1
|
Teofili L, Papacci P, Dani C, Cresi F, Remaschi G, Pellegrino C, Bianchi M, Ansaldi G, Campagnoli MF, Vania B, Lepore D, Franco FGS, Fabbri M, de Vera d' Aragona RP, Molisso A, Beccastrini E, Dragonetti A, Orazi L, Pasciuto T, Mozzetta I, Baldascino A, Locatelli E, Valentini CG, Giannantonio C, Carducci B, Gabbriellini S, Albiani R, Ciabatti E, Nicolotti N, Baroni S, Mazzoni A, Besso FG, Serrao F, Purcaro V, Coscia A, Pizzolo R, Raffaeli G, Villa S, Mondello I, Trimarchi A, Beccia F, Ghirardello S, Vento G. Cord blood transfusions in extremely low gestational age neonates to reduce severe retinopathy of prematurity: results of a prespecified interim analysis of the randomized BORN trial. Ital J Pediatr 2024; 50:142. [PMID: 39113069 PMCID: PMC11305044 DOI: 10.1186/s13052-024-01714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Preterm infants are at high risk for retinopathy of prematurity (ROP), with potential life-long visual impairment. Low fetal hemoglobin (HbF) levels predict ROP. It is unknown if preventing the HbF decrease also reduces ROP. METHODS BORN is an ongoing multicenter double-blinded randomized controlled trial investigating whether transfusing HbF-enriched cord blood-red blood cells (CB-RBCs) instead of adult donor-RBC units (A-RBCs) reduces the incidence of severe ROP (NCT05100212). Neonates born between 24 and 27 + 6 weeks of gestation are enrolled and randomized 1:1 to receive adult donor-RBCs (A-RBCs, arm A) or allogeneic CB-RBCs (arm B) from birth to the postmenstrual age (PMA) of 31 + 6 weeks. Primary outcome is the rate of severe ROP at 40 weeks of PMA or discharge, with a sample size of 146 patients. A prespecified interim analysis was scheduled after the first 58 patients were enrolled, with the main purpose to evaluate the safety of CB-RBC transfusions. RESULTS Results in the intention-to-treat and per-protocol analysis are reported. Twenty-eight patients were in arm A and 30 in arm B. Overall, 104 A-RBC units and 49 CB-RBC units were transfused, with a high rate of protocol deviations. A total of 336 adverse events were recorded, with similar incidence and severity in the two arms. By per-protocol analysis, patients receiving A-RBCs or both RBC types experienced more adverse events than non-transfused patients or those transfused exclusively with CB-RBCs, and suffered from more severe forms of bradycardia, pulmonary hypertension, and hemodynamically significant patent ductus arteriosus. Serum potassium, lactate, and pH were similar after CB-RBCs or A-RBCs. Fourteen patients died and 44 were evaluated for ROP. Ten of them developed severe ROP, with no differences between arms. At per-protocol analysis each A-RBC transfusion carried a relative risk for severe ROP of 1.66 (95% CI 1.06-2.20) in comparison with CB-RBCs. The area under the curve of HbF suggested that HbF decrement before 30 weeks PMA is critical for severe ROP development. Subsequent CB-RBC transfusions do not lessen the ROP risk. CONCLUSIONS The interim analysis shows that CB-RBC transfusion strategy in preterm neonates is safe and, if early adopted, might protect them from severe ROP. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov on October 29, 2021. Identifier number NCT05100212.
Collapse
Affiliation(s)
- Luciana Teofili
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy.
- Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Patrizia Papacci
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Dani
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Francesco Cresi
- Città della Salute e della Scienza, Torino, Italy
- Department of Public Health and Pediatrics, Università di Torino, Torino, Italy
| | | | - Claudio Pellegrino
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Bianchi
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | | | | | | | - Domenico Lepore
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Marco Fabbri
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Anna Molisso
- Ospedale Evangelico Villa Betania, Napoli, Italy
| | | | | | - Lorenzo Orazi
- Polo Nazionale Ipovisione IAPB Italia Onlus, Roma, Italy
| | - Tina Pasciuto
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Iolanda Mozzetta
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Antonio Baldascino
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | | | | | - Carmen Giannantonio
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Brigida Carducci
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | | | | | | | - Nicola Nicolotti
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Silvia Baroni
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Francesca Serrao
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Velia Purcaro
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Alessandra Coscia
- Città della Salute e della Scienza, Torino, Italy
- Department of Public Health and Pediatrics, Università di Torino, Torino, Italy
| | | | - Genny Raffaeli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, Università di Milano, Milano, Italy
| | - Stefania Villa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Isabella Mondello
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Alfonso Trimarchi
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Flavia Beccia
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Giovanni Vento
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
2
|
Chen J, Zhu Y, Li L, Lv J, Li Z, Chen X, Chen X, Huang S, Xie R, Zhang Y, Ye G, Luo R, Shen X, Fu M, Zhuo Y. Visual impairment burden in retinopathy of prematurity: trends, inequalities, and improvement gaps. Eur J Pediatr 2024; 183:1891-1900. [PMID: 38319404 DOI: 10.1007/s00431-024-05450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment, and the increase in number and survival of premature infants may inflate its burden globally. We aimed to comprehensively assess the trends and inequalities in the burden of ROP-related visual impairment and to identify improvement gaps to facilitate appropriate actions in neonatal care systems. We obtained ROP data from the Global Burden of Disease 2019 study. We employed joinpoint regression analysis to assess the trends of the burden of ROP-related visual impairment, measured by age-standardised prevalence rates, health equity analysis methods to evaluate cross-country burden inequalities, and data envelopment and stochastic frontier analyses to identify improvement gaps based on the development status, i.e., sociodemographic index (SDI). Between 1990 and 2019, the age-standardised prevalence rates of ROP-related visual impairment significantly increased worldwide (average annual percentage change: 0.23 [95% confidence interval, 0.21-0.26] among males and 0.26 [0.25-0.27] among females), primarily in developed regions. Although significant SDI-related cross-country inequalities were identified, these reduced over time (slope index of inequality: -57.74 [-66.22 to -49.25] in 1990 to -29.68 [-38.39 to -20.97] in 2019; health concentration index: -0.11 [-0.13 to -0.09] in 1990 to -0.07 [-0.09 to -0.06] in 2019). Notably, some less-developed countries exhibited superior performance despite limited resources, whereas others with a higher SDI delivered lagging performance. Conclusion: The global burden of ROP-related visual impairment has steadily increased between 1990 and 2019, with disproportionate burden concentration among less-developed countries, requiring appropriate preventive and intervention measures. What is Known: • Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment. • The prevalence of ROP is anticipated to increase due to the growing number of extremely premature infants. What is New: • The prevalence of ROP-related visual impairment has increased worldwide, primarily in developed regions, with declining but persisting cross-country inequalities. • The increasing burden of ROP-related visual impairment should be considered as part of global and national health agendas, requiring interventions with proven efficacy.
Collapse
Affiliation(s)
- Jianqi Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Linling Li
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China
| | - Juan Lv
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xuhao Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xiaohong Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Shaofen Huang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Rui Xie
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Yuan Zhang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Ruiyu Luo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xinyue Shen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Min Fu
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China.
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China.
| |
Collapse
|
3
|
Watanabe R, Liu S, Sakaue T, Ikegawa Y, Ohta M, Higaki T, Mogi M, Eguchi M. Amelioration of oxygen-induced retinopathy in neonatal mice with fetal growth restriction. Front Cell Dev Biol 2024; 12:1288212. [PMID: 38434621 PMCID: PMC10904624 DOI: 10.3389/fcell.2024.1288212] [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] [Received: 09/04/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction: With the aim of optimizing the balance of maintaining a safe oxygen saturation and reducing the risk of retinopathy of prematurity in human neonates with fetal growth restriction (FGR), the present study investigated the distinct effects of oxygen supplementation on the retinal neovasculature using a murine premature neonatal oxygen-induced retinopathy (OIR) model with or without fetal growth restriction. Methods: For comparison with normal birth-weight neonates, maternal low-protein diet-induced FGR neonates were subjected to fluctuating oxygen levels to generate oxygen-induced retinopathy. The retinal neovasculature was histologically evaluated, and comprehensive transcriptome analysis was conducted. Results: Compared to OIR neonates with normal birth weight, significant amelioration of the neovasculature, as indicated by decreases in the number of branch junctions, vascular distribution, maximal vascular radius and microaneurysm-like tufts, was observed in OIR mice with FGR. The results of retinal RNA-sequencing revealed downregulation of angiogenic factors that trigger pathological retinal neovascularization, such as the mitogen-activated protein kinase pathway and corresponding upstream signaling pathways in OIR mice with FGR. Conclusion: Our findings demonstrated that FGR neonates have a higher capacity for retinal oxygen stress, and the risk of OIR development is attenuated compared to that in mature neonates with normal birth weight.
Collapse
Affiliation(s)
- Ryusuke Watanabe
- Department of Pharmacology, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
- Department of Pediatrics, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
| | - Shuang Liu
- Department of Pharmacology, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
| | - Tomohisa Sakaue
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
- Department of Cell Growth and Tumor Regulation, Proteo-Science Center (PROS), Matsuyama, Ehime, Japan
| | - Yasuhito Ikegawa
- Department of Pharmacology, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
| | - Masaaki Ohta
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
| | - Takashi Higaki
- Department of Regional Child Health Care, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
| | - Masaki Mogi
- Department of Pharmacology, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
| | - Mariko Eguchi
- Department of Pediatrics, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan
| |
Collapse
|
4
|
Zhou HP, Hashimoto Y, Araki F, Sugimoto K, Nagahara M, Matsui H, Fushimi K, Yasunaga H, Aihara M, Toyama T, Ueta T. RECENT TRENDS IN THE CUMULATIVE INCIDENCE AND INTERVENTION PATTERNS OF RETINOPATHY OF PREMATURITY IN JAPAN: A Multicenter Analysis, 2011-2020. Retina 2024; 44:295-305. [PMID: 37903446 DOI: 10.1097/iae.0000000000003970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE To investigate recent trends in the cumulative incidence and treatment patterns of retinopathy of prematurity (ROP) in Japan. METHODS A retrospective multicenter cohort was conducted from 2011 to 2020 using the Diagnosis Procedure Combination inpatient database. Preterm newborns with birth weight <2,500 g were categorized by birth weight. The cumulative incidence of ROP, treatment patterns, and association between treatment and birth weight were investigated. RESULTS A total of 82,683 preterm infants were identified, of whom 9,335 (11.3%) were diagnosed with ROP. The cumulative incidence of ROP increased by 15% in those with birth weight <500 g over the study period. Among the ROP infants, 20.2% received treatment, including laser photocoagulation (94.8%), intravitreal injection (3.8%), or both (1.8%). The proportion receiving laser photocoagulation decreased followed by an increase in intravitreal injection. This shift in intervention pattern was most conspicuous for those with birth weight 750 to 1,249 g. The risk ratio of receiving laser and intravitreal injection for those weighing <500 g was 24.7 (95% confidence interval, 10.5-58.2) and 28.4 (5.8-138.1), respectively, as compared with infants weighing >1,500 g. CONCLUSION The cumulative incidence of ROP increased in infants with birth weight <500 g. A shift from laser photocoagulation to intravitreal injection was observed in the more recent years.
