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Gimenez LG, Gili JA, Elias DE, Sagula R, Comas B, Santos MR, Campaña H, Poletta FA, Heisecke SL, Ratowiecki J, Cosentino VR, Uranga R, Saleme C, Negri M, Rittler M, Zapata Barrios J, Krupitzki HB, López Camelo JS. Genetic susceptibility for retinopathy of prematurity and its associated comorbidities. Pediatr Res 2024:10.1038/s41390-024-03068-9. [PMID: 38347174 DOI: 10.1038/s41390-024-03068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is one of the leading cause of child blindness. Preterm newborns of very low gestational age (GA) and very low birth weight are at the greatest risk. Our objective was to evaluate the role of genetic variants associated with ROP risk and its comorbidities in an Argentinian sample of premature infants. METHODS A sample of 437 preterm infants <33 weeks GA, born at a maternity hospital in Tucumán, Argentina, 2005-2010, was analyzed. Environmental factors, perinatal outcomes, and fourteen single nucleotide polymorphisms associated with ROP were evaluated, comparing ROP with non-ROP newborns. A lasso logistic regression was performed to select variables; then, a conditional logistic regression was used to identify ROP maternal and perinatal risk factors adjusting by maternal and gestational ages, respectively. RESULTS ROP maternal risk factors were alcohol intake, periodontal infections, and severe stress. Respiratory distress, sepsis, and intracranial hemorrhage were the ROP perinatal risk factors. Markers rs186085 of EPAS1 and rs427832 of AGTR1 were significantly associated with ROP newborns. CONCLUSION We identified three maternal and three perinatal risk factors associated with ROP. Genes EPAS1 and AGTR1, involved in angiogenesis and vascularization, were identified to be of risk for ROP. IMPACT Genetic and environmental risk factors associated with ROP and its comorbidities are evaluated in a Latin American population. Genes EPAS1 and AGTR1, involved in angiogenesis and vascularization, were identified to be of risk for ROP. Three maternal and three perinatal risk factors associated with ROP were also identified. A matrix of significant relationships among genetic markers and comorbidities is presented. Reported data may help develop more effective preventive measures for ROP in the Latin American region.
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Affiliation(s)
- Lucas G Gimenez
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Juan A Gili
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Darío E Elias
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Rubén Sagula
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Belén Comas
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - María R Santos
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Multidisciplinario de Biología Celular, Buenos Aires, Argentina
| | - Hebe Campaña
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
| | - Fernando A Poletta
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina L Heisecke
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Julia Ratowiecki
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Viviana R Cosentino
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Interzonal General de Agudos Luisa C. de Gandulfo, Buenos Aires, Argentina
| | - Rocío Uranga
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital San Juan de Dios, Buenos Aires, Argentina
| | - César Saleme
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, Tucumán, Argentina
| | - Mercedes Negri
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mónica Rittler
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Materno Infantil Ramón Sardá, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge Zapata Barrios
- Hospital Materno Infantil Ramón Sardá, Ciudad Autónoma de Buenos Aires, Argentina
- Departamento de Neonatología, Clínica y Maternidad Suizo Argentina, Ciudad Autónoma de Buenos Aires, Argentina
| | - Hugo B Krupitzki
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-IUC), Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge S López Camelo
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
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Mishra AV, Robitaille JM. Lack of evidence of association between ZNF408 variant and ROP. Ophthalmic Genet 2023; 44:204. [PMID: 33491530 DOI: 10.1080/13816810.2020.1867756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Amit V Mishra
- Dalhousie University Faculty of Medicine, Ophthalmology and Visual Sciences, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Johane M Robitaille
- Dalhousie University Faculty of Medicine, Ophthalmology and Visual Sciences, IWK Health Centre, Halifax, Nova Scotia, Canada
