagnosed with ROP. Laser treatment was administered to 36 infants. The postnatal first-day NLR and SII values were higher in infants with ROP than in infants without ROP (p < 0.001 for both). Postnatal first-month NLR, LMR, and SII values were higher in infants with ROP (p < 0.001, p = 0.007, and p < 0.001, respectively). In multivariate analyses, postnatal first-day NLR and first-month LMR values were regarded as independent risk factors for the development of ROP (OR:8.867 and 1.286, p = 0.002 and p = 0.009, respectively). In multivariate analyses performed for laser treatment requirement, postnatal first-month PLR and SII values were determined as independent risk factors (OR:0.951 and 1.011, respectively, p = 0.004 for both). CONCLUSIONS Postnatal first-day NLR and first-month LMR values were determined as independent risk factors for the development of ROP. For the requirement of laser treatment, the postnatal first-month PLR and SII values were determined as independent risk factors.
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Affiliation(s)
- Oğuzhan Oruz
- Department of Ophthalmology, Başkent University School of Medicine, Adana, Turkey.
| | | | | | - Caner İncekaş
- Department of Biostatistics, Baskent University Faculty of Medicine, Ankara, Turkey
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Almutairi M, Chechalk K, Deane E, Fox R, Janes A, Maguire-Henry T, McCabe D, O'Connor C, Quirk J, Swan E, White K, McCreery K, Isweisi E, Stewart P, Branagan A, Roche EF, Meehan J, Molloy EJ. Biomarkers in retinopathy of prematurity: a systematic review and meta-analysis. Front Pediatr 2024; 12:1371776. [PMID: 38571701 PMCID: PMC10987861 DOI: 10.3389/fped.2024.1371776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Abstract
Aim Retinopathy of prematurity is a significant global cause of childhood blindness. This study aims to identify serum biomarkers that are associated with the development of ROP. Methods A systematic review and meta-analysis was conducted using PRISMA guidelines. Three databases were searched (Pubmed, Scopus and Web of Science) from 2003 to March 2023. Only studies investigating serum biomarker levels in preterm infants (<37 weeks gestation) were included. Results Meta-analysis suggests that low serum IGF-1 levels have a strong association with the development of ROP [SMD (95% CI) of -.46 [-.63, -.30], p < .001]. Meta-analysis suggests that higher serum glucose levels were associated with the development of ROP [SMD (95% CI) of 1.25 [.94, 1.55], p < .001]. Meta-analysis suggests that thrombocytopenia is associated with the development of ROP [SMD (95% CI) of -.62 [-.86, -.37], p < .001]. Conclusion Low levels of serum IGF-1, high levels of serum glucose and thrombocytopenia all appear to have the strongest association with the development of ROP out of the 63 biomarkers investigated in this review. These associations highlight their potential use as diagnostic biomarkers in ROP, though further research is needed to establish the exact relationship between these biomarkers and disease pathogenesis.
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Affiliation(s)
- Mariam Almutairi
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Katherine Chechalk
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Emelia Deane
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Rebecca Fox
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Ava Janes
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Tidgh Maguire-Henry
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Devin McCabe
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Cole O'Connor
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Joseph Quirk
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Evan Swan
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Katherine White
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Kathryn McCreery
- Paediatric Ophthalmology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Eman Isweisi
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Philip Stewart
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Aoife Branagan
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Paediatrics, Coombe Hospital, Dublin, Ireland
| | - Edna F. Roche
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Endocrinology, Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Judith Meehan
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, Trinity Translational Medicine Institute (TTMI), Trinity Centre for Health Sciences, St James Hospital, The University of Dublin, Dublin, Ireland
| | - Eleanor J. Molloy
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Paediatrics, Coombe Hospital, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Endocrinology, Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Trinity College Dublin, Trinity Translational Medicine Institute (TTMI), Trinity Centre for Health Sciences, St James Hospital, The University of Dublin, Dublin, Ireland
- Neurodisability, Children’s Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Neonatology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
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Almutairi MF, Gulden S, Hundscheid TM, Bartoš F, Cavallaro G, Villamor E. Platelet Counts and Risk of Severe Retinopathy of Prematurity: A Bayesian Model-Averaged Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1903. [PMID: 38136105 PMCID: PMC10741847 DOI: 10.3390/children10121903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND We aimed to conduct a systematic review and Bayesian model-averaged meta-analysis (BMA) on the association between platelet counts and severe retinopathy of prematurity (ROP). METHODS We searched for studies reporting on platelet counts (continuous variable) or thrombocytopenia (categorical variable) and severe ROP or aggressive posterior ROP (APROP). The timing of platelet counts was divided into Phase 1 (<2 weeks) and Phase 2 (around ROP treatment). BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1) over the probability of the data under the null hypothesis (H0). RESULTS We included 21 studies. BMA showed an association between low platelet counts and severe ROP. The evidence was strong (BF10 = 13.5, 7 studies) for phase 1 and very strong (BF10 = 51.0, 9 studies) for phase 2. Thrombocytopenia (<100 × 109/L) in phase 2 was associated with severe ROP (BF10 = 28.2, 4 studies). Following adjustment for publication bias, only the association of severe ROP with thrombocytopenia remained with moderate evidence in favor of H1 (BF10 = 4.30). CONCLUSIONS Thrombocytopenia is associated with severe ROP. However, the evidence for this association was tempered when results were adjusted for publication bias.
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Affiliation(s)
- Mohamad F. Almutairi
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, 6202 AZ Maastricht, The Netherlands
| | - Silvia Gulden
- Neonatal Intensive Care Unit, Sant’Anna Hospital, 22020 Como, Italy
| | - Tamara M. Hundscheid
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, 6202 AZ Maastricht, The Netherlands
| | - František Bartoš
- Department of Psychology, University of Amsterdam, 1001 NK Amsterdam, The Netherlands
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Eduardo Villamor
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, 6202 AZ Maastricht, The Netherlands
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Hoyek S, Cruz NFSD, Patel NA, Al-Khersan H, Fan KC, Berrocal AM. Identification of novel biomarkers for retinopathy of prematurity in preterm infants by use of innovative technologies and artificial intelligence. Prog Retin Eye Res 2023; 97:101208. [PMID: 37611892 DOI: 10.1016/j.preteyeres.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Abstract
Retinopathy of prematurity (ROP) is a leading cause of preventable vision loss in preterm infants. While appropriate screening is crucial for early identification and treatment of ROP, current screening guidelines remain limited by inter-examiner variability in screening modalities, absence of local protocol for ROP screening in some settings, a paucity of resources and an increased survival of younger and smaller infants. This review summarizes the advancements and challenges of current innovative technologies, artificial intelligence (AI), and predictive biomarkers for the diagnosis and management of ROP. We provide a contemporary overview of AI-based models for detection of ROP, its severity, progression, and response to treatment. To address the transition from experimental settings to real-world clinical practice, challenges to the clinical implementation of AI for ROP are reviewed and potential solutions are proposed. The use of optical coherence tomography (OCT) and OCT angiography (OCTA) technology is also explored, providing evaluation of subclinical ROP characteristics that are often imperceptible on fundus examination. Furthermore, we explore several potential biomarkers to reduce the need for invasive procedures, to enhance diagnostic accuracy and treatment efficacy. Finally, we emphasize the need of a symbiotic integration of biologic and imaging biomarkers and AI in ROP screening, where the robustness of biomarkers in early disease detection is complemented by the predictive precision of AI algorithms.