Collapse
Grants
- 21AA2007 Ministry of Health, Labor, and Welfare, Japan
- 22AA2003 Ministry of Health, Labor, and Welfare, Japan
- 20H03907 Ministry of Education, Culture, Sports, Science, and Technology, Japan
Collapse
Affiliation(s)
- Han Peng Zhou
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; and
| | - Fumiyuki Araki
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Koichiro Sugimoto
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masako Nagahara
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; and
| | - Kiyohide Fushimi
- Health Policy and Informatics Section, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; and
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Taku Toyama
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
5
|
Avena-Zampieri CL, Hutter J, Uus A, Deprez M, Payette K, Hall M, Bafadhel M, Russell REK, Milan A, Rutherford M, Shennan A, Greenough A, Story L. Functional MRI assessment of the lungs in fetuses that deliver very Preterm: An MRI pilot study. Eur J Obstet Gynecol Reprod Biol 2024; 293:106-114. [PMID: 38141484 PMCID: PMC10929943 DOI: 10.1016/j.ejogrb.2023.12.015] [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: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES To compare mean pulmonary T2* values and pulmonary volumes in fetuses that subsequently spontaneously delivered before 32 weeks with a control cohort with comparable gestational ages and to assess the value of mean pulmonary T2* as a predictor of preterm birth < 32 weeks' gestation. METHODS MRI datasets scanned at similar gestational ages were selected from fetuses who spontaneously delivered < 32 weeks of gestation and a control group who subsequently delivered at term with no complications. All women underwent a fetal MRI on a 3 T MRI imaging system. Sequences included T2-weighted single shot fast spin echo and T2* sequences, using gradient echo single shot echo planar sequencing of the fetal thorax. Motion correction was performed using slice-to-volume reconstruction and T2* maps generated using in-house pipelines. Lungs were manually segmented and volumes and mean T2* values calculated for both lungs combined and left and right lung separately. Linear regression was used to compare values between the preterm and control cohorts accounting for the effects of gestation. Receiver operating curves were generated for mean T2* values and pulmonary volume as predictors of preterm birth < 32 weeks' gestation. RESULTS Datasets from twenty-eight preterm and 74 control fetuses were suitable for analysis. MRI images were taken at similar fetal gestational ages (preterm cohort (mean ± SD) 24.9 ± 3.3 and control cohort (mean ± SD) 26.5 ± 3.0). Mean gestational age at delivery was 26.4 ± 3.3 for the preterm group and 39.9 ± 1.3 for the control group. Mean pulmonary T2* values remained constant with increasing gestational age while pulmonary volumes increased. Both T2* and pulmonary volumes were lower in the preterm group than in the control group for all parameters (both combined, left, and right lung (p < 0.001 in all cases). Adjusted for gestational age, pulmonary volumes and mean T2* values were good predictors of premature delivery in fetuses < 32 weeks (area under the curve of 0.828 and 0.754 respectively). CONCLUSION These findings indicate that mean pulmonary T2* values and volumes were lower in fetuses that subsequently delivered very preterm. This may suggest potentially altered oxygenation and indicate that pulmonary morbidity associated with prematurity has an antenatal antecedent. Future work should explore these results correlating antenatal findings with long term pulmonary outcomes.
Collapse
Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Maria Deprez
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Kelly Payette
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Megan Hall
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Mona Bafadhel
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Richard E K Russell
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Andrew Shennan
- Department of Women and Children's Health King's College London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health King's College London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| |
Collapse
|
6
|
Dammann O, Stansfield BK. Neonatal sepsis as a cause of retinopathy of prematurity: An etiological explanation. Prog Retin Eye Res 2024; 98:101230. [PMID: 37984792 PMCID: PMC10842718 DOI: 10.1016/j.preteyeres.2023.101230] [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: 03/17/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
Retinopathy of prematurity (ROP) is a complex neonatal disorder with multiple contributing factors. In this paper we have mounted the evidence in support of the proposal that neonatal sepsis meets all requirements for being a cause of ROP (not a condition, mechanism, or even innocent bystander) by means of initiating the early stages of the pathomechanism of ROP occurrence, systemic inflammation. We use the model of etiological explanation, which distinguishes between two overlapping processes in ROP causation. It can be shown that sepsis can initiate the early stages of the pathomechanism via systemic inflammation (causation process) and that systemic inflammation can contribute to growth factor aberrations and the retinal characteristics of ROP (disease process). The combined contribution of these factors with immaturity at birth (as intrinsic risk modifier) and prenatal inflammation (as extrinsic facilitator) seems to provide a cogent functional framework of ROP occurrence. Finally, we apply the Bradford Hill heuristics to the available evidence. Taken together, the above suggests that neonatal sepsis is a causal inducer of ROP.
Collapse
Affiliation(s)
- Olaf Dammann
- Dept. of Public Health & Community Medicine, Tufts University School of Medicine, Boston, USA; Dept. of Gynecology & Obstetrics, Hannover Medical School, Hannover, Germany; Dept. of Neuromedicine & Movement Science, Norwegian University of Science & Technology, Trondheim, Norway; Dept. of Philosophy, University of Johannesburg, Johannesburg, South Africa.
| | | |
Collapse
|
7
|
Denier M, Kermorvant-Duchemin E, Barjol A, Caputo G, Chapron T. Retinal detachment following retinopathy of prematurity in France: Screening and treatment pathways. Acta Paediatr 2023; 112:2516-2521. [PMID: 37681343 DOI: 10.1111/apa.16970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
AIM Preterm children are highly vulnerable to sensorial impairments through Retinopathy Of Prematurity (ROP). The objective was to determine whether some cases of ROP requiring surgery could be secondary to deficiencies in care pathways. METHODS Descriptive study of neonatal characteristics and the screening/treatment pathways of children treated for stage ≥4A ROP from 2009 to 2020 in a referral unit in France. RESULTS Twenty-five preterm children (44 eyes) were included: median gestational age was 25 weeks, and median birthweight was 700 grams. Eighty-four per cent had received at least one fundus examination, 50% of which were completed on time. At the time of retinal detachment diagnosis, only 36% of the children had received laser or anti-vascular endothelial growth factor (VEGF) intra-vitreal injection. ROP stage was only reported in 8%, and the zone or type was reported in 16% of the files. CONCLUSION The risk of blindness and the effectiveness of laser or anti-VEGF treatment highlight the need to enhance screening and treatment practices in France.
Collapse
Affiliation(s)
- Margot Denier
- Pediatric Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Elsa Kermorvant-Duchemin
- Department of Neonatal Medicine and Université Paris Cité, AP-HP, Necker-Enfants Malades University Hospital, Paris, France
| | - Amandine Barjol
- Pediatric Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Georges Caputo
- Pediatric Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Thibaut Chapron
- Pediatric Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université Paris Cité, Paris, France
| |
Collapse
|
8
|
Zhang Y, Chai X, Fan Z, Zhang S, Zhang G. Research hotspots and trends in retinopathy of prematurity from 2003 to 2022: a bibliometric analysis. Front Pediatr 2023; 11:1273413. [PMID: 37854031 PMCID: PMC10579817 DOI: 10.3389/fped.2023.1273413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
Background In order to understand the research hotspots and trends in the field of retinopathy of prematurity (ROP), our study analyzed the relevant publications from 2003 to 2022 by using bibliometric analysis. Methods The Citespace 6.2.R3 system was used to analyze the publications collected from the Web of Science Core Collection (WoSCC) database. Results In total, 4,957 publications were included in this study. From 2003 to 2022, the number of publications gradually increased and peaked in 2022. The United States was the country with the most publications, while Harvard University was the most productive institution. The top co-cited journal PEDIATRICS is published by the United States. Author analysis showed that Hellström A was the author with the most publications, while Good WV was the top co-cited author. The co-citation analysis of references showed seven major clusters: genetic polymorphism, neurodevelopmental outcome, threshold retinopathy, oxygen-induced retinopathy, low birth weight infant, prematurity diagnosis cluster and artificial intelligence (AI). For the citation burst analysis, there remained seven keywords in their burst phases until 2022, including ranibizumab, validation, trends, type 1 retinopathy, preterm, deep learning and artificial intelligence. Conclusion Intravitreal anti-vascular endothelial growth factor therapy and AI-assisted clinical decision-making were two major topics of ROP research, which may still be the research trends in the coming years.
Collapse
Affiliation(s)
- Yulin Zhang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Xiaoyan Chai
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Zixin Fan
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Sifan Zhang
- Department of Biology, New York University, New York, NY, United States
| | - Guoming Zhang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| |
Collapse
|
9
|
Youn YA, Kim SY, Cho SJ, Chang YS, Miyake F, Kusuda S, Iskandar ATP, Rohsiswatmo R, Dewi R, Chee SC, Neoh SH, Imperial MLS, Velasco BAE, Quek BH, Lin YJ, Chang JH, Nuntnarumit P, Ngerncham S, Supapannachart S, Ozawa Y, Tomotaki S, Prempunpong C, Prempraphan P, Isayama T. Variations in medical practice of retinopathy of prematurity among 8 Asian countries from an international survey. Sci Rep 2023; 13:15602. [PMID: 37730731 PMCID: PMC10511409 DOI: 10.1038/s41598-023-42432-3] [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: 06/16/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
Advances in perinatal care have led to the increased survival of preterm infants with subsequent neonatal morbidities, such as retinopathy of prematurity (ROP). This study aims to compare the differences of neonatal healthcare systems, resources, and clinical practice concerning ROP in Asia with review of current literature. An on-line survey at the institutional level was sent to the directors of 336 neonatal intensive care units (NICU) in 8 collaborating national neonatal networks through the Asian Neonatal Network Collaboration (AsianNeo). ROP screening was performed in infants born at < 34 weeks in Indonesia and Japan. In South Korea, Malaysia, and Taiwan, most screened for ROP in infants born at < 32 weeks. In all networks, majority of NICUs conducted ROP screening to infants with birth weight < 1500 g. In most NICU's in-hospital ophthalmologists performed indirect ophthalmoscopy and some were supplemented with digital imaging. Both laser photocoagulation and anti-vascular endothelial growth factor injection are performed for treatment and, vitreous surgeries are conducted less frequently in all countries. Despite limited information collected by the survey, this first study to compare ROP practices implemented in eight Asian countries through AsianNeo will enable an understanding of the differences and facilitate quality improvement by sharing better practices.
Collapse
Affiliation(s)
- Young-Ah Youn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sae Yun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University College of Medicine, 1071 AnYang Cheon-ro, YangCheon-gu, Seoul, 07985, Republic of Korea.