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Tan Z, Isaacs M, Zhu Z, Simkin S, He M, Dai S. Retinopathy of prematurity screening: A narrative review of current programs, teleophthalmology, and diagnostic support systems. Saudi J Ophthalmol 2022; 36:283-295. [PMID: 36276257 PMCID: PMC9583350 DOI: 10.4103/sjopt.sjopt_220_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/04/2021] [Accepted: 11/12/2021] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Neonatal care in middle-income countries has improved over the last decade, leading to a "third epidemic" of retinopathy of prematurity (ROP). Without concomitant improvements in ROP screening infrastructure, reduction of ROP-associated visual loss remains a challenge worldwide. The emergence of teleophthalmology screening programs and artificial intelligence (AI) technologies represents promising methods to address this growing unmet demand in ROP screening. An improved understanding of current ROP screening programs may inform the adoption of these novel technologies in ROP care. METHODS A critical narrative review of the literature was carried out. Publications that were representative of established or emerging ROP screening programs in high-, middle-, and low-income countries were selected for review. Screening programs were reviewed for inclusion criteria, screening frequency and duration, modality, and published sensitivity and specificity. RESULTS Screening inclusion criteria, including age and birth weight cutoffs, showed significant heterogeneity globally. Countries of similar income tend to have similar criteria. Three primary screening modalities including binocular indirect ophthalmoscopy (BIO), wide-field digital retinal imaging (WFDRI), and teleophthalmology were identified and reviewed. BIO has documented limitations in reduced interoperator agreement, scalability, and geographical access barriers, which are mitigated in part by WFDRI. Teleophthalmology screening may address limitations in ROP screening workforce distribution and training. Opportunities for AI technologies were identified in the context of these limitations, including interoperator reliability and possibilities for point-of-care diagnosis. CONCLUSION Limitations in the current ROP screening include scalability, geographical access, and high screening burden with low treatment yield. These may be addressable through increased adoption of teleophthalmology and AI technologies. As the global incidence of ROP continues to increase, implementation of these novel modalities requires greater consideration.
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Affiliation(s)
- Zachary Tan
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Brisbane, Australia,Department of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Michael Isaacs
- Department of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
| | - Zhuoting Zhu
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Brisbane, Australia
| | - Samantha Simkin
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Mingguang He
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Brisbane, Australia
| | - Shuan Dai
- Department of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia,Address for correspondence: Dr. Shuan Dai, Assoc. Prof. Shuan Dai, Faculty of Medicine, The University of Queensland, Brisbane, Australia. E-mail:
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Carranza-Mendizabal CS, Diaz-Manrique M, Ruiz Mamani PG, White M, Huancahuire-Vega S. Incidence and Risk Factors Associated with Retinopathy of Prematurity in Peru. Clin Ophthalmol 2021; 15:2141-2148. [PMID: 34079212 PMCID: PMC8163619 DOI: 10.2147/opth.s301439] [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: 02/05/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this research is to determine retinopathy of prematurity (ROP) prevalence and possible risk factors associated with ROP development in newborns admitted to a neonatal unit of a Peruvian National Reference Hospital. Patients and Methods This retrospective study included 216 preterm infants. The data were collected between January 2016 and December 2018. All infants were examined according to Peruvian guidelines for screening and treatment of ROP. The association of clinical risk factors and the development of ROP was analyzed and predictive factors were determined. Results The study subjects were 216 preterm infants of which 72 had some stage of ROP (32 stage 1; 23 stage 2 and 17 stage 3) and 144 preterm infants without ROP. The incidence of ROP in preterm infants less than 32 weeks was 60.9%, while for those weighing less than 1500 g it was 71.6%. The factors associated with ROP were gestational age below 32 weeks, birth weight below 1500 grams, neonatal sepsis, oxygen therapy, mechanical ventilation, hyaline membrane disease, bronchopulmonary dysplasia, persistence of ductus arteriosus and intraventricular hemorrhage. Exclusive breastfeeding was found to play a protective role against ROP. Binary logistic regression analysis found that only gestational age below 32 weeks (OR, 2.637; 95% CI, 1.04–6.69), weight below 1500 grams (OR, 4.377; 95% CI, 1.75–10.92), neonatal sepsis (OR, 6.517; 95% CI, 2.81–15.14), vaginal delivery (OR, 3.748; 95% CI: 1.54–9.14), and the presence of hyaline membrane disease (OR, 3.58; 95% CI, 1.47–8.74) are predictors of ROP. Conclusion The incidence of ROP among very low birth weight infants was 71.6%. Infants with weight below 1500 grams, neonatal sepsis, presence of hyaline membrane disease whose mother had vaginal delivery are at risk for the development of ROP. Thus, preventing premature births and encouraging exclusive breastfeeding are two main ways to prevent ROP.
