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Tapak L, Farahani LN, Taleghani NT, Ebrahimiadib N, Pour EK, Farahani AD, Hamidi O. Risk factors for the time to development of retinopathy of prematurity in premature infants in Iran: a machine learning approach. BMC Ophthalmol 2024; 24:364. [PMID: 39180010 PMCID: PMC11342517 DOI: 10.1186/s12886-024-03637-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 08/14/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP), is a preventable leading cause of blindness in infants and is a condition in which the immature retina experiences abnormal blood vessel growth. The development of ROP is multifactorial; nevertheless, the risk factors are controversial. This study aimed to identify risk factors of time to development of ROP in Iran. METHODS This historical cohort study utilized data from the hospital records of all newborns referred to the ROP department of Farabi Hospital (from 2017 to 2021) and the NICU records of infants referred from Mahdieh Hospital to Farabi Hospital. Preterm infants with birth weight (BW) ≤ 2000 g or gestational age (GA) < 34 wk, as well as selected infants with an unstable clinical course, as determined by their pediatricians or neonatologists, with BW > 2000 g or GA ≥ 34 wk. The outcome variable was the time to development of ROP (in weeks). Random survival forest was used to analyze the data. RESULTS A total of 338 cases, including 676 eyes, were evaluated. The mean GA and BW of the study group were 31.59 ± 2.39 weeks and 1656.72 ± 453.80 g, respectively. According to the criteria of minimal depth and variable importance, the most significant predictors of the time to development of ROP were duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of Total Parenteral Nutrition (TPN), mother age, birth order, number of surfactant administration, and on time screening. The concordance index for predicting survival of the fitted model was 0.878. CONCLUSION Our findings indicated that the duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of TPN, mother age, birth order, number of surfactant administrations, and on time screening are potential risk factors of prognosis of ROP. The associations between identified risk factors were mostly nonlinear. Therefore, it is recommended to consider the nature of these relationships in managing treatment and designing early interventions.
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Affiliation(s)
- Leili Tapak
- Department of Biostatistics, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Naeeme Taslimi Taleghani
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Elias Khalili Pour
- Farabi Eye Hospital, Retina Ward, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Omid Hamidi
- Department of Science, Hamedan University of Technology, Hamedan, Iran.
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Gulden S, Cervellini G, Colombo M, Marangoni MB, Taccani V, Pesenti N, Raffaeli G, Araimo G, Osnaghi S, Fumagalli M, Garrido F, Villamor E, Cavallaro G. Hyperbilirubinemia and retinopathy of prematurity: a retrospective cohort study. Eur J Pediatr 2024:10.1007/s00431-024-05630-3. [PMID: 38877325 DOI: 10.1007/s00431-024-05630-3] [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: 04/09/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024]
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in preterm infants. Oxidative stress plays a key role in the pathogenesis of ROP. Due to its antioxidant effects, bilirubin has been proposed to be protective against ROP. This study explored the association between hyperbilirubinemia and ROP. We analyzed a 10-year cohort from a neonatal intensive care unit in Milan, Italy, including 1606 infants born under 32 weeks and/or < 1500 g. Data from 1606 infants meeting specific inclusion criteria were reviewed. Eighty infants were excluded due to lack of data, 1526 were deemed eligible for analysis, and 1269 had hyperbilirubinemia requiring phototherapy. There was a higher incidence of ROP among infants with hyperbilirubinemia (13.8%) versus those without (7.8%, p<0.01). Infants with any ROP, non-severe or severe ROP, were exposed to hyperbilirubinemia for a significantly higher number of days compared with those without ROP. Each additional day of exposure increases the risk of developing any ROP by 5%, non-severe ROP by 4%, and severe ROP by 6%. However, this correlation was not observed in infants with gestational age less than 27 weeks and/or body weight less than 1000 g. Conclusion: Our data show that hyperbilirubinemia requiring phototherapy is associated with an increased risk of developing ROP. However, severe hyperbilirubinemia and ROP share many of their risk factors. Therefore, rather than being a risk factor itself, hyperbilirubinemia may be a surrogate for other risk factors for ROP. Clinical Trial Registration: NCT05806684. What is Known: • The development of retinopathy of prematurity (ROP) is influenced by several critical risk factors, including low gestational age, low birth weight, supplemental oxygen use, and increased oxidative stress. • In vitro, unconjugated bilirubin is an effective scavenger of harmful oxygen species and a reducing agent, highlighting its potential protective role against oxidative stress. What is New: • Hyperbilirubinemia requiring phototherapy was associated with an increased risk of developing ROP, but this association was not observed in the most vulnerable population of extremely preterm infants. • Every additional day of phototherapy for hyperbilirubinemia increases the risk of ROP by 5% for any ROP, 4% for non-severe ROP, and 6% for severe ROP.