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Affiliation(s)
- Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Natasha F S da Cruz
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Kenneth C Fan
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
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Fevereiro-Martins M, Santos AC, Marques-Neves C, Guimarães H, Bicho M. Complete blood count parameters as biomarkers of retinopathy of prematurity: a Portuguese multicenter study. Graefes Arch Clin Exp Ophthalmol 2023; 261:2997-3006. [PMID: 37129632 PMCID: PMC10543149 DOI: 10.1007/s00417-023-06072-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 01/27/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
PURPOSE To evaluate complete blood count (CBC) parameters in the first week of life as predictive biomarkers for the development of retinopathy of prematurity (ROP). METHODS Multicenter, prospective, observational study of a cohort of preterm infants born with gestational age (GA) < 32 weeks or birth weight < 1500 g in eight Portuguese neonatal intensive care units. All demographic, clinical, and laboratory data from the first week of life were collected. Univariate logistic regression was used to assess risk factors for ROP and then multivariate regression was performed. RESULTS A total of 455 infants were included in the study. The median GA was 29.6 weeks, and the median birth weight was 1295 g. One hundred and seventy-two infants (37.8%) developed ROP. Median values of erythrocytes (p < 0.001), hemoglobin (p < 0.001), hematocrit (p < 0.001), mean corpuscular hemoglobin concentration (p < 0.001), lymphocytes (p = 0.035), and platelets (p = 0.003) of the group of infants diagnosed with ROP any stage were lower than those without ROP. Mean corpuscular volume (MCV) (p = 0.044), red blood cell distribution width (RDW) (p < 0.001), erythroblasts (p < 0.001), neutrophils (p = 0.030), neutrophils-lymphocytes ratio (p = 0.028), and basophils (p = 0.003) were higher in the ROP group. Higher values of MCV, erythroblasts, and basophils remained significantly associated with ROP after multivariate regression. CONCLUSION In our cohort, the increase in erythroblasts, MCV, and basophils in the first week of life was significantly and independently associated with the development of ROP. These CBC parameters may be early predictive biomarkers for ROP.
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Affiliation(s)
- Mariza Fevereiro-Martins
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, Piso 1C, 1649-028 Lisbon, Portugal
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento da Rocha Cabral 14, 1250-012 Lisbon, Portugal
- Departamento de Oftalmologia, Hospital Cuf Descobertas, Rua Mário Botas, 1998-018 Lisbon, Portugal
| | - Ana Carolina Santos
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, Piso 1C, 1649-028 Lisbon, Portugal
| | - Carlos Marques-Neves
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, Piso 1C, 1649-028 Lisbon, Portugal
- Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, Piso 1C, 1649-028 Lisbon, Portugal
| | - Hercília Guimarães
- Departamento de Ginecologia - Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Bicho
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, Piso 1C, 1649-028 Lisbon, Portugal
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento da Rocha Cabral 14, 1250-012 Lisbon, Portugal
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10
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11
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Fevereiro-Martins M, Marques-Neves C, Guimarães H, Bicho M. Retinopathy of prematurity: A review of pathophysiology and signaling pathways. Surv Ophthalmol 2023; 68:175-210. [PMID: 36427559 DOI: 10.1016/j.survophthal.2022.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina and a leading cause of visual impairment and childhood blindness worldwide. The disease is characterized by an early stage of retinal microvascular degeneration, followed by neovascularization that can lead to subsequent retinal detachment and permanent visual loss. Several factors play a key role during the different pathological stages of the disease. Oxidative and nitrosative stress and inflammatory processes are important contributors to the early stage of ROP. Nitric oxide synthase and arginase play important roles in ischemia/reperfusion-induced neurovascular degeneration. Destructive neovascularization is driven by mediators of the hypoxia-inducible factor pathway, such as vascular endothelial growth factor and metabolic factors (succinate). The extracellular matrix is involved in hypoxia-induced retinal neovascularization. Vasorepulsive molecules (semaphorin 3A) intervene preventing the revascularization of the avascular zone. This review focuses on current concepts about signaling pathways and their mediators, involved in the pathogenesis of ROP, highlighting new potentially preventive and therapeutic modalities. A better understanding of the intricate molecular mechanisms underlying the pathogenesis of ROP should allow the development of more effective and targeted therapeutic agents to reduce aberrant vasoproliferation and facilitate physiological retinal vascular development.
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Affiliation(s)
- Mariza Fevereiro-Martins
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Portugal; Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal; Departamento de Oftalmologia, Hospital Cuf Descobertas, Lisboa, Portugal.
| | - Carlos Marques-Neves
- Centro de Estudos das Ci.¼ncias da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Hercília Guimarães
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Bicho
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Portugal; Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal.
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12
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Abstract
Platelet plug formation is critically involved in murine ductus arteriosus closure and thrombocytopenia in preterm infants seems to negatively affect spontaneous and pharmacologically induced ductal closure. Furthermore, platelet dysfunction may contribute to ductal patency, especially in extremely immature infants. Neonatal platelets likely have multifaceted roles during ductal closure, such as secretion of several signaling molecules and facilitation of specific cell-cell interactions. The only available randomized-controlled trial on platelet transfusions in preterm infants with patent ductus arteriosus demonstrated that a liberal transfusion regimen did not promote ductal closure, but was associated with an increased rate of intraventricular hemorrhage. Herein, we discuss the available mechanistic evidence on the role of platelets in ductus arteriosus closure and their potential clinical implications in preterm infants. We further briefly outline future research directions aimed at a better understanding of platelet-endothelial interactions in neonatal health and disease.
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Affiliation(s)
- Hannes Sallmon
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany; Division of Pediatric Cardiology, Graz Medical University, Graz, Austria.
| | - Cassidy A Delaney
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora CO, USA
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13
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Systemic Cytokines in Retinopathy of Prematurity. J Pers Med 2023; 13:jpm13020291. [PMID: 36836525 PMCID: PMC9966226 DOI: 10.3390/jpm13020291] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Retinopathy of prematurity (ROP), a vasoproliferative vitreoretinal disorder, is the leading cause of childhood blindness worldwide. Although angiogenic pathways have been the main focus, cytokine-mediated inflammation is also involved in ROP etiology. Herein, we illustrate the characteristics and actions of all cytokines involved in ROP pathogenesis. The two-phase (vaso-obliteration followed by vasoproliferation) theory outlines the evaluation of cytokines in a time-dependent manner. Levels of cytokines may even differ between the blood and the vitreous. Data from animal models of oxygen-induced retinopathy are also valuable. Although conventional cryotherapy and laser photocoagulation are well established and anti-vascular endothelial growth factor agents are available, less destructive novel therapeutics that can precisely target the signaling pathways are required. Linking the cytokines involved in ROP to other maternal and neonatal diseases and conditions provides insights into the management of ROP. Suppressing disordered retinal angiogenesis via the modulation of hypoxia-inducible factor, supplementation of insulin-like growth factor (IGF)-1/IGF-binding protein 3 complex, erythropoietin, and its derivatives, polyunsaturated fatty acids, and inhibition of secretogranin III have attracted the attention of researchers. Recently, gut microbiota modulation, non-coding RNAs, and gene therapies have shown promise in regulating ROP. These emerging therapeutics can be used to treat preterm infants with ROP.