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Affiliation(s)
- Carmen Sarita Carranza-Mendizabal
- Ophthalmology Service, Hipólito Unanue National Hospital, Lima, Peru.,Human Medicine School, Peruvian Union University (UPeU), Lima, Peru
| | - Mariela Diaz-Manrique
- Ophthalmology Service, Hipólito Unanue National Hospital, Lima, Peru.,Human Medicine School, Peruvian Union University (UPeU), Lima, Peru
| | | | - Michael White
- Directorate General Research, Peruvian Union University (UPeU), Lima, Peru
| | - Salomon Huancahuire-Vega
- Human Medicine School, Peruvian Union University (UPeU), Lima, Peru.,Directorate General Research, Peruvian Union University (UPeU), Lima, Peru
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Mohammadi SF, Rahban A, Darabeigi S, Salimi N, Farahani A, Lashay A, Alinia C. Cost-effectiveness analysis of tele-retinopathy of prematurity screening in Iran. Int J Ophthalmol 2021; 14:560-566. [PMID: 33875948 DOI: 10.18240/ijo.2021.04.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To conduct a cost-utility analysis of the tele-retinopathy of prematurity (ROP) screening program against no screening. METHODS A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective. We used the quality adjusted life years (QALY) index to measure the scenarios' effectiveness, which was discounted for the future years by 0.058. One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information. We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach. The figures of the model's inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data, and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties. RESULTS The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD, respectively. The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD, respectively, and their lifetime discounted QALY gained were calculated as 15.39 and 15.11, respectively. Therefore, incremental cost-effectiveness ratio (ICER) of tele-screening strategy against the competitive strategy was achieved as 161.43 USD. CONCLUSION Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation.
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Affiliation(s)
- Seyed-Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 6719851351, Iran
| | - Ameneh Rahban
- Department of Health Management and Economics, School of Public Health, Urmia University of Medical Sciences, Urmia 571478334, Iran
| | - Sahel Darabeigi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 6719851351, Iran
| | - Nastaran Salimi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 6719851351, Iran
| | - Afsar Farahani
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 6719851351, Iran
| | - Alireza Lashay
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 6719851351, Iran
| | - Cyrus Alinia
- Department of Health Management and Economics, School of Public Health, Urmia University of Medical Sciences, Urmia 571478334, Iran
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Romo-Aguas JC, González-H.León A, Meraz-Gutiérrez MP, Martínez-Castellanos MA. Retinopathy of prematurity: incidence report of outliers based on international screening guidelines. Int J Retina Vitreous 2019; 5:53. [PMID: 31890290 PMCID: PMC6907106 DOI: 10.1186/s40942-019-0203-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AIM The objective of this study is to report the incidence of retinopathy of prematurity (ROP) outliers that fall outside the screening guidelines of the American Academy of Ophthalmology (AAO) in our country. METHODS A retrospective review of 503 records of newborns evaluated in our institution between January 2011 and March 2017. We analyzed the data by subgroups based on gestational age (GA), birth weight (BW) and stage, focusing on the outliers that don't meet the criteria of the screening AAO guidelines (GA ≤ 30 weeks, BW ≤ 1500 g). RESULTS Of the 503 records, 352 had some degree of ROP, 91.76% being bilateral, and 26.2% require treatment. The mean GA at delivery was 30.56 ± 2.33 weeks, and the mean BW was 1287.90 ± 338.52 g. For the current AAO/AAP ROP screening, 19.9% were outliers, of which (57%) had ROP diagnosis and (38%) required treatment. CONCLUSIONS ROP diagnosis in newborns of BW > 1500 g or GA > 30 weeks is not uncommon in Mexico, and it is important to take this into account to adjust the selection criteria on each population to reach all the infants at risk.