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Affiliation(s)
- Silvia Gulden
- Neonatal Intensive Care Unit, Sant'Anna Hospital, 22042, Como, Italy
| | - Gaia Cervellini
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Marta Colombo
- Neonatal Intensive Care Unit, Sant'Anna Hospital, 22042, Como, Italy
| | - Maria Beatrice Marangoni
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Vittoria Taccani
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Nicola Pesenti
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Revelo Datalabs S.R.L, 20142, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy.
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Felipe Garrido
- Neonatal Intensive Care Unit, Clínica Universidad de Navarra, 28027, Madrid, Spain
| | - Eduardo Villamor
- Division of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), Research Institute for Oncology and Reproduction (GROW), Maastricht University, 6202AZ, Maastricht, The Netherlands
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
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Abutrabi IH, Ayed A, Malak MZ, Batran A. Knowledge, Attitudes, and Practices Toward Retinopathy of Prematurity Among Neonatal Intensive Care Nurses: A Cross-sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241249431. [PMID: 38716812 PMCID: PMC11080752 DOI: 10.1177/00469580241249431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024]
Abstract
It is important to study the awareness of retinopathy of prematurity (ROP) among neonatal care nurses in hospitals. Unfortunately, there is a lack of studies conducted among nurses on this subject in Palestine. Thus, this study purposed to assess the knowledge, attitudes, and practices toward ROP among neonatal intensive care nurses in Palestine. A cross-sectional was used to conduct this study. A convenience sampling method was utilized to recruit 289 neonate intensive care nurses working in private and governmental hospitals. The findings showed that around 48.0% of the nurses had low knowledge about preventing ROP. Most of the nurses (78%) reported a neutral attitude toward preventing ROP. Moreover, overall nurses' practices regarding ROP were fair (57.1%). There was a difference in practices regarding ROP according to the health sector (P < .05), in which the private sector had better practices compared to the governmental sector. Additionally, there was a significant difference in knowledge regarding ROP according to educational level (P < .05). Also, a significant difference was found in knowledge and practices regarding ROP according to nurses' experience. Attitudes and practices were the main significant predictors of knowledge (B = 0.153, P < .05; B = 0.172, P < .05, respectively). Knowledge and practices were the main predictors of attitudes (B = 0.126, P < .05; B = 469, P < .001), respectively. Knowledge, attitudes, and experience in neonate intensive care nurses were the main significant predictors of practices (B = 0.135, P < .05; B = 0.449, P < .001; B = 0.224, P < .05, respectively). It is necessary to develop an educational program and competency-based training programs for neonate intensive care nurses about ROP and implement preventive strategies.
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Affiliation(s)
| | | | | | - Ahmad Batran
- Palestine Ahliya University, Bethlehem, Palestine
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Subramaniam A, Orge F, Douglass M, Can B, Monteoliva G, Fried E, Schbib V, Saidman G, Peña B, Ulacia S, Acevedo P, Rollins AM, Wilson DL. Image harmonization and deep learning automated classification of plus disease in retinopathy of prematurity. J Med Imaging (Bellingham) 2023; 10:061107. [PMID: 37794884 PMCID: PMC10546198 DOI: 10.1117/1.jmi.10.6.061107] [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: 02/21/2023] [Revised: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Purpose Retinopathy of prematurity (ROP) is a retinal vascular disease affecting premature infants that can culminate in blindness within days if not monitored and treated. A disease stage for scrutiny and administration of treatment within ROP is "plus disease" characterized by increased tortuosity and dilation of posterior retinal blood vessels. The monitoring of ROP occurs via routine imaging, typically using expensive instruments ($50 to $140 K) that are unavailable in low-resource settings at the point of care. Approach As part of the smartphone-ROP program to enable referrals to expert physicians, fundus images are acquired using smartphone cameras and inexpensive lenses. We developed methods for artificial intelligence determination of plus disease, consisting of a preprocessing pipeline to enhance vessels and harmonize images followed by deep learning classification. A deep learning binary classifier (plus disease versus no plus disease) was developed using GoogLeNet. Results Vessel contrast was enhanced by 90% after preprocessing as assessed by the contrast improvement index. In an image quality evaluation, preprocessed and original images were evaluated by pediatric ophthalmologists from the US and South America with years of experience diagnosing ROP and plus disease. All participating ophthalmologists agreed or strongly agreed that vessel visibility was improved with preprocessing. Using images from various smartphones, harmonized via preprocessing (e.g., vessel enhancement and size normalization) and augmented in physically reasonable ways (e.g., image rotation), we achieved an area under the ROC curve of 0.9754 for plus disease on a limited dataset. Conclusions Promising results indicate the potential for developing algorithms and software to facilitate the usage of cell phone images for staging of plus disease.