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Fuyu Miyake
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Neonatal Research Network of Japan, Kyorin University, Tokyo, Japan
| | - Adhi Teguh Perma Iskandar
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rinawati Rohsiswatmo
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rizalya Dewi
- Budhi Mulia Mother and Child Hospital, Pekanbaru, Indonesia
| | - Seok Chiong Chee
- Department of Pediatrics, Selayang Hospital, Ministry of Health, Batu Caves, Kuala Lumpur, Malaysia
| | - Siew Hong Neoh
- Department of Paediatrics, Hospital Tunku Azizah, Ministry of Health, Kuala Lumpur, Malaysia
| | | | | | - Bin Huey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Yuh-Jyh Lin
- Department of Pediatrics, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Pracha Nuntnarumit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sopapan Ngerncham
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarayut Supapannachart
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yuri Ozawa
- Division of Neonatology, National Center for Child Health and Development, Department of Pediatrics, Kyorin University, Tokyo, Japan
| | - Seiichi Tomotaki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chatchay Prempunpong
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pathaporn Prempraphan
- Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
10
|
Aggarwal V, Bhatia R, Tan K. Oxygen saturation levels and retinopathy of prematurity in extremely preterm infants - a case control study. BMC Pediatr 2023; 23:449. [PMID: 37684577 PMCID: PMC10486104 DOI: 10.1186/s12887-023-04278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE To investigate the association of risk factors, including oxygen exposure, for developing retinopathy of prematurity (ROP) in preterm infants at increased risk of ROP. METHODS A case-control study was conducted where each infant born at < 28 weeks gestation with ROP was matched with another without ROP over five years (July 2015 - June 2020). Clinical information about the infants was collected from electronic medical records, including method of oxygen delivery, oxygen saturation (SpO2), fraction of inspired oxygen (FiO2) and mean airway pressure (MAP) measurements. MATLAB was used for a time-averaged analysis. Stata/SE 16.0 was used for statistical analysis. RESULTS 123 ROP/non-ROP pairs were included in this study. The time-averaged SpO2 analysis showed non-ROP group spent more time in hyperoxia than the ROP group (p < 0.001). The non-ROP group had lower respiratory severity scores and analysis when FiO2 > 21% showed that were was no difference in SpO2 between the two groups when the infants were receiving oxygen support. Conditional logistic regressions showed neonatal surgery significantly increased the risk of ROP (OR = 1.4347, p = 0.010), while the influence of birthweight (odds ratio of 0.9965, p = 0.001) and oxygen exposure (OR = 0.9983, p = 0.012) on ROP outcome was found to be negligible as their odds ratios indicated no influence. CONCLUSIONS At times when infants were receiving respiratory support (FiO2 > 21%) the SpO2 data indicated no difference in SpO2 between the ROP and non-ROP groups. Analysis of clinical variables found that neonatal surgery increased the odds of developing ROP.
Collapse
Affiliation(s)
- Varnika Aggarwal
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Risha Bhatia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Monash Health, Monash Newborn, Melbourne, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Melbourne, Australia.
- Monash Health, Monash Newborn, Melbourne, Australia.
| |
Collapse
|
11
|
Trzcionkowska K, Termote JUM, van Genderen MM, de Vries MJ, van Sorge AJ, Schalij-Delfos NE. Visual impairment due to retinopathy of prematurity and concomitant disabilities in the Netherlands. Early Hum Dev 2023; 182:105793. [PMID: 37263155 DOI: 10.1016/j.earlhumdev.2023.105793] [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: 04/04/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
AIM Determine incidence of visual impairment due to retinopathy of prematurity (ROP) and concomitant disabilities between 2009 and 2018 in the Netherlands and compare data to four former similar studies. Secondly, monitor if infants were missed for ROP-screening since the adoption of stricter, risk factor guided criteria (2013). METHODS Retrospective inventory on anonymous data of infants diagnosed with ROP from Dutch visual impairment-institutes. Data including: best corrected visual acuity, ROP-treatment and concomitant disabilities: bronchopulmonary dysplasia, behavioral abnormalities, epilepsy, hearing deficit, developmental delay, cerebral palsy and cerebral visual impairment. During the study period, lower age limit for neonatal life support (2010) and higher oxygen saturation targets (2014) were implemented. RESULTS Records of 53 infants were analyzed. Visual impairment incidence due to ROP was 2.02 per 100.000 live births (2000-2009: 1.84, p = 0.643). Compared to earlier periods (1975-2000), a significant decrease was observed. The incidence of concomitant disabilities remained stable. Mean gestational age (GA) continued to decrease to 26.6 ± 1.9 weeks (2000-2009: 27.4 ± 2.0 weeks, p = 0.047). All patients met the screening inclusion criteria. CONCLUSION The incidence of visual impairment due to ROP and concomitant disabilities between 2009 and 2018 has not increased, despite lower GA and higher oxygen saturation targets. None of the infants were missed for ROP screening following introduction of more restricted screening inclusion criteria.
Collapse
Affiliation(s)
| | | | - Maria M van Genderen
- Bartiméus Diagnostic Centre for Complex Visual Disorders, Zeist, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands.
| | - Meindert J de Vries
- Royal Dutch Visio Centre of Expertise for Blind and Partially Sighted People, Amsterdam, Netherlands; University Hospital Antwerpen, Edegem, Belgium.
| | - Arlette J van Sorge
- Royal Dutch Visio Centre of Expertise for Blind and Partially Sighted People, Amsterdam, Netherlands.
| | | |
Collapse
|
12
|
Desurmont MG, Bremond-Gignac D, Torchin H, Vacherot B, Jarreau PH, Daruich A. Retinopathy of prematurity detection: a retrospective quality improvement project before-after implementation of retinal digital imaging for screening. Eur J Pediatr 2023:10.1007/s00431-023-04951-z. [PMID: 37076746 DOI: 10.1007/s00431-023-04951-z] [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: 01/24/2023] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023]
Abstract
Screening of retinopathy of prematurity (ROP) was modified in a level-3 neonatal intensive care unit by the introduction of a wide-field retinal imaging. The aim of this study was to evaluate whether retinopathy of prematurity (ROP) diagnosis was improved or not compared to previously used binocular indirect ophthalmoscopy (BIO). This was a retrospective, uncontrolled, quality improvement project. Records of consecutive premature newborns screened for ROP over two 1-year periods were reviewed. Systemic factors potentially influencing the occurrence of ROP were investigated using uni- and multivariable linear regression followed by stepwise forward regression. ROP screening was performed by ophthalmologists using BIO in 2014, and digital wide-field retinal imaging (Panocam™ pro) in 2019. Records of N = 297 patients were analyzed (N = 159 in 2014 and N = 138 in 2019). The proportion of ROP diagnosed at any stage, over the total number of neonates screened, was significantly higher in 2019 (n = 46/138, 33.1%) compared to 2014 (n = 11/159, 6.9%) (p < 0.0001). Most neonates presented with mild forms of ROP during both 1-year periods analyzed. After adjustment for all parameters influencing ROP occurrence, the variables contributing independently to the diagnosis of any stage of ROP were birth weight (p = 0.002), duration of mechanical ventilation (p = 0.028) and wide-field fundus camera-assisted screening (p < 0.001). CONCLUSION After adjusting for many recognized systemic factors influencing the development of ROP, screening by wide-field digital retinal imaging was independently associated with higher ROP detection. WHAT IS KNOWN • No consensus has been reached to replace binocular indirect ophthalmoscopy by retinal imaging for ROP screening. • Diagnostic accuracy and high sensitivity and specificity has been reported for wide-field digital imaging. WHAT IS NEW • The introduction of wide-field imaging for ROP screening in at level-3 reference center was independently associated to higher ROP detection.
Collapse
Affiliation(s)
- Marie-Gwenola Desurmont
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, 149 Rue de Sèvres, 75015, Paris, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, 149 Rue de Sèvres, 75015, Paris, France
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France
| | - Héloïse Torchin
- Neonatology Intensive Care Unit of Port-Royal, AP-HP.Centre Université de Paris Cochin Hospital, FHU Prema, Paris, France
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPe, INSERM U1153, Paris University, Paris, France
| | - Brigitte Vacherot
- Neonatology Intensive Care Unit of Port-Royal, AP-HP.Centre Université de Paris Cochin Hospital, FHU Prema, Paris, France
| | - Pierre-Henri Jarreau
- Neonatology Intensive Care Unit of Port-Royal, AP-HP.Centre Université de Paris Cochin Hospital, FHU Prema, Paris, France
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPe, INSERM U1153, Paris University, Paris, France
| | - Alejandra Daruich
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, 149 Rue de Sèvres, 75015, Paris, France.
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France.
| |
Collapse
|
13
|
Srimanan W, Kitsirilarp W. The incidence and risk factors associated with the retinopathy of prematurity in a tertiary hospital using 10-year retrospective data. ANNALS OF CLINICAL EPIDEMIOLOGY 2023; 5:80-87. [PMID: 38504725 PMCID: PMC10944979 DOI: 10.37737/ace.23011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND The study aimed to examine the incidence and risk factors associated with retinopathy of prematurity at Phramongkutklao Hospital. METHODS A retrospective review was conducted on the medical records of premature infants screened for retinopathy of prematurity between January 2011 and December 2021. The screening examination was performed on infants who met the screening criteria, and retinopathy of prematurity was diagnosed according to the International Classification of Retinopathy of Prematurity. Maternal, obstetric, neonatal, and medical data were retrieved. Logistic regression analysis was used to identify the risk factors associated with retinopathy of prematurity. RESULTS A total of 403 premature infants were screened. The mean ± SD birth weight and gestational ages were 1,538 ± 543 grams and 31 ± 3 weeks, respectively. The incidence of any retinopathy of prematurity and stages 2 and 3 were 13.6%, 3.5%, and 10.1%, respectively. Multiple logistic regression analysis demonstrated that gestational age (adjusted odds ratio = 1.98, 95% CI:1.15-3.39), low birth weight (adjusted odds ratio = 0.99, 95% CI: 0.99-1.00), and phototherapy (adjusted odds ratio = 0.41, 95% CI: 0.17-1.00) were significant factors associated with the development of retinopathy of prematurity, after controlling for other confounding factors. CONCLUSIONS The incidence of total retinopathy of prematurity cases in this population was 13.6%. Overall, retinopathy of prematurity cases classified as stage 2 equated to 3.5% and stage 3 to 4.1%. Our data suggest that factors associated with retinopathy of prematurity consist of birth weight, gestational age, and phototherapy.
Collapse
|
14
|
Hawn VS, Muhtadi R, Suman P, Latuga MS, Quinn G, Mian U. Premature infants with gestational age less than 25 weeks require increased ophthalmology resources for retinopathy of prematurity. J AAPOS 2022; 26:307.e1-307.e5. [PMID: 36404441 DOI: 10.1016/j.jaapos.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND It is unclear how increasing survival of low gestational age (GA) infants affects ophthalmologic screening and treatment rates for retinopathy of prematurity (ROP). This study compared the examination and treatment rates of infants born at GA of <25 weeks and those born at GA of at least 25 weeks. METHODS This was a retrospective study of patients who met institutional ROP screening criteria and were admitted to two neonatal intensive care units (NICUs) from January 2017 to June 2020. Variables analyzed were GA, birth weight, number of ophthalmology examinations, worst stage of ROP, presence of type 1 ROP, and comorbidities associated with ROP. The χ2, Fisher exact, and two-tailed t tests, as well as univariate and multivariable logistic regression, were used for statistical analysis. RESULTS Compared to the GA≥25 group, the GA<25 group had a higher number of total exams (10 vs 4.3 [P < 0.001]), higher average worst stage of ROP (1.4 vs 0.3 [P < 0.001]) and higher rate of type 1 ROP (21% vs 1.4% [P < 0.001]), as well as higher mortality (37% vs 8.11% [P < 0. 001]). Multivariable logistic regression analysis controlling for GA, sepsis, and number of transfusions revealed that only GA was significantly associated with developing type 1 ROP. CONCLUSIONS Infants with GA <25 weeks had more severe ROP and required significantly more ophthalmologic examinations than GA ≥25. It is important for ROP services to plan for this increased screening load, especially if the number of such lower-weight infants in their NICUs increases.