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Affiliation(s)
- Juan Carlos Romo-Aguas
- Retina Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Ana González-H.León
- Retina Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | | | - María A. Martínez-Castellanos
- Retina Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
- Retina Service, Asociación para Evitar la Ceguera Hospital ‘‘Luis Sánchez Bulnes’’ I.A.P., Vicente Garcia Torres No. 46 Coyoacán, 04030 Mexico, D.F. Mexico
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Freitas AM, Mörschbächer R, Thorell MR, Rhoden EL. Incidence and risk factors for retinopathy of prematurity: a retrospective cohort study. Int J Retina Vitreous 2018; 4:20. [PMID: 29881640 PMCID: PMC5984384 DOI: 10.1186/s40942-018-0125-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/26/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Advances in neonatal care promoted increased survival rates of preterm infants, with a consequent increase in the number of children affected by retinopathy of prematurity (ROP). This study estimates the incidence of ROP and evaluates potential risk factors associated. METHODS A retrospective cohort study of preterm infants born in a tertiary neonatal intensive care unit was conducted from March 2005 to August 2015. Six hundred and thirty-nine newborns were included based on the following criteria: infants born with less than 32 weeks' gestation or birth weight below 1500 g; or neonates born with 32-37 weeks' gestation or birth weight above 1500 g and any of the following associated: multiple gestation, respiratory distress syndrome, sepsis, blood transfusions or intraventricular hemorrhage. Neonates were followed up until disease resolution or until treatment criteria was achieved. RESULTS A total of 602 newborns were evaluated after applying the exclusion criteria. Mean gestational age was 30.7 ± 2.5 weeks. The incidences of ROP at any stage and of type 1 prethreshold ROP were 33.9 and 5.0% respectively. Logistic regression analysis revealed that risk factors associated with ROP at any stage were extremely low birth weight (ELBW) (odds ratio [OR] = 3.10; 95% confidence interval [95% CI]:1.73-5.55), pulmonary diseases (OR = 2.49; 95% CI: 1.35-4.59), intraventricular hemorrhage (OR = 2.17; 95% CI: 1.10-4.30), and low gestational age (OR = 0.81; 95% CI: 0.73-0.91). The main risk factors associated with type 1 prethreshold ROP were pulmonary diseases (OR = 9.58; 95% CI: 1.27-72.04) and ELBW (OR = 3.66; 95% CI: 1.67-8.00). CONCLUSION This study found a significant incidence of ROP (33.9%) in the studied population, and highlighted pulmonary diseases as a significant risk factor for type 1 prethreshold ROP.
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Affiliation(s)
- André Moraes Freitas
- Universidade Federal de Ciências Da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre, RS 90050-170 Brazil
| | - Ricardo Mörschbächer
- Universidade Federal de Ciências Da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre, RS 90050-170 Brazil
| | | | - Ernani Luis Rhoden
- Universidade Federal de Ciências Da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre, RS 90050-170 Brazil
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Kelkar J, Agashe S, Kelkar A, Khandekar R. Mobile unit for retinopathy of prematurity screening and management at urban Neonatal Intensive Care Units: Outcomes and impact assessment. Oman J Ophthalmol 2017; 10:13-16. [PMID: 28298858 PMCID: PMC5338045 DOI: 10.4103/0974-620x.200684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To study the outcomes and impact of a mobile unit for retinopathy of prematurity (ROP) screening and management at urban Neonatal Intensive Care Units (NICUs). Study Design: Public health intervention study. Methods: This study was conducted in 2012. Staff of a mobile unit assessed all infants aged 32 weeks or less and/or weight 1250 g or less admitted in five NICUs between 2009 and 2011. An ophthalmologist performed bedside ROP screening through dilated pupils using indirect ophthalmoscopy. ROP was graded and managed as per the International Classification of ROP treatment guidelines. Counseling and laser treatment were the interventions. The incidence, grade, and determinants of ROP were estimated. Direct and indirect costs were calculated to estimate the unit cost of screening and managing a child with ROP using the mobile unit. Result: The study sample included 104 preterm/underweight infants. The prevalence of ROP of different grades in either eye was 32.7% (95% confidence intervals: 23.7–41.7). ROP Stage I was present in 75% of these eyes. The mobile unit could help in preventing/reducing visual disability in 5 infants with advanced stages of ROP. The unit cost of ROP screening, identifying one child with ROP, and addressing visual disability due to ROP was US $310, 950, and 6500, respectively. Conclusion: A mobile screening is likely feasible and cost-effective method to detect ROP and offer timely intervention in urban areas with limited resources.