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Affiliation(s)
- Ananya Subramaniam
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Faruk Orge
- Case Medical Center University Hospitals, Department of Ophthalmology, Cleveland, Ohio, United States
| | - Michael Douglass
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Basak Can
- Case Medical Center University Hospitals, Department of Ophthalmology, Cleveland, Ohio, United States
| | | | - Evelin Fried
- Hospital Italiano de San Justo Agustin Rocca, Buenos Aires, Argentina
| | - Vanina Schbib
- Hospital de Niños Sor Maria Ludovica, Buenos Aires, Argentina
| | | | - Brenda Peña
- Centro Integral de Salud Visual Daponte, Buenos Aires, Argentina
| | - Soledad Ulacia
- Mineserio de Salud Argentina, Ministry of Public Works Building, Buenos Aires, Argentina
| | | | - Andrew M. Rollins
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - David L. Wilson
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
- Case Western Reserve University, Department of Radiology, Cleveland, Ohio, United States
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Ansari-Mohseni N, Ghorani-Azam A, Mohajeri SA. Therapeutic effects of herbal medicines in different types of retinopathies: A systematic review. AVICENNA JOURNAL OF PHYTOMEDICINE 2023; 13:118-142. [PMID: 37333471 PMCID: PMC10274316 DOI: 10.22038/ajp.2022.62423.2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/13/2022] [Indexed: 06/20/2023]
Abstract
Objective Retinopathy is an ocular manifestation of systemic diseases such as diabetes and vascular diseases. Herbal drugs have been considered as an effective therapeutic option with minimal side effects for the treatment of retinopathy by reducing the symptoms and improving visual acuity. The purpose of this systematic review was to collect studies on the effectiveness of medicinal plants in the treatment or prevention of retinopathy. Materials and Methods A systematic literature search was performed in PubMed, Scopus, Google Scholar, and other databases in April 2021 using "herbal products" and "Retinopathy" with all their equivalent and similar terms. For this purpose, human clinical trials with the English language were included and articles with subject irrelevancy were excluded from further evaluation. Results Overall, 30 articles with 2324 patients were studied for possible effects of herbal therapy on retinopathy. From 30 included articles, different herbal products had been evaluated. Out of 30 selected articles, 11 articles were for the treatment of age-related macular degeneration (AMD), 14 articles covered patients with diabetic retinopathy, and the other five studies were for other retinal disorders. The outcomes in majority of the studies include changes in visual acuity (VA), fundus performance, best-corrected visual acuity (BCVA), central macular thickness (CMT), focal electroretinogram (fERG), supplements and adjuvant medications appeared to be more beneficial in patients with AMD and diabetic maculopathy. Conclusion Herbal therapy can be considered as a potential candidate in the adjuvant and complementary therapies of retinopathy. However, further studies are required to verify such efficiency.
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Affiliation(s)
- Negin Ansari-Mohseni
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
- Equal first author
| | - Adel Ghorani-Azam
- Department of Forensic Medicine and Toxicology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
- Equal first author
| | - Seyed Ahmad Mohajeri
- Pharmacetical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Bujoreanu Bezman L, Tiutiuca C, Totolici G, Carneciu N, Bujoreanu FC, Ciortea DA, Niculet E, Fulga A, Alexandru AM, Stan DJ, Nechita A. Latest Trends in Retinopathy of Prematurity: Research on Risk Factors, Diagnostic Methods and Therapies. Int J Gen Med 2023; 16:937-949. [PMID: 36942030 PMCID: PMC10024537 DOI: 10.2147/ijgm.s401122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/17/2023] [Indexed: 03/15/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disorder with an imminent risk of blindness, in cases where early diagnosis and treatment are not performed. The doctors' constant motivation to give these fragile beings a chance at life with optimal visual acuity has never stopped, since Terry first described this condition. Thus, throughout time, several specific advancements have been made in the management of ROP. Apart from the most known risk factors, this narrative review brings to light the latest research about new potential risk factors, such as: proteinuria, insulin-like growth factor 1 (IGF-1) and blood transfusions. Digital imaging has revolutionized the management of retinal pathologies, and it is more and more used in identifying and staging ROP, particularly in the disadvantaged regions by the means of telescreening. Moreover, optical coherence tomography (OCT) and automated diagnostic tools based on deep learning offer new perspectives on the ROP diagnosis. The new therapeutical trend based on the use of anti-VEGF agents is increasingly used in the treatment of ROP patients, and recent research sustains the theory according to which these agents do not interfere with the neurodevelopment of premature babies.