Collapse
Affiliation(s)
- Vivian S Hawn
- Albert Einstein College of Medicine, Bronx, New York
| | - Rakin Muhtadi
- Albert Einstein College of Medicine, Bronx, New York
| | - Pamela Suman
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Mariam S Latuga
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Graham Quinn
- Division of Ophthalmology, Children's Hospital of Pennsylvania, Philadelphia
| | - Umar Mian
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York.
| |
Collapse
|
15
|
Trends in Retinopathy of Prematurity Care in the US 2009-2018: A Nationwide Analysis using National Inpatient Sample. Ophthalmol Retina 2022; 7:360-366. [PMID: 36280204 DOI: 10.1016/j.oret.2022.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Retinopathy of prematurity (ROP) represents a leading cause of childhood blindness. The purpose of our study was to evaluate incidence, trends in cost and length of hospital stay, and risk factors for ROP using a publicly available population-based dataset, the National Inpatient Sample. DESIGN This cross-sectional study analyzed data from 2009 to 2018 using the National Inpatient Sample. PARTICIPANTS Premature neonates (n = 717 277) who met the screening criteria for ROP with gestational age of ≤ 30 weeks or birthweight (BW) of ≤ 1500 g were identified. METHODS Database analysis. MAIN OUTCOME MEASURES Incidence, demographics, risk factors for ROP development, trends in cost, and length of stay were evaluated. RESULTS In total, incidence of ROP increased from 11% in 2009 to 15% in 2018 (P < 0.001). Multivariate logistic regression model of ROP development showed its associations with female sex (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.10-1.17), Hispanic (OR, 1.10; 95% CI, 1.03-1.18), and Black (OR, 0.91; 95% CI 0.86-0.96) ethnicity. Neonates with lower BWs, particularly those in the 500- to 999-g subgroup (OR, 2.64; 95% CI, 2.44-2.85) and younger gestational ages, particularly those born between 25 and 28 weeks gestational age (OR, 2.41; 95% CI, 2.25-2.58), had increased risk of developing ROP. Comorbidities associated with the development of ROP were perinatal jaundice (OR, 1.84; 95% CI, 1.74-1.94), patent ducts arteriosus (OR, 1.67; 95% CI, 1.60-1.75), intraventricular hemorrhage (OR, 1.41; 95% CI, 1.35-1.48), perinatal infection (OR, 1.84; 95% CI, 1.74-1.94), and respiratory distress syndrome (OR, 1.05; 95% CI, 1.01-1.10). CONCLUSIONS Retinopathy of prematurity develops in about 1 of 10 premature infants and incidence has been shown to be increasing. Significant risk factors were female sex, Hispanic ethnicity, lower BW, younger gestational age, and systemic comorbidities, including perinatal jaundice, patent ductus arteriosus, intraventricular hemorrhage, perinatal sepsis, and respiratory distress syndrome. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Zhou TE, Kassis PO, Qian C, Bérubé-Thevenet R, Chappaz A, Hamel P, Chemtob S, Nuyt AM, Luu TM. Reduced Contrast Sensitivity in Young Adults Who Had Retinopathy of Prematurity. Ophthalmol Retina 2022; 6:744-746. [PMID: 35430418 DOI: 10.1016/j.oret.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Tianwei Ellen Zhou
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Cynthia Qian
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Ophthalmology, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | | | - Ariane Chappaz
- Department of Ophthalmology, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | - Patrick Hamel
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Ophthalmology, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | - Sylvain Chemtob
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Ophthalmology, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada; Department of Pediatrics, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | - Anne-Monique Nuyt
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Pediatrics, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Pediatrics, CHU Sainte-Justine Hospital and Research Center, Montreal, Quebec, Canada.
| |
Collapse
|
18
|
Chow SC, Lam PY, Lam WC, Fung NSK. The role of anti-vascular endothelial growth factor in treatment of retinopathy of prematurity-a current review. Eye (Lond) 2022; 36:1532-1545. [PMID: 35017699 PMCID: PMC9307789 DOI: 10.1038/s41433-021-01922-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/27/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022] Open
Abstract
The review aims to evaluate the uses of conventional laser therapy and intravitreal injection of various anti-VEGF in terms of efficacy and side effects for the treatment of retinopathy of prematurity. A literature search of the publication, concerning conventional laser treatment and intravitreal injection of anti-VEGF for ROP. A total of 40 articles were reviewed after curation by the authors for relevance. Intravitreal anti-VEGF showed better ocular efficacy in zone I ROP while laser therapy had a lower recurrence rate in zone II. Comparing the two mainstay anti-VEGF agents, bevacizumab showed lower ROP recurrence rate than ranibizumab. Anti-VEGF has a higher chance in developing persistent peripheral avascularisation compared to conventional laser therapy, but a lower chance of developing high myopia. Ranibizumab has a lower systemic absorption than bevacizumab, despite having no difference in the incidence of persistent peripheral avascularisation. In conclusion, it is advised that intravitreal anti-VEGF should be used as the first-line treatment for zone I ROP while laser therapy should be the mainstay for zone II ROP owing to the different pathogenetic mechanisms. In patients with recurrence after initial anti-VEGF injection, that given ranibizumab may opt to repeat the injection while that given bevacizumab should consider supplement laser ablative treatment.
Collapse
Affiliation(s)
- Shing Chuen Chow
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pun Yuet Lam
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Ching Lam
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Queen Mary Hospital & Grantham Hospital, Pok Fu Lam, Hong Kong
| | - Nicholas Siu Kay Fung
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Queen Mary Hospital & Grantham Hospital, Pok Fu Lam, Hong Kong.
| |
Collapse
|
19
|
Hawn VS, Muhtadi R, Oliviera J, Suman P, Quinn G, Mian U. The time and financial ramifications of providing services for retinopathy of prematurity at a single inner-city institution in the United States: a pilot study. J AAPOS 2022; 26:135.e1-135.e4. [PMID: 35550860 DOI: 10.1016/j.jaapos.2022.02.008] [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: 09/04/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a sight-threatening disease that requires strict, scheduled screening and timely treatment. Examining infants in the neonatal intensive care unit (NICU) confers an added burden for ophthalmologists whose practices are predominantly outpatient. We sought to evaluate the time required for ROP services and to approximate compensation to better understand the implications of providing this crucial service. METHODS The ROP coordinator tracked the time ophthalmologists spent providing ROP services at two NICUs (2018-2020). Estimated revenue was calculated using Medicaid Current Procedural Terminology codes. Total ophthalmologist time was from NICU arrival to departure; travel time was estimated as 45 minutes. RESULTS The ophthalmologists cumulatively spent on average 98 and 108 hours yearly for screening only (SO) and screening plus treatment (ST), respectively; this increased to 164 and 181 hours yearly with travel time, respectively. Estimated annual Medicaid physician reimbursements were $15,246 ($156/hour) for SO and $19,184 for ST ($177/hour). Actual annual physician reimbursements were $39,655 ($405/hour) for SO and $53,385 for ST ($492/hour). With travel time, reimbursements decreased by about 40%. A hypothetical full-time ROP practice would generate annual physician salaries of $204,732 for SO and $232,807 for ST. With travel time, this decreases to $122,452 and $139,379, respectively. CONCLUSIONS Performing ROP services requires substantial time, especially when including travel among facilities. This study highlights the extensive requirements for the critical task of decreasing ROP blindness.
Collapse
Affiliation(s)
- Vivian S Hawn
- Albert Einstein College of Medicine, Bronx, New York
| | - Rakin Muhtadi
- Albert Einstein College of Medicine, Bronx, New York
| | - Jason Oliviera
- Department of Financial Planning, Montefiore Medical Center, Bronx, New York
| | - Pamela Suman
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Graham Quinn
- Division of Ophthalmology, Children's Hospital of Pennsylvania, Philadelphia
| | - Umar Mian
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York.
| |
Collapse
|
20
|
Yücel H, Sayın O. Evaluation of neonatal hearing screening results of newborns with premature retinopathy. Int J Pediatr Otorhinolaryngol 2022; 156:111112. [PMID: 35325847 DOI: 10.1016/j.ijporl.2022.111112] [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: 11/27/2021] [Revised: 01/29/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To reveal the risk situations of ROP patients in terms of hearing loss by examining the newborn hearing screening test results. METHODS Hearing screening test results of ROP patients and newborns with similar congenital risk factors(control group) treated in our hospital were retrospectively screened. Both groups were compared in terms of newborn hearing screening test results. RESULTS In the first screening test, the rate of ''refer'' result in the ROP group was significantly higher than the control group (p < 0.05). There was no significant difference between the two groups in terms of second hearing screening test results (p > 0.05). In the second screening test, 100% of stage 3 ROP patients failed from the right ear and 80% in the left ear, and this difference was statistically significant compared to the other two groups (p < 0.05). CONCLUSION Newborn hearing screenings of patients with advanced stage ROP patients should be followed up more sensitively, since stage 3 ROP patients had more failure results from the screening test in our study.
Collapse
Affiliation(s)
- Hilal Yücel
- Department of Otorhinolaryngology Head and Neck Surgery, Konya City Hospital, University of Health Sciences, Konya, Turkey.
| | - Osman Sayın
- Department of Eye Diseases, Konya Health Application and Research Hospital, University of Health Sciences, Konya, Turkey.
| |
Collapse
|
21
|
Hong EH, Shin YU, Cho H. Retinopathy of prematurity: a review of epidemiology and current treatment strategies. Clin Exp Pediatr 2022; 65:115-126. [PMID: 34645255 PMCID: PMC8898617 DOI: 10.3345/cep.2021.00773] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022] Open
Abstract
Retinopathy of prematurity (ROP) is among the most common causes of childhood blindness. Three phases of ROP epidemics have been observed worldwide since ROP was first described in the 1940s. Despite advances in neonatal care, the occurrence of ROP and associated visual impairment has been increasing somewhere on Earth and remains difficult to control. Conventional treatment options for preventing ROP progression include retinal ablation using cryotherapy or laser therapy. With the emergence of anti-vascular endothelial growth factor (anti-VEGF) treatment for ocular diseases, the efficacy and safety of anti-VEGF therapy for ROP have recently been actively discussed. In the advanced stage of ROP with retinal detachment, surgical treatment including scleral buckling or vitrectomy is needed to maintain or induce retinal attachment. At this stage, the visual outcome is usually poor despite successful anatomical retinal attachment. Therefore, preventing ROP progression by timely screening examinations and treatment remains the most important part of ROP management.
Collapse
Affiliation(s)
- Eun Hee Hong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
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
Collapse
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
| |
Collapse
|
23
|
Trzcionkowska K, Termote JU, Böhringer S, van Sorge AJ, Schalij-Delfos N. Nationwide inventory on retinopathy of prematurity screening in the Netherlands. Br J Ophthalmol 2021; 107:712-716. [PMID: 34893474 PMCID: PMC10176329 DOI: 10.1136/bjophthalmol-2021-319929] [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: 06/23/2021] [Accepted: 11/21/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Provide up-to-date insight in incidence of retinopathy of prematurity (ROP), logistics of screening and treatment in the Netherlands and influence of the new national ROP guideline in which more stringent screening criteria were implemented and the early treatment for ROP criteria (ETROP) were emphasised. METHODS Multicentre prospective nationwide study including all preterm infants, born in the Netherlands in 2017, and considered eligible for ROP screening. Anonymised data from ophthalmologists and paediatricians were merged. Outcome data were compared with the first national ROP inventory (NEDROP-1, 2009). RESULTS In 2017, 1492 infants were live born with gestational age (GA) <32 weeks (2009: 1662); 1287 infants were eligible for screening (2009: 2033). Ophthalmologists screened 1085 infants, versus 1688 in 2009, corrected with factor 1.114 for the difference in number of live births, a 28.4% (479/1688) decrease in screened infants was seen. Among surviving infants with GA <32 week, ROP was found in 305/1492 babies, 20.4% (2009: 324/1662, 19.5%) of which 49/1492 stage ≥3, 3.3% (2009: 30/1662, 1.8%). In all infants, report on presence or absence of plus disease was provided, according to the ETROP criteria. Treatment was performed in 39 infants. Of infants with ROP stage ≥3, 3/49 (6.1%) progressed to retinal detachment (2009: 6/30, 20.0%). CONCLUSION The overall ROP incidence expressed as a percentage, remained stable but the number of infants that developed severe ROP nearly doubled. A near one-third reduction in screened infants shows satisfactory implementation of the new screening criteria. A notable decrease in retinal detachment delineates improved treatment outcome.