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14
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Abstract
The formation of new blood and lymphatic vessels is essential for both the development of multicellular organisms and (patho)physiological processes like wound repair and tumor growth. In the 1990s, circulating blood platelets were first postulated to regulate tumor angiogenesis by interacting with the endothelium and releasing angiogenic regulators from specialized α granules. Since then, many studies have validated the contributions of platelets to tumor angiogenesis, while uncovering novel roles for platelets in other angiogenic processes like wound resolution and retinal vascular disease. Although the majority of (lymph)angiogenesis occurs during development, platelets appear necessary for lymphatic but not vascular growth, implying their particular importance in pathological cases of adult angiogenesis. Future work is required to determine whether drugs targeting platelet production or function offer a clinically relevant tool to limit detrimental angiogenesis.
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Affiliation(s)
- Harvey G Roweth
- Hematology Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Elisabeth M Battinelli
- Hematology Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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15
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Seliniotaki AK, Lithoxopoulou M, Moutzouri S, Bouras E, Diamanti E, Ziakas N, Lundgren P, Hellström A, Haidich A, Mataftsi A. Is thrombocytopenia and postnatal weight gain associated with treatment‐requiring retinopathy of prematurity? A matched case–control study. Acta Ophthalmol 2022; 101:433-442. [PMID: 36468823 DOI: 10.1111/aos.15302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 10/12/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was to investigate the association of platelet parameters and postnatal weight gain with treatment-requiring ROP (TR-ROP). METHODS In this retrospective matched case-control study, infants with TR-ROP were individually matched, according to gestational age and birth weight, with one or two untreated infants who developed no or spontaneously regressed ROP. Longitudinal data on platelet count (PLT), mean platelet volume (MPV), daily weight and platelet transfusions were collected. Platelet mass index (PMI) and weight standard deviation score (WSDS) were also calculated. Conditional logistic regression analysis was performed to adjust for matching. RESULTS Fourteen cases, presenting type I ROP, and 25 matched controls were included. The odds of developing TR-ROP decreased as PLT increased during 31st week of postmenstrual age (PMA) or during 1st and 2nd week of postnatal age (PNA). The odds of developing TR-ROP were 16.7 times higher in infants receiving at least one platelet transfusion compared with those who were not transfused. The odds of developing TR-ROP increased by 31.2% as the mean volume of platelet transfusion per infant increased by 1 ml. The odds of developing TR-ROP decreased as PMI increased during 1st week PNA, and as weight and WSDS increased during 4th -6th week PNA. Analysis of MPV, number of thrombopenic episodes per infant, number of platelet transfusions per infant and days with WSDS < -2 showed no association with TR-ROP. CONCLUSION To our knowledge, this is the first study ascertaining an association of platelet transfusions with type I ROP. Prospective cohort studies are required to confirm our findings.
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Affiliation(s)
- Aikaterini K. Seliniotaki
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
- Department of Hygiene, Social‐Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Maria Lithoxopoulou
- 2nd Department of Neonatology, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Stella Moutzouri
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Emmanouil Bouras
- Department of Hygiene, Social‐Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Elisavet Diamanti
- 2nd Department of Neonatology, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Pia Lundgren
- Department of Clinical Neuroscience, The Sahlgrenska Centre for Pediatric Ophthalmology Research Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Ann Hellström
- Department of Clinical Neuroscience, The Sahlgrenska Centre for Pediatric Ophthalmology Research Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Anna‐Bettina Haidich
- Department of Hygiene, Social‐Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
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Fu Z, Nilsson AK, Hellstrom A, Smith LEH. Retinopathy of prematurity: Metabolic risk factors. eLife 2022; 11:e80550. [PMID: 36420952 PMCID: PMC9691009 DOI: 10.7554/elife.80550] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
At preterm birth, the retina is incompletely vascularized. Retinopathy of prematurity (ROP) is initiated by the postnatal suppression of physiological retinal vascular development that would normally occur in utero. As the neural retina slowly matures, increasing metabolic demand including in the peripheral avascular retina, leads to signals for compensatory but pathological neovascularization. Currently, only late neovascular ROP is treated. ROP could be prevented by promoting normal vascular growth. Early perinatal metabolic dysregulation is a strong but understudied risk factor for ROP and other long-term sequelae of preterm birth. We will discuss the metabolic and oxygen needs of retina, current treatments, and potential interventions to promote normal vessel growth including control of postnatal hyperglycemia, dyslipidemia and hyperoxia-induced retinal metabolic alterations. Early supplementation of missing nutrients and growth factors and control of supplemental oxygen promotes physiological retinal development. We will discuss the current knowledge gap in retinal metabolism after preterm birth.
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Affiliation(s)
- Zhongjie Fu
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Anders K Nilsson
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Ann Hellstrom
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Lois EH Smith
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical SchoolBostonUnited States
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17
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A systematic review and meta-analysis of preanalytical factors and methodological differences influencing the measurement of circulating vascular endothelial growth factor. PLoS One 2022; 17:e0270232. [PMID: 35793362 PMCID: PMC9258884 DOI: 10.1371/journal.pone.0270232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intraocular treatment with antibodies targeting vascular endothelial growth factor (anti-VEGF) inhibits pathological vessel growth in adults and preterm infants. Recently, concerns regarding the impact of anti-VEGF treatment on systemic VEGF levels in preterm infants have been raised. Earlier studies suggest that preanalytical and methodological parameters impact analytical VEGF concentrations, but we have not found a comprehensive systematic review covering preanalytical procedures and methods for VEGF measurements. Objective This review aimed to evaluate the most critical factors during sample collection, sample handling, and the analytical methods that influence VEGF levels and therefore should be considered when planning a prospective collection of samples to get reproducible, comparable results. Material and methods PubMed and Scopus databases were searched 2021/Nov/11. In addition, identification of records via other methods included reference, citation, and Google Scholar searches. Rayyan QCRI was used to handle duplicates and the selection process. Publications reporting preanalytical handling and/or methodological comparisons using human blood samples were included. Exclusion criteria were biological, environmental, genetic, or physiological factors affecting VEGF. The data extraction sheets included bias assessment using the QUADAS-2 tool, evaluating patient selection, index-test, reference standard, and flow and timing. Concentrations of VEGF and results from statistical comparisons of analytical methods and/or preanalytical sample handling and/or different sample systems were extracted. The publications covering preanalytical procedures were further categorized based on the stage of the preanalytical procedure. Meta-analysis was used to visualize VEGF concentrations among healthy individuals. The quality of evidence was rated according to GRADE. Results We identified 1596 publications, and, after the screening process, 43 were considered eligible for this systematic review. The risk of bias estimation was difficult for 2/4 domains due to non-reported information. Four critical steps in the preanalytical process that impacted VEGF quantification were identified: blood drawing and the handling before, during, and after centrifugation. Sub-categorization of those elements resulted in nine findings, rated from moderate to very low evidence grade. The choice of sample system was the most reported factor. VEGF levels (mean [95% CI]) in serum (n = 906, 20 publications), (252.5 [213.1–291.9] pg/mL), were approximated to ninefold higher than in plasma (n = 1122, 23 publications), (27.8 [23.6–32.1] pg/mL), based on summarized VEGF levels with meta-analysis. Notably, most reported plasma levels were below the calibration range of the used method. Conclusion When measuring circulating VEGF levels, choice of sample system and sample handling are important factors to consider for ensuring high reproducibility and allowing study comparisons. Protocol: CRD42020192433
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18
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Seliniotaki AK, Haidich AB, Moutzouri S, Lithoxopoulou M, Ziakas N, Lundgren P, Hellstrom A, Mataftsi A. Association of platelet deficiency with severe retinopathy of prematurity: a review. Acta Paediatr 2022; 111:2056-2070. [PMID: 35778901 DOI: 10.1111/apa.16472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022]
Abstract
AIM The aim of this review was to compile existing evidence on the role of platelets in the development of severe retinopathy of prematurity (ROP), highlight the strengths and weaknesses of the available studies and critically discuss the reported data. METHODS A comprehensive literature search was conducted on PubMed from January 2000 to January 2022, and the reference lists of the included studies were screened manually. RESULTS There were 19 primary studies that fulfilled the eligibility criteria. Experimental research indicated lower platelet count in mice oxygen-induced retinopathy model compared with normoxia controls, while platelet transfusions suppressed neovascularisation. The latter finding was not consistently confirmed in clinical research, where a low platelet count, an increased number of thrombopenic episodes and of platelet transfusions have all been implicated in the development of ROP requiring treatment, either type I or aggressive posterior or both. However, existing studies exhibit significant clinical heterogeneity and present methodological limitations that imperil their reliability and validity. CONCLUSION Platelet deficiency has been associated with severe ROP. However, critical thresholds of platelet parameters are still unrecognised. Future research is required to determine whether platelet parameters can be predictive biomarkers for ROP requiring treatment and at what thresholds.