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Affiliation(s)
- Laura Bujoreanu Bezman
- Department of Ophthalmology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Carmen Tiutiuca
- Department of Ophthalmology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Correspondence: Carmen Tiutiuca, Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, 800008, Romania, Tel +40741330788, Email
| | - Geanina Totolici
- Department of Ophthalmology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Nicoleta Carneciu
- Department of Ophthalmology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Florin Ciprian Bujoreanu
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Florin Ciprian Bujoreanu, Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, 800008, Romania, Tel +40741395844, Email
| | - Diana Andreea Ciortea
- Department of Pediatrics, “Sfantul Ioan” Emergency Clinical Hospital for Children, Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Ana Fulga
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Anamaria Madalina Alexandru
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Department of Neonatology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Daniela Jicman Stan
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Aurel Nechita
- Department of Pediatrics, “Sfantul Ioan” Emergency Clinical Hospital for Children, Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
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Boskabadi H, Shoeibi N, Bagheri F, Pourbadakhshan N, Moradi A, Zakerihamidi M. Potential Role of Bilirubin in Preventing Retinopathy of Prematurity. Curr Pediatr Rev 2023; 19:197-202. [PMID: 35986544 DOI: 10.2174/1573396318666220819151154] [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: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND One of the most common problems in preterm neonates is retinopathy of prematurity (ROP). It has been shown antioxidants may be effective in preventing the development and progression of ROP. Considering the antioxidant properties of bilirubin, we decided to investigate the bilirubin level in neonates with ROP and compare it with healthy neonates. METHODS This case-control study was performed on VLBW neonates admitted to the NICU of Ghaem Hospital in Mashhad between 2014 and 2020 for a Jaundice evaluation. Complete neonate's characteristics, maternal history and laboratory results were collected in a questionnaire. Then the neonates were examined for ROP by a fellowship of the retina of an ophthalmologist at 32 weeks or four weeks after birth. The highest bilirubin levels during their hospitalization were also recorded. RESULTS Of 427 neonates examined, 121 (37.7%) had a normal eye examination, and 266 (62.3%) had ROP. The mean weight, gestational age and bilirubin were 1455.8 ± 431.4 grams, 31.6 ± 2.3 weeks and 8.8 ± 2.4 mg/dl, respectively. There was a significant difference between controls and neonates with ROP with regard to birth weight, duration of intermittent positive pressure ventilation (IPPV), duration of oxygen therapy, first and fifth minute Apgar scores, the maximum level of bilirubin and gestational age (P < 0.05). It was observed that the maximum level of bilirubin was lower in neonates with higher stages of ROP. CONCLUSION According to the results of this study, higher levels of bilirubin in neonates may be a protective factor against ROP. Moreover, increased levels of bilirubin are associated with reduced severity of ROP. Therefore, prophylaxis phototherapy in premature infants may need to be reconsidered.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naser Shoeibi
- Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Bagheri
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Nafiseh Pourbadakhshan
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- PhD (Tissue Engineering), Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Nguyen TTB, Bui VT, Pham VPT, Pham TN. Retinopathy of Prematurity: A Study of Incidence and Risk Factors in a Tertiary Hospital in Vietnam. Clin Ophthalmol 2022; 16:3361-3367. [PMID: 36237485 PMCID: PMC9553427 DOI: 10.2147/opth.s386808] [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: 08/19/2022] [Accepted: 09/30/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To determine the incidence and risk factors for the development of retinopathy of prematurity (ROP) in the neonatal intensive care unit (NICU) of Hue Central Hospital, Vietnam. Methods A prospective study was performed in 214 preterm infants with gestational age (GA) ≤33 weeks and/or ≤1800 grams of birth weight (BW) or infants with a GA >33 weeks and a BW >1800 grams with an unstable clinical course who were screened for ROP in Hue Central Hospital, Vietnam. Results Fifty-eight infants (27.1%) developed ROP; 39.7% cases were stage 1, 34.5% cases were stage 2, and 25.8% cases were stage 3. Gestational age (GA), birth weight, anemia, sepsis, respiratory distress syndrome, total days on oxygen supplementation > 1 week, continuous positive airway pressure (CPAP), mechanical ventilation, blood transfusion, and surfactant had a significant association with ROP in univariate analysis (p<0.05). Using multivariate analysis, GA less than 32 weeks, sepsis, and CPAP/mechanical ventilation remained independent risk factors for ROP development. Conclusion The incidence of ROP in Vietnam was 27.1%. A GA less than 32 weeks, sepsis, and CPAP/mechanical ventilation are important risk factors for developing ROP.