Collapse
Affiliation(s)
| | - Jacqueline U Termote
- Neonatology, Wilhelmina Children's Hospital-University Medical Center, Utrecht, The Netherlands
| | - Stefan Böhringer
- Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | | | | |
Collapse
|
24
|
Xia F, Xu Y, Zhang X, Lyu J, Zhao P. Competing endogenous RNA network associated with oxygen-induced retinopathy: Expression of the network and identification of the MALAT1/miR-124-3p/EGR1 regulatory axis. Exp Cell Res 2021; 408:112783. [PMID: 34469714 DOI: 10.1016/j.yexcr.2021.112783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023]
Abstract
Retinopathy of prematurity (ROP) is a severe retinal dysfunction in prematurely born babies. The relationship between non-coding RNAs and retinopathy of prematurity (ROP) remain unclear. Microarray analysis of lncRNAs, miRNAs, and mRNAs was conducted in a mouse model of ROP. A competing endogenous RNA (ceRNA) network was constructed. The relationship among MALAT1, miR-124-3p, and Early growth response protein 1 (EGR1) was assessed in hypoxia-induced primary human umbilical vein endothelial cells (HUVECs) and ROP mouse model. In the study, we found 2252 lncRNAs, 1239 mRNAs, and 36 miRNAs were differentially regulated. ceRNA network consisting of 21 lncRNAs, 10 miRNAs, and 19 mRNAs was established. Of the most down-regulated miRNAs, miR-124-3p was selected for additional study. miR-124-3p ceased the migration and proliferation of primary HUVECs in hypoxic conditions, and directly suppressed EGR1. Additionally, MALAT1 directly sponged miR-124-3p. Knockdown of MALAT1 decreased EGR1 expression and inhibited the migration and proliferation of primary HUVECs in hypoxia. Furthermore, these changes were rescued by depletion of miR-124-3p. In vivo, intravitreal injection of miR-124-3p, shMALAT1 decreased EGR1 expression and markedly suppressed retinal neovascularization in OIR models. Intravitreal injection of shMALAT1 and miR-124-3p antagomir at the same time can promote retinal neovascularization, which reversed the suppression of retinal neovascularization functioned by shMALAT1. In conclusion, the expression profiles of lncRNAs and miRNAs and the ceRNA network in a mouse model of ROP may be indicative of the underlying mechanisms of retinal angiogenesis and neural activity. The MALAT1/miR-124-3p/EGR1 regulatory axis is partly responsible for retinal neovascularization, which may provide a novel theoretical basis for the pathogenesis of ROP.
Collapse
Affiliation(s)
- Fengjie Xia
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Yu Xu
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiang Zhang
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Jiao Lyu
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China.
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China.
| |
Collapse
|
25
|
Özdek Ş, Özmen MC, Yalınbaş D, Atalay HT, Coşkun D. Immediate Sequential Bilateral Vitrectomy Surgery for Retinopathy of Prematurity: A Single Surgeon Experience. Turk J Ophthalmol 2021; 51:225-230. [PMID: 34461709 PMCID: PMC8411288 DOI: 10.4274/tjo.galenos.2020.07377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: We report the safety and efficacy of simultaneous bilateral vitrectomy for stage 4 and stage 5 retinopathy of prematurity (ROP). Materials and Methods: Babies who had immediate sequential bilateral vitrectomy surgery for stage 4 or stage 5 ROP were included in this retrospective study. Clinical history, demographic characteristics of the patients, surgical procedure details, perioperative and postoperative ophthalmic and systemic complications, and postoperative anatomical success rates were evaluated. General anesthesia features were also recorded. Results: Seventy eyes of 35 babies who had immediate sequential bilateral vitrectomy surgery for stage 4 or stage 5 ROP were reviewed. At the time of surgery, the mean age was 41.4±4.9 weeks. There was preoperative plus disease in 58.6% of the eyes. The mean surgery/eye ratio was 1.2. Mean anesthesia time was 95±64 minutes. The mean follow-up was 28.1 months (3 to 84 months). Anatomical success was 95.7% for stage 4A (44/46 eyes), 83.3% for stage 4B (15/18 eyes), and 50% for stage 5 (3/6 eyes) ROP. Patients with stage 5 ROP had significantly less anatomical success than stage 4A and 4B (p=0.004). None of the patients had endophthalmitis and anesthesiarelated severe complications. Conclusion: Immediate sequential bilateral vitrectomy surgery can be considered an option for patients with active bilateral stage 4 and stage 5 ROP. The risk of endophthalmitis should be weighed against the risks of disease progression and anesthesia-related complications.
Collapse
Affiliation(s)
- Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Mehmet Cüneyt Özmen
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Duygu Yalınbaş
- Cumhuriyet University Faculty of Medicine, Department of Ophthalmology, Sivas, Turkey
| | - Hatice Tuba Atalay
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Demet Coşkun
- Gazi University Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey
| |
Collapse
|
26
|
Tekchandani U, Katoch D, Dogra MR. Five-year demographic profile of retinopathy of prematurity at a tertiary care institute in North India. Indian J Ophthalmol 2021; 69:2127-2131. [PMID: 34304192 PMCID: PMC8482912 DOI: 10.4103/ijo.ijo_132_21] [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] [Indexed: 12/01/2022] Open
Abstract
Purpose: The purpose of this study is to study the demographic profile and pattern of retinopathy of prematurity (ROP) at a tertiary care institute in India. Methods: An ambispective study from January 2013 to December 2017. Infants with birth weights (BWs) <1750 g and gestational ages <34 weeks were screened for ROP. Demographic details and ROP severity were recorded. Results: Data of 2595 of the 3697 infants screened were analyzed. The number of infants screened and treated for ROP increased from 190 and 29, respectively (2013), to 818 and 132, respectively (2017). The overall incidence of “any ROP” was 32.3%, and severe ROP was 17.7%. Though 39.5% of all infants were outborns (not born in the study center), severe ROP was present in 69.7% of these compared to 18.8% among inborns. Outborns with ROP had a higher mean BW (1308 g) compared to inborns (1202 g) (P < 0.01). ROP Stage 1 was seen in 12%, Stage 2 in 34%, Stage 3 in 13%, Stage 4 in 6%, Stage 5 in 14%, and aggressive posterior ROP (APROP) in 20%. APROP was seen in 16% of infants in 2013, 10% in 2014, 15% in 2015, 22% in 2016, and 28% in 2017. Infants with Stage 4B/Stage5 (15.6% of all ROP) were presented at a mean age of 7.5 months and all had no/delayed screening. Conclusion: Incidence of any ROP was 32.3% and was more common in outborns than inborns. The proportion of infants with APROP showed a rising trend over the years. Nearly 15.6% of infants were presented with stage4B/5 ROP due to delayed/absent screening.
Collapse
Affiliation(s)
- Uday Tekchandani
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
27
|
Risk Factors Associated with Retinopathy of Prematurity in Very and Extremely Preterm Infants. ACTA ACUST UNITED AC 2021; 57:medicina57050420. [PMID: 33925286 PMCID: PMC8146817 DOI: 10.3390/medicina57050420] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. We studied the relationship between different perinatal characteristics, i.e., sex; gestational age (GA); birth weight (BW); C-reactive protein (CRP) and lactate dehydrogenase (LDH) concentrations; ventilation, continuous positive airway pressure (CPAP), and surfactant administration; and the incidence of Stage 1–3 ROP. Materials and Methods: This study included 247 preterm infants with gestational age (GA) < 32 weeks that were successfully screened for ROP. Univariate and multivariate binary analyses were performed to find the most significant risk factors for ROP (Stage 1–3), while multivariate multinomial analysis was used to find the most significant risk factors for specific ROP stages, i.e., Stage 1, 2, and 3. Results: The incidence of ROP (Stage 1–3) was 66.40% (164 infants), while that of Stage 1, 2, and 3 ROP was 15.38% (38 infants), 27.53% (68 infants), and 23.48% (58 infants), respectively. Following univariate analysis, multiple perinatal characteristics, i.e., GA; BW; and ventilation, CPAP, and surfactant administration, were found to be statistically significant risk factors for ROP (p < 0.001). However, in a multivariate model using the same characteristics, only BW and ventilation were significant ROP predictors (p < 0.001 and p < 0.05, respectively). Multivariate multinomial analysis revealed that BW was only significantly correlated with Stage 2 and 3 ROP (p < 0.05 and p < 0.001, respectively), while ventilation was only significantly correlated with Stage 2 ROP (p < 0.05). Conclusions: The results indicate that GA; BW; and the use of ventilation, CPAP, and surfactant were all significant risk factors for ROP (Stage 1–3), but only BW and ventilation were significantly correlated with ROP and specific stages of the disease, namely Stage 2 and 3 ROP and Stage 2 ROP, respectively, in multivariate models.
Collapse
|
28
|
Mesenchymal stem cell-derived secretomes for therapeutic potential of premature infant diseases. Biosci Rep 2021; 40:222738. [PMID: 32320046 PMCID: PMC7953482 DOI: 10.1042/bsr20200241] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
Preterm birth is a complex syndrome and remains a substantial public health problem globally. Its common complications include periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). Despite great advances in the comprehension of the pathogenesis and improvements in neonatal intensive care and associated medicine, preterm birth-related diseases remain essentially without adequate treatment and can lead to high morbidity and mortality. The therapeutic potential of mesenchymal stem/stromal cells (MSCs) appears promising as evidenced by their efficacy in preclinical models of pathologies relevant to premature infant complications. MSC-based therapeutic efficacy is closely associated with MSC secretomes and a subsequent paracrine action response to tissue injuries, which are complex and abundant in response to the local microenvironment. In the current review, we summarize the paracrine mechanisms of MSC secretomes underlying diverse preterm birth-related diseases, including PVL, BPD, NEC and ROP, are summarized, and focus is placed on MSC-conditioned media (CM) and MSC-derived extracellular vesicles (EVs) as key mediators of modulatory action, thereby providing new insights for future therapies in newborn medicine.
Collapse
|
29
|
Jabroun MN, AlWattar BK, Fulton AB. Optical Coherence Tomography Angiography in Prematurity. Semin Ophthalmol 2021; 36:264-269. [PMID: 33689582 DOI: 10.1080/08820538.2021.1893760] [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] [Indexed: 10/22/2022]
Abstract
Purpose: During normal foveal development there is a close interaction between the neurosensory and vascular elements of the fovea making it vulnerable to prematurity and retinopathy of prematurity (ROP). We aim to assess this potential effect on foveal development in preterms evaluated simultaneously with both optical coherence tomography (OCT) and OCT angiography (OCTA).Method: Unrestricted literature search in the PubMed and Cochrane library databases yielded 20 distinct citations. Fifteen were relevant and reviewed.Results: In preterms, OCTA demonstrated a significant decrease in the foveal avascular zone area and an increase in foveal vessel density. OCT showed a decrease in foveal pit depth and an increase in the thickness of the subfoveal retinal layers. Some studies correlated these changes with reduced vision.Conclusion: Changes in the vascular and neurosensory retina were found in premature children. It remains unclear whether this is related to prematurity alone or ROP and its treatment.