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Affiliation(s)
- Aikaterini K Seliniotaki
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Moutzouri
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Lithoxopoulou
- 2nd Department of Neonatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellstrom
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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Davenport P, Sola‐Visner M. Platelets in the neonate: Not just a small adult. Res Pract Thromb Haemost 2022; 6:e12719. [PMID: 35592812 PMCID: PMC9102610 DOI: 10.1002/rth2.12719] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/08/2022] [Accepted: 03/31/2022] [Indexed: 12/25/2022] Open
Abstract
Neonates, particularly those born preterm, have a high incidence of thrombocytopenia and bleeding, most commonly in the brain. Because of this, it has historically been accepted that neonates should be transfused at higher platelet counts than older children or adults, to decrease their bleeding risk. However, a number of observational studies and a recent large, randomized trial found a higher incidence of bleeding and mortality in neonates who received more platelet transfusions. The mechanisms underlying the deleterious effects of platelet transfusions in neonates are unknown, but it has been hypothesized that transfusing adult platelets into the very different physiological environment of a neonate may result in a “developmental mismatch” with potential negative consequences. Specifically, neonatal platelets are hyporeactive in response to multiple agonists and upon activation express less surface P‐selectin than adult platelets. However, this hyporeactivity is well balanced by factors in neonatal blood that promote clotting, such as the elevated hematocrit, elevated von Willebrand factor (VWF) levels, and a predominance of ultra‐long VWF polymers, with the net result of normal neonatal primary hemostasis. So far, most studies on the developmental differences between neonatal and adult platelets have focused on their hemostatic functions. However, it is now clear that platelets have important nonhemostatic functions, particularly in angiogenesis, immune responses, and inflammation. Whether equally important developmental differences exist with regard to those nonhemostatic platelet functions and how platelet transfusions perturb those processes in neonates remain unanswered questions.
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Affiliation(s)
- Patricia Davenport
- Division of Newborn Medicine Boston Children's Hospital Harvard Medical School Boston MA USA
| | - Martha Sola‐Visner
- Division of Newborn Medicine Boston Children's Hospital Harvard Medical School Boston MA USA
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20
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Danielsson H, Tebani A, Zhong W, Fagerberg L, Brusselaers N, Hård AL, Uhlén M, Hellström A. Blood protein profiles related to preterm birth and retinopathy of prematurity. Pediatr Res 2022; 91:937-946. [PMID: 33895781 PMCID: PMC9064798 DOI: 10.1038/s41390-021-01528-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/25/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Nearly one in ten children is born preterm. The degree of immaturity is a determinant of the infant's health. Extremely preterm infants have higher morbidity and mortality than term infants. One disease affecting extremely preterm infants is retinopathy of prematurity (ROP), a multifactorial neurovascular disease that can lead to retinal detachment and blindness. The advances in omics technology have opened up possibilities to study protein expressions thoroughly with clinical accuracy, here used to increase the understanding of protein expression in relation to immaturity and ROP. METHODS Longitudinal serum protein profiles the first months after birth in 14 extremely preterm infants were integrated with perinatal and ROP data. In total, 448 unique protein targets were analyzed using Proximity Extension Assays. RESULTS We found 20 serum proteins associated with gestational age and/or ROP functioning within mainly angiogenesis, hematopoiesis, bone regulation, immune function, and lipid metabolism. Infants with severe ROP had persistent lower levels of several identified proteins during the first postnatal months. CONCLUSIONS The study contributes to the understanding of the relationship between longitudinal serum protein levels and immaturity and abnormal retinal neurovascular development. This is essential for understanding pathophysiological mechanisms and to optimize diagnosis, treatment and prevention for ROP. IMPACT Longitudinal protein profiles of 14 extremely preterm infants were analyzed using a novel multiplex protein analysis platform combined with perinatal data. Proteins associated with gestational age at birth and the neurovascular disease ROP were identified. Among infants with ROP, longitudinal levels of the identified proteins remained largely unchanged during the first postnatal months. The main functions of the proteins identified were angiogenesis, hematopoiesis, immune function, bone regulation, lipid metabolism, and central nervous system development. The study contributes to the understanding of longitudinal serum protein patterns related to gestational age and their association with abnormal retinal neuro-vascular development.