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Affiliation(s)
- Thi Thanh Binh Nguyen
- Department of Pediatrics, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam,Correspondence: Thi Thanh Binh Nguyen, Department of Pediatrics, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, Hue City, 49000, Vietnam, Email ;
| | - Van Trieu Bui
- Department of Pediatrics, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Vo Phuong Thao Pham
- Department of Pediatrics, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thi Ny Pham
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy Hospital, Hue University, Hue City, Vietnam
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Noor MS, Elbarbary M, Embabi SN, Zaki MA, Awad H, Al-Feky M. Screening and Risk Factors for Retinopathy of Prematurity in a Tertiary Care Hospital in Cairo, Egypt. Clin Ophthalmol 2022; 16:3257-3267. [PMID: 36211718 PMCID: PMC9533779 DOI: 10.2147/opth.s383493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the retinopathy of prematurity (ROP) prevalence, risk factors and screening outcome in a tertiary hospital in Cairo, Egypt. Methods A prospective observational study was done in Neonatal Intensive Care Unit in Ain Shams University Hospital. A total of 159 premature infants were screened for ROP based on the most inclusive criteria reported to date. Screening included premature infants with gestational age (GA) of ≤34 weeks or birth weight (BW) of ≤2000 grams, or GA >34 weeks or BW >2000 grams, with multiple co-morbidities. The prevalence of ROP, plus disease and their correlation with risk factors of interest were studied. Results The GA of the included infants ranged from 27 to 36 weeks, mean (SD) 31.87 (± 1.81) weeks. The BW ranged from 640 to 3900 grams, mean (SD) 1784.71 (± 560.30) grams. The prevalence of ROP more than stage 0 was 25.8% (41 infants), 7.3% of the cases (11 infants) showed plus disease and 6.3% (10 infants) showed severe ROP requiring treatment. Of those, 2 cases (20%) fell outside the British Guideline's criteria for Screening. There was a highly significant (p < 0.0001) correlation between ROP more than stage 0 and low GA, low BW, mechanical ventilation, respiratory distress syndrome, necrotizing enterocolitis, intraventricular haemorrhage, and blood transfusion. No significant correlation was found between appearance of ROP more than stage 0 and gender (p = 0.911), patent ductus arteriosus (p =0.187), or sepsis (p =0.998). Conclusion ROP is a significant problem in the premature infants in Egypt. Extremely premature infants with lower BW are more prone to develop ROP. However, cases with higher GA and BW than mentioned in the British guidelines screening criteria especially with multiple comorbidities showed severe ROP requiring intervention, which implies the need to develop a screening guideline for the Egyptian population.