Collapse
Affiliation(s)
- Mireille N Jabroun
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Bilal K AlWattar
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
30
|
Dericioğlu V, Butur S, Celiker H, Şahin Ö. Incidence, Risk Factors and Screening Evaluation of Retinopathy of Prematurity in High Birthweight Infants: A Large Cohort Study in Turkey. Ophthalmic Epidemiol 2021; 29:78-84. [PMID: 33682596 DOI: 10.1080/09286586.2021.1894582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To report and evaluate the incidence and risk factors of retinopathy of prematurity (ROP) and to assess the sensitivity and specificity of Turkish national screening guideline (NSG) in heavier infants with a birth weight (BW) of >1500 g.Methods: The data of 1784 preterm infants with BW>1500 g, who were screened between 2009 and 2016 in a university hospital in Turkey, were analyzed retrospectively. The rates of any stage and severe (treatment-requiring) ROP incidence were investigated. The possible protective and risk factors were evaluated with univariate analyses and logistic regression analysis.Results: The rate of any stage ROP was 14.1% (n = 251). Severe ROP was observed in 11 infants (0.6%), and 2 of the infants (0.1%) had a gestational age (GA)>32 weeks, which fell outside of the NSG. In logistic regression analysis, BW, GA, O2 therapy duration, and exchange transfusion were determined to be independent risk factors (respectively, p < .001, p < .001, P = .055, and P = .033). Furthermore, antenatal steroid therapy was determined to have a highly significant protective effect on ROP development (p < .001). The sensitivity of Turkish NSG in identifying severe ROP increased from 82% to 100% with the inclusion of risk factors in addition to GA and BW.Conclusion: This study shows the presence of severe ROP in mature and heavy infants in Turkey. The positive effect of antenatal steroid use and the negative impact of exchange transfusion have been demonstrated for ROP development in mature infants. Possible risk factors should be evaluated with GA and BW to avoid missing severe ROP.
Collapse
Affiliation(s)
- Volkan Dericioğlu
- Ophthalmology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Sedat Butur
- Ophthalmology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Hande Celiker
- Ophthalmology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Özlem Şahin
- Ophthalmology Department, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
31
|
Yılmaz FH, Tutar MS, Arslan D, Çeri A. Readability, understandability, and quality of retinopathy of prematurity information on the web. Birth Defects Res 2021; 113:901-910. [PMID: 33594835 DOI: 10.1002/bdr2.1883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/30/2021] [Accepted: 02/05/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The purpose of this study is to assess the readability, understandability, and quality of information on retinopathy of prematurity presented at websites frequently visited by parents. METHODS A total of 220 websites were assessed, which were recruited by searching for "retinopathy of prematurity" at the Google search engine. The readability of each web page was assessed by Flesch Reading Ease Score, Gobbledygook's Gunning Frequency, Flesch Kincaid Grade Level, Coleman Liau score, The Simple Measure of Gobbledygook, Fry Graph Readability Formula, and Automated readability score. The understandability of the web pages included in the study was measured by using the Patient Education Materials Assessment Tool. Quality was evaluated using Health in Net code and JAMA. The ALEXA traffic tool was used to reference the domains' popularity and visibility. RESULTS Sixty-four websites were included to the study. The average Flesch Reading Ease Score was 50.1 ± 11.4, Gunning Frequency of Gobbledygook level was 13.4 ± 2.5, The Flesch-Kincaid Grade level was 10.7 ± 2.2, Coleman Liau level was 10.8 ± 1.7, Simple Measure of Gobbledygook level was 10.0 ± 1.9, and Fry Graph Readability Formula 11.9 ± 2.7, Automated readability score 10.4 ± 2.5. The average understandability score for all website-based patient education materials was 76.9 ± 15.2. Total JAMA Benchmark score is 2.27 ± 1.14 (range from 1 to 4). The quality of information at most websites were determined by our chosen assessments to not to be good. CONCLUSION Websites addressed to parents for retinopathy of prematurity had found to have high understandability. It was concluded based on this study that readability and quality of presented written materials at online sources need to be improved.
Collapse
Affiliation(s)
- Fatma Hilal Yılmaz
- Department of Neonatology, Dr. Ali Kemal Belviranli Hospital for Obstetrics and Pediatrics, Konya, Turkey
| | - Mahmut Sami Tutar
- Department of Anesthesiology and Reanimation Clinic, Konya Numune Hospital, Konya, Turkey
| | - Derya Arslan
- Department of Pediatric Cardiology, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey
| | - Ayhan Çeri
- Department of Child Health and Disease, Dr. Ali Kemal Belviranli Hospital for Obstetrics and Pediatrics, Konya, Turkey
| |
Collapse
|
32
|
Trzcionkowska K, Vehmeijer WB, Kerkhoff FT, Bauer NJ, Bennebroek CA, Dijk PH, Dijkman KP, Dungen FA, Eggink CA, Feenstra RP, Groenendaal F, Heijst AF, Hoeven MA, Kornelisse RF, Kraal‐Biezen E, Lopriore E, Onland W, Renardel de Lavalette VW, Rijn LJ, Schuerman FA, Simonsz HJ, Voskuil‐Kerkhof ES, Witlox RS, Termote JU, Schalij‐Delfos NE. Increase in treatment of retinopathy of prematurity in the Netherlands from 2010 to 2017. Acta Ophthalmol 2021; 99:97-103. [PMID: 32701185 PMCID: PMC7891652 DOI: 10.1111/aos.14501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
Purpose Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods. Methods Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1‐1‐2010 to 31‐3‐2013 and P2: 1‐4‐2013 to 31‐12‐2016. Treatment characteristics, adherence to early treatment for ROP (ETROP) criteria, outcome of treatment and changes in neonatal parameters and policy of care were compared. Results Overall 196 infants were included, 57 infants (113 eyes) in P1 and 139 (275 eyes) in P2, indicating a 2.1‐fold increase in ROP treatment. No differences were found in mean gestational age (GA) (25.9 ± 1.7 versus 26.0 ± 1.7 weeks, p = 0.711), mean birth weight (791 ± 311 versus 764 ± 204 grams, p = 0.967) and other neonatal risk factors for ROP. In P2, the number of premature infants born <25 weeks increased by factor 1.23 and higher oxygen saturation levels were aimed at in most centres. At treatment decision, 59.6% (P1) versus 83.5% (P2) (p = 0.263) infants were classified as Type 1 ROP (ETROP classification). Infants were treated with laser photocoagulation (98 versus 96%) and intravitreal bevacizumab (2 versus 4%). Retreatment was necessary in 10 versus 21 (p = 0.160). Retinal detachment developed in 6 versus 13 infants (p = 0.791) of which 2 versus 6 bilateral (p = 0.599). Conclusion In period 2, the number of infants treated according to the ETROP criteria (Type 1) increased, the number of ROP treatments, retinal detachments and retreatments doubled and the absolute number of retinal detachments increased. Neonatal data did not provide a decisive explanation, although changes in neonatal policy were reported.
Collapse
Affiliation(s)
| | | | | | | | | | - Peter H. Dijk
- University Medical Center Groningen Groningen Netherlands
| | | | | | - Cathrien A. Eggink
- Radboud University Medical Center – Amalia Children’s Hospital Nijmegen Netherlands
| | | | | | - Arno F. Heijst
- Radboud University Medical Center – Amalia Children’s Hospital Nijmegen Netherlands
| | | | | | | | | | - Wes Onland
- Amsterdam University Medical Center Amsterdam Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Hong EH, Shin YU, Bae GH, Choi YJ, Ahn SJ, Sobrin L, Hong R, Kim I, Cho H. Nationwide incidence and treatment pattern of retinopathy of prematurity in South Korea using the 2007-2018 national health insurance claims data. Sci Rep 2021; 11:1451. [PMID: 33446899 PMCID: PMC7809441 DOI: 10.1038/s41598-021-80989-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/29/2020] [Indexed: 02/08/2023] Open
Abstract
The aim of this study is to investigate the nationwide incidence and treatment pattern of retinopathy of prematurity (ROP) in South Korea. Using the population-based National Health Insurance database (2007–2018), the nationwide incidence of ROP among premature infants with a gestational age (GA) < 37 weeks (GA < 28 weeks, GA28; 28 weeks ≤ GA < 37 weeks; GA28-37) and the percentage of ROP infants who underwent treatment [surgery (vitrectomy, encircling/buckling); retinal ablation (laser photocoagulation, cryotherapy)] were evaluated. We identified 141,964 premature infants, 42,300 of whom had ROP, with a nationwide incidence of 29.8%. The incidence of ROP in GA28 group was 4.3 times higher than in GA28-37 group (63.6% [2240/3522] vs 28.9% [40,060/138,442], p < 0.001). As for the 12-year trends, the incidence of ROP decreased from 39.5% (3308/8366) in 2007 to 23.5% (2943/12,539) in 2018. 3.0% of ROP infants underwent treatment (25.0% in GA28; 1.7% in GA28-37); 0.2% (84/42,300) and 2.9% (1214/42,300) underwent surgery and retinal ablation, respectively. The overall percentage of ROP infants who underwent treatment has decreased from 4.7% in 2007 to 1.8% in 2018. This first Korean nationwide epidemiological study of ROP revealed a decreased incidence of ROP and a decreased percentage of ROP infants undergoing conventional treatment during a 12-year period.
Collapse
Affiliation(s)
- Eun Hee Hong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Gi Hwan Bae
- Department of Occupational and Environment Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young Jin Choi
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Seong Joon Ahn
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Rimkyung Hong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Inah Kim
- Department of Occupational and Environment Medicine, Hanyang University College of Medicine, Seoul, Korea.
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea.
| |
Collapse
|
34
|
Park JY, Park CW, Moon KC, Park JS, Jun JK, Lee SJ, Kim JH. Retinopathy of prematurity in infants without fetal growth restriction is decreased with the progression of acute histologic chorioamnionitis: New observation as a protective factor against retinopathy of prematurity. Placenta 2020; 104:161-167. [PMID: 33348284 DOI: 10.1016/j.placenta.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION IGF-1 deficiency in prenatal period is known to be a definite pathophysiology of retinopathy of prematurity(ROP), which is more frequent in infants with fetal growth restriction(FGR). Of note, recent reports demonstrated intra-amniotic inflammation(IAI) closely linked to acute histologic chorioamnionitis(acute-HCA) is associated with a decrease in intact-form of IGFBP-1, ultimately rising the probability of an increase in IGF-1. Therefore, we hypothesized ROP in preterm-infants without FGR would be decreased with the progression of acute-HCA. METHODS The frequency of ROP was examined in 85 singleton preterm-infants(24.5weeks ≤ gestational-age[GA] at delivery<30weeks) due to either preterm-labor and intact-membranes(PTL) or preterm premature rupture of membranes(preterm-PROM) without FGR(birth-weight<5th percentile for GA). Patients were divided according to the progression of inflammation in extra-placental membranes(EPM) and the progression of inflammation in chorionic-vessel(CV) and umbilical-cord(UC). RESULTS 1) ROP was present in 40%(34/85) of study-population; 2) Of note, there was a significant stepwise-decrease in ROP with the progression of inflammation in EPM(inflammation-free EPM vs. inflammation restricted to CD vs. amnionitis; 55.6%[15/27]vs.39.5%[17/43]vs.13.3%[2/15]) and the progression of inflammation in CV and UC(inflammation-free CV and UC vs. inflammation restricted to CV and umbilical vessels vs. inflammation in Wharton's jelly[WJ]; 49.2%[29/59]vs.25.0%[3/12]vs.14.3%[2/14])(each-for P < 0.05, Chi-square test and each-for P < 0.01, linear-by-linear association); 3) Multiple logistic-regression analysis demonstrated amnionitis(Odds-Ratio 0.120, 95%Confidence-Interval 0.022-0.654, P = 0.014) and inflammation in WJ(Odds-Ratio 0.124, 95%Confidence-Interval 0.022-0.694, P = 0.018) were independent protective-factors against ROP. DISCUSSION ROP in preterm-infants due to PTL or preterm-PROM without FGR is decreased with the progression of acute-HCA. This finding may be an evidence to suggest the progression of acute-HCA is closely associated with reducing the pathophysiology of ROP.