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Affiliation(s)
- Hanna Danielsson
- grid.4714.60000 0004 1937 0626Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Sach’s Children’s and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Abdellah Tebani
- grid.5037.10000000121581746Science for Life Laboratory, Department of Protein Science, KTH—Royal Institute of Technology, Stockholm, Sweden ,grid.41724.340000 0001 2296 5231Department of Metabolic Biochemistry, Rouen University Hospital, Rouen, France ,grid.41724.340000 0001 2296 5231Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, Rouen, France
| | - Wen Zhong
- grid.5037.10000000121581746Science for Life Laboratory, Department of Protein Science, KTH—Royal Institute of Technology, Stockholm, Sweden
| | - Linn Fagerberg
- grid.5037.10000000121581746Science for Life Laboratory, Department of Protein Science, KTH—Royal Institute of Technology, Stockholm, Sweden
| | - Nele Brusselaers
- grid.4714.60000 0004 1937 0626Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden ,grid.5284.b0000 0001 0790 3681Global Health Institute, Antwerp University, Antwerp, Belgium ,grid.5342.00000 0001 2069 7798Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Anna-Lena Hård
- grid.1649.a000000009445082XThe Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mathias Uhlén
- grid.5037.10000000121581746Science for Life Laboratory, Department of Protein Science, KTH—Royal Institute of Technology, Stockholm, Sweden
| | - Ann Hellström
- The Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
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21
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Parrozzani R, Marchione G, Fantin A, Frizziero L, Salvadori S, Nardo D, Midena G. Thrombocytopenia as Type 1 ROP Biomarker: A Longitudinal Study. J Pers Med 2021; 11:jpm11111120. [PMID: 34834472 PMCID: PMC8624128 DOI: 10.3390/jpm11111120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/21/2022] Open
Abstract
This study aimed to prospectively evaluate the association between the appearance and evolution of retinopathy of prematurity (ROP) and selected blood parameters, focusing on platelets count. In total, 157 preterm consecutive babies screened for ROP were included and classified in: ROP necessitating treatment (group ROP1), ROP regressed without therapy (group ROP2) and no ROP (group no-ROP), divided in two phases for each group depending on gestational age. Blood parameters were weekly gathered and referred to postmenstrual age, ROP severity and phase. Platelet count mean values were statistically lower (p < 0.001) during both phases in ROP1 group (179 × 109/L vs. 213 × 109/L in phase 1 and 2, respectively) vs. other groups (ROP2: 286 × 109/L vs. 293 × 109/L; no ROP: 295 × 109/L vs. 313 × 109/L). Platelet count at birth <181 × 109 was statistically associated with Type 1 ROP development and evolution (sensibility = 76.47%, 95% confidence interval 60.0–87.6; specificity = 66.12%, 95% confidence interval 57.3–73.9). In ROP 1 group, a platelets count mean value “spike” (392.6 × 109/L) was documented at 36 weeks of corrected gestational age, preceding the need for treatment performed at a median of 38.1 ± 3.2 weeks. Early birth thrombocytopenia is confirmed as a biomarker of development and progression of ROP requiring treatment. The increase of platelets count at 35–37 weeks of corrected gestational age can be considered a possible clinical biomarker anticipating Type 1 ROP progression in preterm infants.
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Affiliation(s)
- Raffaele Parrozzani
- Department of Neuroscience-Ophthalmology, University of Padova, 35128 Padova, Italy; (G.M.); (A.F.); (L.F.)
- Correspondence: ; Tel.: +39-049-8212110
| | - Giulia Marchione
- Department of Neuroscience-Ophthalmology, University of Padova, 35128 Padova, Italy; (G.M.); (A.F.); (L.F.)
| | - Alberto Fantin
- Department of Neuroscience-Ophthalmology, University of Padova, 35128 Padova, Italy; (G.M.); (A.F.); (L.F.)
| | - Luisa Frizziero
- Department of Neuroscience-Ophthalmology, University of Padova, 35128 Padova, Italy; (G.M.); (A.F.); (L.F.)
| | - Sabrina Salvadori
- Department of Womens’ and Children Health, University of Padova, 35128 Padova, Italy; (S.S.); (D.N.)
| | - Daniel Nardo
- Department of Womens’ and Children Health, University of Padova, 35128 Padova, Italy; (S.S.); (D.N.)
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Tomita Y, Usui-Ouchi A, Nilsson AK, Yang J, Ko M, Hellström A, Fu Z. Metabolism in Retinopathy of Prematurity. Life (Basel) 2021; 11:life11111119. [PMID: 34832995 PMCID: PMC8620873 DOI: 10.3390/life11111119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022] Open
Abstract
Retinopathy of prematurity is defined as retinal abnormalities that occur during development as a consequence of disturbed oxygen conditions and nutrient supply after preterm birth. Both neuronal maturation and retinal vascularization are impaired, leading to the compensatory but uncontrolled retinal neovessel growth. Current therapeutic interventions target the hypoxia-induced neovessels but negatively impact retinal neurons and normal vessels. Emerging evidence suggests that metabolic disturbance is a significant and underexplored risk factor in the disease pathogenesis. Hyperglycemia and dyslipidemia correlate with the retinal neurovascular dysfunction in infants born prematurely. Nutritional and hormonal supplementation relieve metabolic stress and improve retinal maturation. Here we focus on the mechanisms through which metabolism is involved in preterm-birth-related retinal disorder from clinical and experimental investigations. We will review and discuss potential therapeutic targets through the restoration of metabolic responses to prevent disease development and progression.
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Affiliation(s)
- Yohei Tomita
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.T.); (J.Y.); (M.K.)
| | - Ayumi Usui-Ouchi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Chiba 279-0021, Japan;
| | - Anders K. Nilsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 413 19 Gothenburg, Sweden; (A.K.N.); (A.H.)
| | - Jay Yang
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.T.); (J.Y.); (M.K.)
| | - Minji Ko
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.T.); (J.Y.); (M.K.)
| | - Ann Hellström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 413 19 Gothenburg, Sweden; (A.K.N.); (A.H.)
| | - Zhongjie Fu
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.T.); (J.Y.); (M.K.)
- Correspondence:
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23
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Nilsson AK, Andersson MX, Sjöbom U, Hellgren G, Lundgren P, Pivodic A, Smith LEH, Hellström A. Sphingolipidomics of serum in extremely preterm infants: Association between low sphingosine-1-phosphate levels and severe retinopathy of prematurity. Biochim Biophys Acta Mol Cell Biol Lipids 2021; 1866:158939. [PMID: 33862236 PMCID: PMC8633973 DOI: 10.1016/j.bbalip.2021.158939] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Extremely preterm infants are at risk of developing retinopathy of prematurity (ROP) that can cause impaired vision or blindness. Changes in blood lipids have been associated with ROP. This study aimed to monitor longitudinal changes in the serum sphingolipidome of extremely preterm infants and investigate the relationship to development of severe ROP. METHODS This is a prospective study that included 47 infants born <28 gestational weeks. Serum samples were collected from cord blood and at postnatal days 1, 7, 14, and 28, and at postmenstrual weeks (PMW) 32, 36, and 40. Serum sphingolipids and phosphatidylcholines were extracted and analyzed by LC-MS/MS. Associations between sphingolipid species and ROP were assessed using mixed models for repeated measures. RESULTS The serum concentration of all investigated lipid classes, including ceramide, mono- di- and trihexosylceramide, sphingomyelin, and phosphatidylcholine displayed distinct temporal patterns between birth and PMW40. There were also substantial changes in the lipid species composition within each class. Among the analyzed sphingolipid species, sphingosine-1-phosphate showed the strongest association with severe ROP, and this association was independent of gestational age at birth and weight standard deviation score change. CONCLUSIONS The serum phospho- and sphingolipidome undergoes significant remodeling during the first weeks of the preterm infant's life. Low postnatal levels of the signaling lipid sphingosine-1-phosphate are associated with the development of severe ROP.