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Affiliation(s)
- Mohamed Salaheldeen Noor
- Ophthalmology Department, Ain Shams University, Cairo, Egypt,Correspondence: Mohamed Salaheldeen Noor, Ophthalmology Department, Ain Shams University, 22 Abdullah Ibn Eltaher street, Makram Edeid, Nasr city, Cairo, Egypt, Tel +201093769896, Email
| | | | - Sherif N Embabi
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
| | - Mohamed A Zaki
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
| | - Hisham Awad
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
| | - Mariam Al-Feky
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
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10
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Gao X, Liao Y, Lin D, Wang L, Yu D, Li Z, Zhang Y, Lan Y. Incidence and Characteristics of Retinopathy of Prematurity Patients With Late Gestational Age and Large Birth Weight in South China. Front Med (Lausanne) 2022; 9:712759. [PMID: 35308553 PMCID: PMC8927732 DOI: 10.3389/fmed.2022.712759] [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: 05/21/2021] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the incidence and characteristics of retinopathy of prematurity (ROP) premature infants with late gestational age (GA) and large birth weight (BW) and show a 7-year trend of ROP incidence in South China. Methods This retrospective, cross-sectional study included premature infants who received ROP screening in a 7-year period (from 2010 to 2016) at the Sun Yat-sen Memorial Hospital (SYSMH), Guangzhou, South China. Infants were screened if they had GA <37 weeks or BW <2,500 g. All screened infants were divided into two groups: Group 1 (with both GA ≥ 35 weeks and BW ≥ 1,750 g) and Group 2 (others). The characteristics of ROP infants in Group 1 were analyzed and compared with those in Group 2. Results A total of 911 premature infants were screened, with 282 infants in Group 1 and 629 in Group 2. Both the incidences of any ROP (6.7 vs. 8.3%, p = 0.50) and Type 1 ROP (1.4 vs. 1.7%, p = 0.72) in Group 1 were comparable with those in Group 2. Lower proportions of respiratory distress (15.8 vs. 71.2%, p < 0.001), blood transfusion (5.3 vs. 32.7%, p = 0.028), and oxygen administration (31.6 vs. 86.5%, p < 0.001) among ROP patients in Group 1 than those in Group 2 were revealed. Vaginal delivery [OR: 4.73 (1.83–12.26)] was identified as a factor associated with ROP among the infants in Group 1. Forty percent (6/15) of Type 1 ROP in this study would have been missed under the current screening criteria in China (GA ≤ 34 weeks and/or BW ≤ 2,000 g). Trends of increased incidence of Type 1 ROP and decreased BW were exhibited in the 7-year study period. Conclusions These findings indicate that even the premature infants with late GA and large BW also have a high risk of developing ROP, especially for those delivered by vagina. The findings may provide a significant reference for ROP screening and neonatal care in South China and other regions with similar conditions.
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Affiliation(s)
- Xiang Gao
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yunru Liao
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lisha Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Deying Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zijing Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yichi Zhang
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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11
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Lin YW, Chen SN, Muo CH, Sung FC, Lin MH. Risk of Retinopathy of Prematurity in Preterm Births with Respiratory Distress Syndrome: A Population-Based Cohort Study in Taiwan. Int J Gen Med 2022; 15:2149-2162. [PMID: 35241930 PMCID: PMC8887609 DOI: 10.2147/ijgm.s344056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Ya-Wen Lin
- School of Nursing and Graduate Institute of Nursing, China Medical University, Taichung, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
- Fung-Chang Sung, Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan, Email
| | - Ming-Hung Lin
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
- Correspondence: Ming-Hung Lin, Department of Pharmacy, Chia Nan University of Pharmacy and Science, No. 60, Sec. 1, Erren Road, Rende District, Tainan City, 71710, Taiwan, Email
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12
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Sankar BK, Marakkar RK, Varghese S. Effectiveness of Developmentally Supportive Education Program on Nursing Knowledge of Retinopathy of Prematurity in Neonatal Intensive Care Unit. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:67-70. [PMID: 35280195 PMCID: PMC8865242 DOI: 10.4103/ijnmr.ijnmr_279_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/24/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
Background Retinopathy of Prematurity (ROP) is a preventable cause of childhood blindness. India accounts for nearly 10% of the worldwide estimate of blindness and visual impairment due to ROP. Nurses are pillars of neonatal intensive care units (NICUs) and play a critical role in the prevention and management of ROP. The primary aim of this study was to evaluate the effect of developmentally supportive education program on knowledge regarding prevention and management of ROP among nurses working in NICU. Materials and Methods A hospital based pre-experimental, one group pre-test-post-test study was carried out among 32 staff nurses working in the NICU of a tertiary care center during January to February 2019. Knowledge regarding the prevention and management of ROP was assessed before and after the implementation of developmentally supportive education program using a structured knowledge questionnaire. Results Pre-test knowledge score was mean (Standard Deviation [SD]) 9.00 (3.68) and after the educational program post-test knowledge score was found to be mean (SD) 14.53 (2.39). Paired t-test was used to evaluate the effect of developmentally supportive education program and was found to be statistically significant (t32= 10.09, p < 0.001). Conclusions Developmentally supportive educational program can be used as an effective intervention for improving the knowledge regarding ROP among nurses in NICU.