Collapse
Affiliation(s)
- Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Reproductive Medicine and Population, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Reproductive Medicine and Population, Seoul National University Medical Research Center, Seoul, South Korea
| | - Seok Jae Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Hun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
35
|
Small-Molecule Modulation of PPARs for the Treatment of Prevalent Vascular Retinal Diseases. Int J Mol Sci 2020; 21:ijms21239251. [PMID: 33291567 PMCID: PMC7730325 DOI: 10.3390/ijms21239251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 02/08/2023] Open
Abstract
Vascular-related retinal diseases dramatically impact quality of life and create a substantial burden on the healthcare system. Age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity are leading causes of irreversible blindness. In recent years, the scientific community has made great progress in understanding the pathology of these diseases and recent discoveries have identified promising new treatment strategies. Specifically, compelling biochemical and clinical evidence is arising that small-molecule modulation of peroxisome proliferator-activated receptors (PPARs) represents a promising approach to simultaneously address many of the pathological drivers of these vascular-related retinal diseases. This has excited academic and pharmaceutical researchers towards developing new and potent PPAR ligands. This review highlights recent developments in PPAR ligand discovery and discusses the downstream effects of targeting PPARs as a therapeutic approach to treating retinal vascular diseases.
Collapse
|
36
|
Hombrebueno JR, Lynch A, Byrne EM, Obasanmi G, Kissenpfennig A, Chen M, Xu H. Hyaloid Vasculature as a Major Source of STAT3 + (Signal Transducer and Activator of Transcription 3) Myeloid Cells for Pathogenic Retinal Neovascularization in Oxygen-Induced Retinopathy. Arterioscler Thromb Vasc Biol 2020; 40:e367-e379. [PMID: 33115265 DOI: 10.1161/atvbaha.120.314567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Myeloid cells are critically involved in inflammation-induced angiogenesis, although their pathogenic role in the ischemic retina remains controversial. We hypothesize that myeloid cells contribute to pathogenic neovascularization in retinopathy of prematurity through STAT3 (signal transducer and activator of transcription 3) activation. Approach and Results: Using the mouse model of oxygen-induced retinopathy, we show that myeloid cells (CD45+IsolectinB4 [IB4]+) and particularly M2-type macrophages (CD45+ Arg1+), comprise a major source of STAT3 activation (pSTAT3) in the immature ischemic retina. Most of the pSTAT3-expressing myeloid cells concentrated at the hyaloid vasculature and their numbers were strongly correlated with the severity of pathogenic neovascular tuft formation. Pharmacological inhibition of STAT3 reduced the load of IB4+ cells in the hyaloid vasculature and significantly reduced the formation of pathogenic neovascular tufts during oxygen-induced retinopathy, leading to improved long-term visual outcomes (ie, increased retinal thickness and scotopic b-wave electroretinogram responses). Genetic deletion of SOCS3 (suppressor of cytokine signaling 3), an endogenous inhibitor of STAT3, in myeloid cells, enhanced pathological and physiological neovascularization in oxygen-induced retinopathy, indicating that myeloid-STAT3 signaling is crucial for retinal angiogenesis. CONCLUSIONS Circulating myeloid cells may migrate to the immature ischemic retina through the hyaloid vasculature and contribute to retinal neovascularization via activation of STAT3. Understanding how STAT3 modulates myeloid cells for vascular repair/pathology may provide novel therapeutic options in pathogenic angiogenesis.
Collapse
Affiliation(s)
- Jose R Hombrebueno
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom (J.R.H., A.L., E.M.B., G.O., A.K., M.C., H.X.).,Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (J.R.H.)
| | - Aisling Lynch
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom (J.R.H., A.L., E.M.B., G.O., A.K., M.C., H.X.)
| | - Eimear M Byrne
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom (J.R.H., A.L., E.M.B., G.O., A.K., M.C., H.X.)
| | - Gideon Obasanmi
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom (J.R.H., A.L., E.M.B., G.O., A.K., M.C., H.X.)
| | - Adrien Kissenpfennig
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom (J.R.H., A.L., E.M.B., G.O., A.K., M.C., H.X.)
| | - Mei Chen
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom (J.R.H., A.L., E.M.B., G.O., A.K., M.C., H.X.)
| | - Heping Xu
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom (J.R.H., A.L., E.M.B., G.O., A.K., M.C., H.X.)
| |
Collapse
|
37
|
Taner A, Tekle S, Hothorn T, Adams M, Bassler D, Gerth‐Kahlert C. Higher incidence of retinopathy of prematurity in extremely preterm infants associated with improved survival rates. Acta Paediatr 2020; 109:2033-2039. [PMID: 31991001 DOI: 10.1111/apa.15197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/30/2022]
Abstract
AIM This study assessed possible reasons for the increasing incidence of retinopathy of prematurity (ROP) since mid-2015 at our institution. METHODS Retrospective analysis of all preterm infants born July 2013 to June 2017 with a gestational age (GA) <29 completed weeks admitted to the neonatal intensive care unit at the University Hospital Zurich during the first 28 days of life. The primary outcome measures were severest ROP stage. Statistical analysis was performed using generalised additive models in R. RESULTS During the study period, survival increased in extremely preterm infants. Significant predictors for severest ROP stage were GA, days of mechanical ventilation and multiple gestation (P = .0322). A composite of severe comorbidities had no significant effect on severest ROP stage. GA was identified as the only significant risk factor the for severest ROP stage (P = .0045). CONCLUSION Increased survival rate of extremely preterm infants was associated with an increased incidence of ROP at our institution. Despite the increase, the incidence is still very low compared with other countries. No other additive factors were identified.
Collapse
Affiliation(s)
- Aylin Taner
- Department of Ophthalmology University Hospital Zurich and University of Zurich Zurich Switzerland
| | - Senait Tekle
- Institute for Epidemiology, Biostatistics and Prevention Department of Biostatistics University of Zurich Zurich Switzerland
| | - Torsten Hothorn
- Institute for Epidemiology, Biostatistics and Prevention Department of Biostatistics University of Zurich Zurich Switzerland
| | - Mark Adams
- Department of Neonatology University Hospital Zurich and University of Zurich Zurich Switzerland
| | - Dirk Bassler
- Department of Neonatology University Hospital Zurich and University of Zurich Zurich Switzerland
| | - Christina Gerth‐Kahlert
- Department of Ophthalmology University Hospital Zurich and University of Zurich Zurich Switzerland
| |
Collapse
|
38
|
Mehner LC, Wagner BD, Bol KA, Singh JK, Oliver SC, Patnaik JL, Palestine AG, McCourt EA, Mandava N, Wymore EM, Lynch AM. Trends in Retinopathy of Prematurity over 12 Years in a Colorado Cohort. Ophthalmic Epidemiol 2020; 28:220-226. [PMID: 32893714 DOI: 10.1080/09286586.2020.1815801] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine trends in retinopathy of prematurity (ROP) in a Colorado cohort between 2006 and 2017 and compare trends in risk factors between our cohort and statewide data. METHODS A retrospective cohort study was conducted by the use of records from two registry databases: 1) an academic center's ROP registry, and 2) vital statistics birth data from the Colorado Department of Public Health and Environment (CDPHE). ROP was categorized as severe (type 1 or type 2), low grade (not type 1 or type 2), or no ROP. Other variables included in the analyses were gestational age and birth weight at delivery, and infant mortality. Trends over time were evaluated for both registry databases using generalized linear models. RESULTS In our ROP registry cohort of 1,267 eligible infants, 134 (10.6%) developed severe ROP and 279 (22%) developed low-grade ROP. We found no overall trend in severe ROP rates (p = .23), and a decreasing trend in rates of low-grade ROP (p < .01) over the study period. Trends in gestational age, birth weight, and mortality rates remained stable during the study period in both the ROP registry and the CDPHE cohorts. CONCLUSION The rate of severe ROP in our ROP registry cohort did not change over time. There was evidence of a decreasing trend in low grade ROP during the 12-year study period that was not explained by a change in the primary ROP risk factors in either the ROP registry cohort or the Colorado statewide data.
Collapse
Affiliation(s)
- Lauren C Mehner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandie D Wagner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
| | - Kirk A Bol
- Colorado Department of Public Health and Environment, Registries and Vital Statistics Branch, Denver, CO, USA
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott Cn Oliver
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Emily A McCourt
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erica M Wymore
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
39
|
Huang YP, Basanta H, Kang EYC, Chen KJ, Hwang YS, Lai CC, Campbell JP, Chiang MF, Chan RVP, Kusaka S, Fukushima Y, Wu WC. Automated detection of early-stage ROP using a deep convolutional neural network. Br J Ophthalmol 2020; 105:1099-1103. [PMID: 32830123 DOI: 10.1136/bjophthalmol-2020-316526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/21/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIM To automatically detect and classify the early stages of retinopathy of prematurity (ROP) using a deep convolutional neural network (CNN). METHODS This retrospective cross-sectional study was conducted in a referral medical centre in Taiwan. Only premature infants with no ROP, stage 1 ROP or stage 2 ROP were enrolled. Overall, 11 372 retinal fundus images were compiled and split into 10 235 images (90%) for training, 1137 (10%) for validation and 244 for testing. A deep CNN was implemented to classify images according to the ROP stage. Data were collected from December 17, 2013 to May 24, 2019 and analysed from December 2018 to January 2020. The metrics of sensitivity, specificity and area under the receiver operating characteristic curve were adopted to evaluate the performance of the algorithm relative to the reference standard diagnosis. RESULTS The model was trained using fivefold cross-validation, yielding an average accuracy of 99.93%±0.03 during training and 92.23%±1.39 during testing. The sensitivity and specificity scores of the model were 96.14%±0.87 and 95.95%±0.48, 91.82%±2.03 and 94.50%±0.71, and 89.81%±1.82 and 98.99%±0.40 when predicting no ROP versus ROP, stage 1 ROP versus no ROP and stage 2 ROP, and stage 2 ROP versus no ROP and stage 1 ROP, respectively. CONCLUSIONS The proposed system can accurately differentiate among ROP early stages and has the potential to help ophthalmologists classify ROP at an early stage.