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Affiliation(s)
- Jai Kelkar
- Department of Pediatric Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Supriya Agashe
- Department of Pediatric Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aditya Kelkar
- Department of Pediatric Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Santos JP, Cecatti JG, Serruya SJ, Almeida PV, Duran P, de Mucio B, Pileggi-Castro, C. Neonatal Near Miss: the need for a standard definition and appropriate criteria and the rationale for a prospective surveillance system. Clinics (Sao Paulo) 2015; 70:820-6. [PMID: 26735223 PMCID: PMC4676313 DOI: 10.6061/clinics/2015(12)10] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/24/2022] Open
Abstract
In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure) but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization.
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Affiliation(s)
- Juliana P Santos
- Universidade de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Ginecologia e Obstetrícia, Campinas/SP, Brazil
| | - José G Cecatti
- Universidade de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Ginecologia e Obstetrícia, Campinas/SP, Brazil
- Corresponding author: E-mail:
| | - Suzanne J Serruya
- Latin American Center of Perinatology (CLAP), Pan American Health Organization (PAHO), Montevideo, Uruguay
| | | | - Pablo Duran
- Latin American Center of Perinatology (CLAP), Pan American Health Organization (PAHO), Montevideo, Uruguay
| | - Bremen de Mucio
- Latin American Center of Perinatology (CLAP), Pan American Health Organization (PAHO), Montevideo, Uruguay
| | - Cynthia Pileggi-Castro,
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto/SP, Brazil
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Arámbulo O, Dib G, Iturralde J, Duran F, Brito M, Fortes Filho JB. Intravitreal ranibizumab as a primary or a combined treatment for severe retinopathy of prematurity. Clin Ophthalmol 2015; 9:2027-32. [PMID: 26604673 PMCID: PMC4631423 DOI: 10.2147/opth.s90979] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The aim of the study was to assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II treated with intravitreal ranibizumab (IVR) as monotherapy or combined treatment with laser photocoagulation. METHODS This is a retrospective study analyzing clinical records of the included patients. Patients were divided into two groups: group 1 included patients who received only IVR treatment; and group 2 was subdivided into group 2A - including patients with IVR as initial treatment and complementary laser photocoagulation if retinal neovascularization or plus disease did not regress, and group 2B - including patients with initial laser photocoagulation and IVR as rescue therapy. Favorable outcomes were regression of the retinal neovascularization and plus disease, meaning control of the disease. Unfavorable outcomes were progression to stages 4 and 5 of ROP. RESULTS Fifty-seven eyes were included in the study. Mean birth weight and gestational age were 1,281±254 g and 29.5±2.1 weeks, respectively. Group 1 comprised of 16 eyes, with favorable outcomes in 14 eyes (87.5%). Group 2 comprised of 41 eyes, with favorable outcomes in 29 eyes (70.7%), in a mean follow-up period of 12.8 months. CONCLUSION IVR was effective to treat severe cases of ROP as a primary or a combined treatment. Forty-three of the 57 treated eyes (75.4%) achieved regression of ROP and favorable outcomes.
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Affiliation(s)
- Odalis Arámbulo
- Department of Ophthalmology, University Hospital of Maracaibo, Maracaibo, Venezuela, Brazil
| | - Gabriel Dib
- Department of Ophthalmology, University Hospital of Maracaibo, Maracaibo, Venezuela, Brazil
| | - Juan Iturralde
- Department of Ophthalmology, University Hospital of Maracaibo, Maracaibo, Venezuela, Brazil
| | - Fahir Duran
- Department of Ophthalmology, University Hospital of Maracaibo, Maracaibo, Venezuela, Brazil
| | - Miguel Brito
- Department of Ophthalmology, University Hospital of Maracaibo, Maracaibo, Venezuela, Brazil
| | - João B Fortes Filho
- Department of Ophthalmology, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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