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Affiliation(s)
- Bindu Kunnumpurath Sankar
- Department of Child Health Nursing, Government College of Nursing, Thrissur, Kerala, India,Address for correspondence:Mrs. Bindu Kunnumpurath Sankar, Govt. College of Nursing, Thrissur - 680 596, Kerala, India. E-mail:
| | - Riaz Karoly Marakkar
- Department of Mental Health Nursing, Government College of Nursing, Thrissur, Kerala, India
| | - Shalu Varghese
- Research Assistant, Academic Staff College, Kerala University of Health Sciences, Thrissur, Kerala, India
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Rasoulinejad SA, Maroufi F, Alizadeh A. Clinical parameters in different stages, zones, and remission/progression statuses of retinopathy of prematurity. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:385-392. [PMID: 35919643 PMCID: PMC9301226 DOI: 10.22088/cjim.13.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 10/31/2022]
Abstract
Background Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in premature infants that causes lifetime visual impairment and blindness in the early ages. In this study, we investigated the differences in the values of clinical laboratory parameters between different ROP and its remission/progression statuses regarding stages and zones. Methods This historical cohort study includes 828 infants divided into two groups after the first examination containing ROP infants and controls. The biochemical and hematological parameters of the two groups have been collected from the patient's history. Results In infants with ROP, the hematopoiesis-related parameters, including the mean level of hemoglobin, total bilirubin, potassium, calcium were significantly less than controls (P=0.039, P=0.001, P=0.001, and P=0.046, respectively). The percentages of reticulocyte and the levels of BUN in ROP patients were significantly higher than in normal infants (P=0.015 and p <0.001, respectively). Moreover, the levels of hemoglobin and BUN were significantly different in the different zones of ROP (P=0.017 and P=0.001, respectively). Also, higher hemoglobin levels, total bilirubin, and CRP were observed in the reduced stages of ROP (P=0.041, P=0.045, and P=0.039, respectively). Conclusion Laboratory parameters are different in different stages, zones and remission/ progression ROP infants.
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Affiliation(s)
- Seyed Ahmad Rasoulinejad
- Department of Ophthalmology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.,Correspondence: Seyed Ahmad Rasoulinejad, Department of Ophthalmology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran. E-mail: , Tel: 0098 1132238284, Fax: 0098 1132238284
| | - Faezeh Maroufi
- Department of Medical Laboratory Sciences, Faculty of Allied Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ahad Alizadeh
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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Tawfik S, Mansour A, Selim NL, Habib AM, Fouad YA, Tawfik MA, Al-Feky M. Analysis of a two-year independent screening effort for retinopathy of prematurity in rural Egypt. BMC Ophthalmol 2021; 21:445. [PMID: 34961497 PMCID: PMC8711162 DOI: 10.1186/s12886-021-02193-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The third epidemic of retinopathy of prematurity (ROP) has majorly involved middle income countries in which tailored screening and local guidelines require development. The data regarding ROP prevalence and cutoff numbers for screening in Egypt are lacking. METHODS Retrospective analysis of an independent screening effort spanning 2 years (February 2019 to February 2021) and involving 32 neonatal care units within Sharkia governorate, Egypt. Infants of gestational age (GA) ≤ 34 weeks and/or birth weight (BW) ≤ 2000 g were included, as well as those with unstable clinical course. Two eyecare centers located in Sharkia and Cairo governorates served as referral centers for any required interventions. RESULTS Of the 276 screened infants, 133 (48.2%) had some form of ROP that was bilateral in 127 (95.5%) of them. Aggressive posterior ROP (AP-ROP) was detected in both eyes of 24 infants (8.7%). The median (IQR) GA of infants with ROP was 32 (30-34) weeks, and the median (IQR) BW was 1600 (1350-2000) g. Sixty-three infants (47.4%) required treatment. Of the total 84 eyes that primarily were treated, 73 (86.9%) received intravitreal ranibizumab, 8 (9.5%) underwent laser ablation therapy, and 3 eyes (3.6%) underwent surgery. Recurrence rate was 16.7% (14 eyes). Final outcome was favorable in 83 eyes (98.8%). Applying the American Academy criteria would have led to the missing of 36.8% of infants with ROP and 28.6% of those requiring treatment in our sample. CONCLUSION The incidence of both ROP and AP-ROP in the Egyptian rural setting appears to be in the high end of global reported rates. Prevention measures should urgently be planned and implemented.
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Affiliation(s)
- Sara Tawfik
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
| | - Ahmed Mansour
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Norhan Lotfy Selim
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
| | - Ahmed M Habib
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Yousef A Fouad
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt.