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Affiliation(s)
- Anders K Nilsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Mats X Andersson
- Department of Biology and Environmental Sciences, The Faculty of Science, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Sjöbom
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hellgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pia Lundgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Aldina Pivodic
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lois E H Smith
- The Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ann Hellström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lim ZD, Pheng E, Min ETL, Van Rostenberghe H, Shatriah I. Comparison of Mean Platelet Counts in Preterm Infants with and without Retinopathy of Prematurity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3783. [PMID: 33916368 PMCID: PMC8038626 DOI: 10.3390/ijerph18073783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/06/2021] [Accepted: 02/12/2021] [Indexed: 01/28/2023]
Abstract
Platelets are a primary source of pro- and anti-angiogenic cytokines. However, the evidence of their role in retinopathy of prematurity (ROP) is controversial. This retrospective study aimed to compare mean weekly platelet counts between infants with and without ROP over the first 6 weeks of life. A total of 93 infants matched by gestational age and birth weight were recruited (31 with ROP, 62 without ROP). Weekly mean platelet counts and other related risk factors were documented. The repeated measure analysis of variance (ANOVA) and the repeated measure analysis of covariance (ANCOVA) were used to compare mean platelet counts over time between the two groups, with and without adjusting for confounders. We found significant differences in the weekly mean platelet counts of infants with and without ROP over the first 6 weeks of life (p = 0.002). These differences disappeared after adjusting for covariates (p = 0.489). Lower mean platelet counts in ROP infants are not directly related to ROP, but rather to the presence of other risk factors for ROP, such as culture-proven sepsis, blood transfusion and bronchopulmonary dysplasia.
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Affiliation(s)
- Zi Di Lim
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Z.D.L.); (E.P.)
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kota Bharu Kelantan 16150, Malaysia;
| | - Edwin Pheng
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Z.D.L.); (E.P.)
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kota Bharu Kelantan 16150, Malaysia;
| | - Evelyn Tai Li Min
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Z.D.L.); (E.P.)
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kota Bharu Kelantan 16150, Malaysia;
| | - Hans Van Rostenberghe
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kota Bharu Kelantan 16150, Malaysia;
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Shatriah
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Z.D.L.); (E.P.)
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kota Bharu Kelantan 16150, Malaysia;
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25
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Sallmon H, Timme N, Atasay B, Erdeve Ö, Hansmann G, Singh Y, Weber SC, Shelton EL. Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants. Front Pediatr 2021; 9:612242. [PMID: 33718298 PMCID: PMC7946843 DOI: 10.3389/fped.2021.612242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
Platelets are critically involved in murine patent ductus arteriosus (PDA) closure. To date, the clinical significance of these findings in human preterm infants with PDA is still controversial. We discuss the available study data on the role of platelets for PDA closure in preterm infants: Several mostly retrospective studies have yielded conflicting results on whether thrombocytopenia contributes to failed spontaneous ductal closure. The same applies to investigations on the role of thrombocytopenia as a risk factor for unsuccessful ductus arteriosus closure by pharmacological treatment with cyclooxygenase inhibitors. Nonetheless, recent meta-analyses have concluded that thrombocytopenia constitutes an independent risk factor for both failed spontaneous and pharmacological PDA closure in preterm infants. However, the available investigations differ in regard to patient characteristics, diagnostic strategies, and treatment protocols. Several studies suggest that impaired platelet function rather than platelet number is critically involved in failure of ductus arteriosus closure in the preterm infant. A recent randomized-controlled trial on platelet transfusions in preterm infants with PDA failed to show any benefit for liberal vs. restrictive transfusion thresholds on PDA closure rates. Importantly, liberal transfusions were associated with an increased rate of intraventricular hemorrhage, and thus should be avoided. In conclusion, the available evidence suggests that thrombocytopenia and platelet dysfunction contribute to failure of spontaneous and pharmacological PDA closure in preterm infants. However, these platelet effects on PDA seem to be of only moderate clinical significance. Furthermore, platelet transfusions in thrombocytopenic preterm infants in order to facilitate PDA closure appear to cause more harm than good.
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Affiliation(s)
- Hannes Sallmon
- Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Natalie Timme
- Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany
| | - Begüm Atasay
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Ömer Erdeve
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Georg Hansmann
- Department of Pediatric Cardiology and Intensive Care Medicine, Medizinische Hochschule Hannover, Hanover, Germany
| | - Yogen Singh
- Department of Neonatology and Pediatric Cardiology, Cambridge University Hospitals, Cambridge, United Kingdom
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Sven C. Weber
- Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany
| | - Elaine L. Shelton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
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26
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Hellgren G, Lundgren P, Pivodic A, Löfqvist C, Nilsson AK, Ley D, Sävman K, Smith LE, Hellström A. Decreased Platelet Counts and Serum Levels of VEGF-A, PDGF-BB, and BDNF in Extremely Preterm Infants Developing Severe ROP. Neonatology 2021; 118:18-27. [PMID: 33611321 PMCID: PMC10539685 DOI: 10.1159/000512282] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Thrombocytopenia has been identified as an independent risk factor for retinopathy of prematurity (ROP), although underlying mechanisms are unknown. In this study, the association of platelet count and serum platelet-derived factors with ROP was investigated. METHODS Data for 78 infants born at gestational age (GA) <28 weeks were included. Infants were classified as having no/mild ROP or severe ROP. Serum levels of vascular endothelial growth factor A, platelet-derived growth factor BB, and brain-derived neurotrophic factor were measured in serum samples collected from birth until postmenstrual age (PMA) 40 weeks. Platelet counts were obtained from samples taken for clinical indication. RESULTS Postnatal platelet counts and serum concentrations of the 3 growth factors followed the same postnatal pattern, with lower levels in infants developing severe ROP at PMA 32 and 36 weeks (p < 0.05-0.001). With adjustment for GA, low platelet counts and low serum concentrations of all 3 factors at PMA 32 weeks were significantly associated with severe ROP. Serum concentrations of all 3 factors also strongly correlated with platelet count (p < 0.001). CONCLUSION In this article, we show that ROP, platelet counts, and specific pro-angiogenic factors correlate. These data suggest that platelet-released factors might be involved in the regulation of retinal and systemic angiogenesis after extremely preterm birth. Further investigations are needed.
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Affiliation(s)
- Gunnel Hellgren
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Aldina Pivodic
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chatarina Löfqvist
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders K Nilsson
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Ley
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Karin Sävman
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lois E Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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27
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Thau A, Saffren B, Zakrzewski H, Anderst JD, Carpenter SL, Levin A. Retinal hemorrhage and bleeding disorders in children: A review. CHILD ABUSE & NEGLECT 2021; 112:104901. [PMID: 33401159 DOI: 10.1016/j.chiabu.2020.104901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Retinal hemorrhages (RH) are a common manifestation of abusive head trauma (AHT) resulting from acceleration-deceleration injury with or without blunt impact. Evaluation of a child with RH requires careful consideration of these differential diagnoses. The extent to which coagulopathy alone can cause RH would be useful to understand as coagulopathy may accompany AHT. OBJECTIVE In this systematic review, we sought to identify whether coagulopathies have been reported with RH similar to those of AHT. METHODS We performed a literature search for ocular manifestations of bleeding disorders in children less than 18 years old. We included clotting factor deficiencies, vitamin K deficiency, platelet function abnormalities, thrombocytopenia, disseminated intravascular coagulation (DIC), and trauma induced coagulopathy (TIC). We included only pediatric reports of intraocular bleeding or documented eye examinations that indicated no hemorrhages. We then re-examined cases for ocular and systemic findings that could potentially mimic abuse. RESULTS Our initial search yielded 816 results. Sixty-one articles met our inclusion criteria. Of these, there were 32 children within the AHT age range (less than 5 years old) who had RH and concomitant coagulopathy. Only 5 cases might potentially be confused for abuse. Of these, no classic characteristics of RH from abuse such as retinoschisis or retinal folds were found. Systemic features were inconsistent with AHT. CONCLUSIONS The presence of coagulopathy alone does not rule out the possibility that the child has been abused. Coagulopathy alone has not been reported as an etiology of RH that are consistent with AHT, especially when other findings are present.