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.
| | - Mohamed A Tawfik
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Memorial Institute for Ophthalmic Research, Giza, Egypt
| | - Mariam Al-Feky
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
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15
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Markasz L, Olsson KW, Holmström G, Sindelar R. Cluster Analysis of Early Postnatal Biochemical Markers May Predict Development of Retinopathy of Prematurity. Transl Vis Sci Technol 2020; 9:14. [PMID: 33344058 PMCID: PMC7726592 DOI: 10.1167/tvst.9.13.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Growth factors and inflammatory and angiogenetic proteins are involved in the development of retinopathy of prematurity (ROP). However, no early biochemical markers are in clinical use to predict ROP. By performing cluster analysis of multiple biomarkers, we aimed to determine patient groups with high and low risk for developing ROP. Methods In total, 202 protein markers in plasma were quantified by proximity extension assay from 35 extremely preterm infants on day 2 of life. Infants were sorted in groups by automated two-dimensional hierarchical clustering of all biomarkers. ROP was classified as stages I to III with or without surgical treatment. Predictive biomarkers were evaluated by analysis of variance and detected differences by two-sided paired t-test with Bonferroni corrections for multiple comparisons. Results Differences in 39 biochemical markers divided infants without ROP into two control groups (control 1, n = 7; control 2, n = 5; P < 0.05). Sixty-six biochemical markers defined differences between the control groups (n = 13) and all ROP infants (n = 23; P < 0.05). PARK7, VIM, MPO, CD69, and NEMO were markedly increased in control 1 compared to all ROP infants (P < 0.001). Lower TNFRSF4 and higher HER2 and GAL appeared in infants with ROP as compared to control 1 and/or 2 (P < 0.05, respectively). Conclusions Our data suggest that early elevated levels of PARK7, VIM, MPO, CD69, and NEMO may be associated with lower risk of developing ROP. Lower levels of TNFRSF4 with higher levels of HER2 and GAL may predict ROP development. Translational Relevance Cluster analysis of early postnatal biomarkers may help to identify infants with low or high risk of developing ROP.
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Affiliation(s)
- Laszlo Markasz
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karl-Wilhelm Olsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Gerd Holmström
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Richard Sindelar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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16
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Zhu Z, Hua X, Yu Y, Zhu P, Hong K, Ke Y. Effect of red blood cell transfusion on the development of retinopathy of prematurity: A systematic review and meta-analysis. PLoS One 2020; 15:e0234266. [PMID: 32512582 PMCID: PMC7279893 DOI: 10.1371/journal.pone.0234266] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/21/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The effect of red blood cell (RBC) transfusion on retinopathy of prematurity (ROP) is difficult to establish, because ROP may also be influenced by other factors. Therefore, we carried out a systematic review and meta-analysis to explore the relationship between RBC transfusion and the development of ROP. METHODS The PubMed, Embase, Cochrane Library and Web of Science databases were searched from their inception to September 1, 2019. Observational studies that reported the relationship between RBC transfusion and ROP after adjusting for other potential risk factors were included. The combined result was analyzed by a random effect model. Heterogeneity and publication bias were tested, and sensitivity analysis was performed. RESULTS Of the 2628 identified records, 18 studies including 15072 preterm infants and 5620 cases of ROP were included. A random effect model was used and revealed that RBC transfusion was significantly associated with ROP (pooled OR = 1.50, 95% CI: 1.27-1.76), with moderate heterogeneity among the included studies (I2 = 44.2%). Subgroup analysis indicated that RBC transfusion was more closely related to ROP in the group with a gestational age (GA) ≤32 weeks (OR = 1.77, 95% CI: 1.29-2.43) but not in the groups with a GA ≤34 weeks (OR = 1.36, 95% CI: 0.85-2.18) or a GA <37 weeks (OR = 1.25, 95% CI: 0.86-1.82). No obvious publication bias was found based on the funnel plot and Egger's test. Removing any single study did not significantly alter the combined result in the sensitivity analysis. CONCLUSIONS Our study revealed that RBC transfusion is an independent risk factor for the development of ROP, especially in younger preterm infants. However, there seemed to be no evidence to support an effect of RBC transfusion on ROP in older groups. Further studies addressing this issue in older preterm neonates are warranted.
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Affiliation(s)
- Zhe Zhu
- Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Xin Hua
- Ningbo Institute life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Department of Clinical Laboratory, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Yong Yu
- Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Pan Zhu
- Neonatal intensive care unit, Ningbo Women & Children’s Hospital, Ningbo, Zhejiang, China
| | - Kairui Hong
- Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Yefang Ke
- Department of Clinical Laboratory, Ningbo Women & Children’s Hospital, Ningbo, Zhejiang, China
- * E-mail:
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