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Affiliation(s)
- Avrey Thau
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Brooke Saffren
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Helena Zakrzewski
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - James D Anderst
- Division of Child Adversity and Resilience, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shannon L Carpenter
- Department of Hematology, Oncology, and Bone Marrow Transplantation, Children's Mercy Hospital, Kansas City, MO, USA
| | - Alex Levin
- Flaum Eye Institute and Golisano Children's Hospital, University of Rochester, New York, USA.
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28
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Parrozzani R, Nacci EB, Bini S, Marchione G, Salvadori S, Nardo D, Midena E. Severe retinopathy of prematurity is associated with early post-natal low platelet count. Sci Rep 2021; 11:891. [PMID: 33441659 PMCID: PMC7807000 DOI: 10.1038/s41598-020-79535-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pathophysiology of retinopathy of prematurity (ROP) still presents a gap. Lately blood tests parameters of premature infants have been measured at different times of ROP, attempting to detect correlations with ROP development and progression. So far, very early post-natal biomarkers, predictive of ROP outcome, have not been detected. Our purpose is to evaluate, in the earliest post birth blood sample, the correlation between routinely dosed blood parameters and ROP outcome. 563 preterm babies, screened according to ROP guidelines, were included and classified in conformity with ET-ROP study in "Group 1" (ROP needing treatment), "Group 2" (ROP spontaneously regressed) and "noROP" group (never developed ROP). The earliest (within an hour after delivery) blood test parameters routinely dosed in each preterm infant were collected. Platelet count was decreased in Group 1 versus noROP group (p = 0.0416) and in Group 2 versus noROP group (p = 0.1093). The difference of thrombocytopenic infants among groups was statistically significant (p = 0.0071). CRP was higher in noROP versus all ROPs (p = 0.0331). First post-natal blood sample revealed a significant thrombocytopenia in ROP needing treatment, suggesting a role of platelets in the pathophysiology and progression of ROP, possibly considering it as a predictive parameter of ROP evolution.
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Affiliation(s)
| | | | - Silvia Bini
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Giulia Marchione
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Sabrina Salvadori
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Daniel Nardo
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy.
- IRCCS-Fondazione Bietti, Rome, Italy.
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29
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Elgendy MM, Durgham R, Othman HF, Heis F, Abu-Shaweesh G, Saker F, Karnati S, Aly H. Platelet Transfusion and Outcomes of Preterm Infants: A Cross-Sectional Study. Neonatology 2021; 118:425-433. [PMID: 33975321 DOI: 10.1159/000515900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prophylactic platelet transfusion has been adopted as a ubiquitous practice in management of thrombocytopenia in preterm infants to reduce the risk of bleeding. OBJECTIVES The objectives of this study were to report the prevalence of platelet transfusion among preterm infants with thrombocytopenia and to assess the association of platelet transfusion with mortality and morbidity in this population. METHODS A cross-sectional study that utilized National Inpatient Sample for the years 2000-2017 was conducted. All preterm infants delivered nationally with birth weight (BW) <1,500 g or gestational age <32 weeks were included. Analyses were repeated after stratifying the population into 2 BW subcategories <1,000 g and 1,000-1,499 g. Logistic regression analysis was performed to adjust for confounding variables. RESULTS The study included 1,780,299 infants; of them, 22,609 (1.27%) were diagnosed with thrombocytopenia and 5,134 (22.7%) received platelet transfusion. Platelet transfusion was associated with significant increase in mortality (24.8 vs. 13.8%), retinopathy of prematurity (22.3 vs. 19.2%), severe intraventricular hemorrhage (18.3 vs. 10.1%), median length of hospital stays (51 vs. 47 days), and cost of hospitalization (USD 298,204 vs. USD 219,760). Increased mortality was noted in <1,000-g infants (aOR = 1.96, CI: 1.76-2.18, p < 0.001) and 1,000-1,499-g infants (aOR = 2.02, CI: 1.62-2.53, p < 0.001). Platelet transfusion increased over the years in infants with BW <1,000 g (p = 0.001) and in infants with BW 1,000-1,499 g (p < 0.001). CONCLUSIONS Platelet transfusion is associated with increased mortality and comorbidities in premature infants. There is a trend for increased utilization of platelet transfusions over the study period.
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Affiliation(s)
- Marwa M Elgendy
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Ryan Durgham
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Hasan F Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan, USA
| | - Farah Heis
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Ghada Abu-Shaweesh
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Firas Saker
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
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30
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Tian X, Lv Y, Fan Y, Wang Z, Yu B, Song C, Lu Q, Xi C, Pi L, Zhang X. Safety evaluation of mice exposed to 7.0-33.0 T high-static magnetic fields. J Magn Reson Imaging 2020; 53:1872-1884. [PMID: 33382516 DOI: 10.1002/jmri.27496] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 01/26/2023] Open
Abstract
Magnetic resonance imaging (MRI) of 7 T and higher can provide superior image resolution and capability. Clinical tests have been performed in 9.4 T MRI, and 21.1 T small-bore-size MRI has also been tested in rodents. Although the safety issue is a prerequisite for their future medical application, there are very few relevant studies for the safety of static magnetic fields (SMFs) of ≧20 T. The aim of this study was to assess the biological effects of 7.0-33.0 T SMFs in healthy adult mice. This was a prospective study, in which 104 healthy adult C57BL/6 mice were divided into control, sham control, and 7.0-33.0 T SMF-exposed groups.The sham control group and SMF group were handled identically, except for the electric current for producing SMF. A separate control group was placed outside the magnet and their data were used as normal range. After 1 h exposure, all mice were routinely fed for another 2 months while their body weight and food/water consumption were monitored. After 2 months, their complete blood count, blood biochemistry, key organ weight, and histomorphology were examined. All data are normally distributed. Differences between the sham and SMF-exposed groups were evaluated by unpaired t test. Most indicators did not show statistically significant changes or were still within the normal ranges, with only a few exceptions. For example, mono % in Group 2 (11.1 T) is 6.03 ± 1.43% while the normal range is 6.60-9.90% (p < 0.05). The cholesterol level in 33 T group is 3.38 ± 0.36 mmol/L while the normal range is 2.48-3.29 mmol/L (p < 0.05). The high-density lipoprotein cholesterol level in 33 T group is 2.54 ± 0.29 mmol/L while the normal reference range is 1.89-2.43 mmol/L (p < 0.01). Exposure to 7.0-33.0 T for 1 h did not have detrimental effects on normal adult mice. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Xiaofei Tian
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Institutes of Physical Science and Information Technology, Anhui University, Hefei, China
| | - Yue Lv
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Science Island Branch of Graduate School, University of Science and Technology of China, Hefei, China
| | - Yixiang Fan
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Science Island Branch of Graduate School, University of Science and Technology of China, Hefei, China
| | - Ze Wang
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Hefei National Laboratory for Physical Sciences at Microscale, University of Science and Technology of China, Hefei, China
| | - Biao Yu
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Science Island Branch of Graduate School, University of Science and Technology of China, Hefei, China
| | - Chao Song
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Science Island Branch of Graduate School, University of Science and Technology of China, Hefei, China
| | - Qingyou Lu
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Hefei National Laboratory for Physical Sciences at Microscale, University of Science and Technology of China, Hefei, China.,Anhui Province Key Laboratory of Condensed Matter Physics at Extreme Conditions, Hefei, China
| | - Chuanying Xi
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Li Pi
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Xin Zhang
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Science Island Branch of Graduate School, University of Science and Technology of China, Hefei, China.,Institutes of Physical Science and Information Technology, Anhui University, Hefei, China
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Şahinoğlu Keşkek N, Gülcan H, Yılmaz G, Akkoyun İ. Impact of Platelet Count in Retinopathy of Prematurity. Turk J Ophthalmol 2020; 50:351-355. [PMID: 33389935 PMCID: PMC7802096 DOI: 10.4274/tjo.galenos.2020.01058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/11/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives The aim of the study was to investigate the risk factors for retinopathy of prematurity (ROP), including platelet count. Materials and Methods This retrospective study analyzed 137 infants in 3 subgroups: no ROP; mild ROP, and severe ROP requiring laser treatment (type 1 ROP). A retrospective review of records was performed and statistical analysis of possible risk factors for ROP including platelet count was evaluated by using logistic regression. Results Birth weight (BW), gestational age (GA), and low platelet count in the first week after birth were significant risk factors for developing ROP (p=0.038, 0.02, and 0.004, respectively). BW, GA, ventilation, and lower platelet count were associated with progression to type 1 ROP (p=0.004; 0.027, and 0.021, respectively). Conclusion Lower platelet count in the first week after birth is a risk factor for ROP development in addition to the previously established factors of ventilation need, low BW, and low GA.
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Affiliation(s)
- Nedime Şahinoğlu Keşkek
- Başkent University Faculty of Medicine, Adana Research and Training Center, Department of Ophthalmology, Adana, Turkey
| | - Hande Gülcan
- Başkent University Faculty of Medicine, Adana Research and Training Center, Department of Pediatrics, Division of Neonatology, Adana, Turkey
| | - Gürsel Yılmaz
- Başkent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - İmren Akkoyun
- Başkent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Hengartner T, Adams M, Pfister RE, Snyers D, McDougall J, Waldvogel S, Held-Egli K, Spring L, Rogdo B, Riedel T, Arlettaz Mieth R. Associations between Red Blood Cell and Platelet Transfusions and Retinopathy of Prematurity. Neonatology 2020; 117:1-7. [PMID: 33291117 PMCID: PMC7845415 DOI: 10.1159/000512020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022]
Abstract
AIM The aim of this study is to examine possible associations between the transfusion of RBC or platelets (PLTs) and the development of retinopathy of prematurity (ROP) in infants. METHODS This retrospective, national, case-control study included all live births in Switzerland between 2013 and 2018. We investigated preterm infants at a gestational age of <28 weeks, who developed higher stage ROP (≥stage 2, n = 178). Each case infant was matched to another of the same sex who did not develop ROP (n = 178, control group). RESULTS When compared with the control group, we observed higher numbers of RBC transfusions per infant and higher percentages of infants receiving PLT transfusions in the case group. An adjusted logistic regression analysis revealed that both RBC (odds ratio [OR] 1.081, 95% confidence interval [CI] 1.020-1.146) and PLT transfusions (OR = 2.502, 95% CI 1.566-3.998) numbers were associated with ROP development. CONCLUSIONS Multiple RBC and PLT transfusions are associated with higher stage ROP development. Prospective studies are required to determine their potential as risk factors.
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Affiliation(s)
- Tobias Hengartner
- Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland,
| | - Mark Adams
- Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Riccardo E Pfister
- Department of Child and Adolescent, University Hospital Geneva, Geneva, Switzerland
| | - Diane Snyers
- Department of Neonatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Jane McDougall
- Department of Neonatology, University Hospital Berne, Berne, Switzerland
| | - Salome Waldvogel
- Department of Neonatology, University of Basel Children's Hospital, Basel, Switzerland
| | - Katrin Held-Egli
- Department of Neonatology, Children's Clinic, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lea Spring
- Department of Neonatology, Children's Hospital of Lucerne, Lucerne, Switzerland
| | - Bjarte Rogdo
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas Riedel
- Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Romaine Arlettaz Mieth
- Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
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Pediatric non-red cell blood product transfusion practices: what's the evidence to guide transfusion of the 'yellow' blood products? Curr Opin Anaesthesiol 2020; 33:259-267. [PMID: 32049883 DOI: 10.1097/aco.0000000000000838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Research studies pertaining to the management of pediatric non-red cell blood product transfusion is limited. Clinical practices vary within disciplines and regions. Anesthesiologists need evidence-based guidelines to make appropriate and safe decisions regarding transfusion of the 'yellow' blood products for pediatric patients. RECENT FINDINGS This review outlines clinical indications for transfusion of fresh frozen plasma, cryoprecipitate, platelets, and fibrinogen concentrate in pediatrics. Recent studies of non-red blood cell transfusions in critical, but stable situations are highlighted. Recommendations to guide transfusion of the 'yellow' blood products in operative and non-operative settings are summarized. Special attention is drawn to guidelines in massive hemorrhage and trauma situations. SUMMARY Evidence-based guidelines and expert consensus recommendations exist to guide the transfusion of pediatric non-red blood products and should be followed when transfusing the 'yellow' blood components. As high-quality studies in neonates, infants and children are limited, future research should broaden our knowledge in this direction with the goal to use restrictive strategies to improve patient outcomes.
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Abstract
Thrombocytopenia is common in preterm neonates. Thresholds for prophylactic platelet transfusion vary widely due to lack of evidence. The results of the PlaNet-2/MATISSE Study identified harm in the form of mortality and major bleed in babies prophylactically transfused below a platelet count of 50 × 109/L compared to 25 × 109/L. Neonatal platelet transfusions are administered at volumes based on historical practice which greatly exceed those routinely used in adults. Rate of transfusion is also based around practice in trauma and does not take into account the physiology of the preterm infant. There are multiple ways in which platelets may be mediating harm and this review discusses these potential mechanisms including immunological, inflammatory and blood group incompatibility. Much of the difficulty in assessing harm relates to problems in classification of transfusion-associated adverse events in babies. Thrombocytopenia and timing, efficacy and adverse effects of platelet transfusion are poorly understood. Further research is essential.
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Affiliation(s)
| | - Anna Curley
- National Maternity Hospital, Holles Street, Dublin 2, Ireland.
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