Collapse
Affiliation(s)
- Yo-Ping Huang
- Department of Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan.,Department of Information and Communication Engineering, Chaoyang University of Technology, Taichung, Taiwan
| | - Haobijam Basanta
- Department of Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - John P Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, Chicago, Illinois, USA
| | - Shunji Kusaka
- Department of Ophthalmology, Kindai University, Osaka, Japan
| | - Yoko Fukushima
- Department of Ophthalmology, Osaka University, Osaka, Japan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan .,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
40
|
Na KH, Kim KH, Kang TU, Hann HJ, Ahn HS, Kim HJ. Incidence, Long-Term Visual Outcomes, and Mortality in Retinopathy of Prematurity in Korea: A Nationwide Population-Based Study. Invest Ophthalmol Vis Sci 2020; 61:14. [PMID: 32761140 PMCID: PMC7443112 DOI: 10.1167/iovs.61.10.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the incidence, visual prognosis, and mortality in retinopathy of prematurity (ROP) in Korea. Methods We used the National Health Insurance and the Korean Disability Registry database, which covers the entire newborn population in 2006 to 2014 and includes information on all newborns diagnosed with ROP until 2016. Using these databases, we evaluated the incidence, rate of visual impairment (VI), and mortality in patients with ROP according to the birth weight categories and treatment modalities. Results The ROP incidence per 1000 newborns was 1.99, which broke down into 317.14 in the very low birth weight (VLBW) less than 1500 g population, 25.45 in the 1500 to 2499 g population, and 0.29 in the 2500 g or greater population. When assessed at age 10, the VI rate was 2.2 per 100 person-years, which was highest at 4.5 per 100 person-years in the VLBW population compared with the population in other birth weight categories. Among treated cases, the proportion of VI in patients undergoing laser photocoagulation or cryotherapy was 1.6% (42/2595), which was lower than the 2.9% (2/68) of patients treated with anti-vascular endothelial growth factor injection, and 32.2% (82/255) of patients undergoing vitrectomy or scleral buckling. The mortality rate was 4.8 per 1000 person-years, which was highest in the VLBW population, but similar across treatment modalities. Conclusions The ROP incidence in Korea was approximately 1 in 500 among all newborns, and 1 in 3 in the VLBW population. As the first nationwide population-based study of long-term visual prognosis in ROP, we report the higher VI rate in ROP than previously determined in other studies. Differences in visual outcomes and comparable mortality risks between treatment modalities require further verification.
Collapse
|
41
|
Senjam SS, Chandra P. Retinopathy of prematurity: Addressing the emerging burden in developing countries. J Family Med Prim Care 2020; 9:2600-2605. [PMID: 32984093 PMCID: PMC7491791 DOI: 10.4103/jfmpc.jfmpc_110_20] [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: 01/18/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/04/2022] Open
Abstract
Retinopathy of prematurity has emerged and continues to be one of the leading causes of avoidable childhood blindness in low- and middle-income countries over the past few years. A major reason is the lack of adoption of effective and efficient screening for retinopathy of prematurity in various neonatal or newborn units across the countries. At the same time, there is an improvement in the survival rate of high-risk newborn babies which causes a further rise in retinopathy of prematurity. Most of the associated risk factors for retinopathy of prematurity are avoidable, therefore, various preventive strategies can be developed at various levels of healthcare facilities ranging from primary to tertiary level. The integration of appropriate retinopathy of prematurity intervention programs between healthcare departments and partnerships with other non-governmental eye care institutions would be an important as well as critical step to prevent blindness and visual impairment due to retinopathy of prematurity in India and other developing nations.
Collapse
Affiliation(s)
- Suraj Singh Senjam
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Vitreoretina and ROP Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
42
|
Yang Y, Wu Z, Li S, Yang M, Xiao X, Lian C, Wen W, He H, Zeng J, Wang J, Zhang G. Targeted Blood Metabolomic Study on Retinopathy of Prematurity. Invest Ophthalmol Vis Sci 2020; 61:12. [PMID: 32049343 PMCID: PMC7326483 DOI: 10.1167/iovs.61.2.12] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/20/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose This study aims at exploring alterations of major metabolites and metabolic pathways in retinopathy of prematurity (ROP) infants and identifying biomarkers that may merit early diagnosis of ROP. Methods We analyzed targeted metabolites from 81 premature infants (<34 weeks of gestational age), including 40 ROP cases (15 males and 25 females, birth weight 1.263 ± 0. 345 kg, gestational age 31.20 ± 4.62 weeks) and 41 cases (30 males, 11 females, birth weight 1.220 ± 0.293 kg, gestational age 30.96 ± 4.17 weeks) of well-matched non-ROP controls. Metabolites were measured by ultra-performance liquid chromatography-tandem mass spectrometry. Standard multivariate and univariate analysis was performed to interpret metabolomic results. Results Glycine, glutamate, leucine, serine, piperidine, valine, tryptophan, citrulline, malonyl carnitine (C3DC), and homocysteine were identified as the top discriminant metabolites. In particular, discriminant concentrations of C3DC and glycine were also confirmed by univariate analysis as statistically significant different between ROP and non-ROP infants. Conclusions This study gained an insight into the metabolomic aspects of ROP development. We suggest that higher blood levels of C3DC and glycine can be promising biomarkers to predict the occurrence, but not the severity of ROP.
Collapse
|
43
|
|
44
|
Retinopathy of prematurity occurrence and evaluation of screening policy in a large tertiary Greek cohort. Int Ophthalmol 2019; 40:385-391. [PMID: 31641909 DOI: 10.1007/s10792-019-01195-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 10/10/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the frequency of retinopathy of prematurity (ROP) and evaluate the appropriateness of screening guidelines in a tertiary hospital in Thessaloniki, Greece. METHODS Retrospective review of consecutive infants admitted to the IInd Department of the Neonatal Care Unit of Aristotle University in the period April 2004-2015. ROP screening took place according to the Royal College of Paediatrics and Child Health and Royal College of Ophthalmologists (UK) guidelines [i.e. gestational age < 32 weeks and/or birth weight < 1501 g)], plus a few additional cases due to comorbidity. RESULTS 1178 out of the 8782 admitted infants underwent ROP screening. ROP was detected in 232 (19.7%) infants of whom 87 developed severe form of the disease (i.e. ≥ stage 3). Treatment was required in 30 (2.5%) infants, all of whom fulfilled the screening criteria. Two of the 206 infants who were additionally screened due to comorbidity developed severe ROP which regressed spontaneously. Disease regression was achieved in 27/29 (93%) treated infants who survived. CONCLUSIONS The frequency of ROP observed in this cohort was as low as that reported in other developed countries. The currently used screening criteria permitted identification of all infants who were at risk and, therefore, need not be changed.
Collapse
|
45
|
Ying GS, Bell EF, Donohue P, Tomlinson LA, Binenbaum G. Perinatal Risk Factors for the Retinopathy of Prematurity in Postnatal Growth and Rop Study. Ophthalmic Epidemiol 2019; 26:270-278. [PMID: 31012360 DOI: 10.1080/09286586.2019.1606259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/11/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022]
Abstract
Objective: To evaluate perinatal risk factors for retinopathy of prematurity (ROP), in a large, broad-risk cohort of premature infants. Study design: Secondary analysis of data from the Postnatal Growth and ROP (G-ROP) Study, a retrospective cohort study of infants undergoing ROP examinations at 29 North American hospitals in 2006-2012. Results: Among 7483 infants, 3224 (43.1%) had any ROP and 931 (12.4%) had severe ROP (Type 1 or 2 ROP). In multivariable logistic regression analysis, significant risk factors for any ROP were lower birth weight (BW, odds ratio (OR) = 5.2, <501 g vs. >1250 g), younger gestational age (GA, OR = 32, <25 vs. >29 weeks), 1-min Apgar score <4 (OR = 1.2), race (OR = 1.6, White vs. Black), outborn (OR = 1.5), and delivery room intubation (OR = 1.3); and for severe ROP were lower BW (OR = 20, <501 g vs. >1250 g), younger GA (OR = 30, <25 vs. >29 weeks), male (OR = 1.5), Hispanic ethnicity (OR = 1.8), race (OR = 1.6, White vs. Black), outborn (OR = 1.6), and delivery room intubation (OR = 1.6). Together, these factors predicted well for any ROP (area under ROC curve (AUC) = 0.87) and severe ROP (AUC = 0.89), but BW and GA were the dominant factors for ROP (AUC = 0.86) and severe ROP (AUC = 0.88). Conclusions: Based on the largest report to date with detailed ROP data from infants meeting current screening guidelines, ROP risk is predominantly determined by the degree of prematurity at birth, with other perinatal factors contributing minimally.
Collapse
Affiliation(s)
- Gui-Shuang Ying
- a Department of Ophthalmology , Scheie Eye Institute, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Edward F Bell
- b Department of Pediatrics , University of Iowa , Iowa City , Iowa , USA
| | - Pamela Donohue
- c Department of Pediatrics , Johns Hopkins University , Baltimore , Maryland , USA
| | - Lauren A Tomlinson
- d Division of Pediatric Ophthalmology , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - Gil Binenbaum
- a Department of Ophthalmology , Scheie Eye Institute, University of Pennsylvania , Philadelphia , Pennsylvania , USA
- d Division of Pediatric Ophthalmology , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| |
Collapse
|
46
|
Abstract
Introduction Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Areas covered Recent methods to identify and manage treatment-warranted vascularly active ROP are recognized and being compared to standard care by laser treatment in prospective large-scale clinical studies. Pharmacologic anti-angiogenic (anti-VEGF) treatment has changed the natural history of vascularly active ROP by reducing stage 3 intravitreal neovascularization and extending physiologic retinal vascularization in many infants. Tractional retinal detachments in stage 4 ROP after treatment with anti-VEGF agents show additional fibrovascular complexity compared to eyes treated with laser only. We review current management and outcomes for vascularly active and fibrovascular retinal detachment in ROP (stages 3, 4, 5 ROP), highlighting the evidence from recent clinical studies. Included are technical details important in surgery for retinal detachment in ROP. Literature searches were employed through PubMed. Expert opinion Methods in pediatric imaging, safer pharmacologic treatments, and surgical techniques continue to advance to improve future ROP outcomes.
Collapse
Affiliation(s)
- Eric D Hansen
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | | |
Collapse
|
47
|
Estimate of incidence of ROP requiring treatment in extreme preterms and impact on service-7 year review in tertiary unit. Eye (Lond) 2019; 33:845-849. [PMID: 30651593 DOI: 10.1038/s41433-018-0330-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/03/2018] [Accepted: 12/13/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES Retinopathy of prematurity (ROP) is a potentially blinding disorder affecting premature infants. Our Eye Unit supports two neonatal intensive care units (NICUs), one provides neonatal surgical and medical facilities and the other is exclusively medical. Our objectives were to (1) to identify the annual rate of ROP treatments during the period 2009-2015 and (2) to estimate the incidence of ROP treatment in babies born very prematurely (<27 weeks). SUBJECTS/METHODS Records for all infants treated for ROP by our unit during the period 2009-2015 were reviewed. We calculated numbers treated in each year. Records of babies born under 27 weeks of gestation and cared for in the non-surgical NICU were also reviewed. Their requirement for laser treatments for ROP was calculated by the week of gestation at birth. RESULTS In the two NICUs combined, 95 infants were treated for ROP between 2009 and 2015. The numbers treated increased from 9/158 (5.7%) of babies screened in 2009 to 22/159 (13.8%) in 2015 (ptrend = 0.004). The rate of laser treatment for ROP increased as gestation at birth decreased: from 12/100 (12%) of babies born at 26 weeks to 17/29 (59%) of babies born at 23 weeks (ptrend = 0.001). CONCLUSION The number of laser treatments for ROP carried out by this unit has increased steadily between 2009 and 2015 and this may in part be due to the increased need for ROP treatment in extremely preterm babies, whose survival has increased in the same period. These data may aid planning for ROP services.
Collapse
|
48
|
Ausayakhun S, Yen M, Jirawison C, Ausayakhun S, Khunsongkiet P, Leenasirimakul P, Kamphaengkham S, Snyder BM, Heiden D, Holland GN, Margolis TP, Keenan JD. Visual acuity outcomes in cytomegalovirus retinitis: early versus late diagnosis. Br J Ophthalmol 2018; 102:1607-1610. [DOI: 10.1136/bjophthalmol-2018-312191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/29/2018] [Accepted: 08/12/2018] [Indexed: 12/12/2022]
Abstract
AimsTo determine if early dilated fundus examination for cytomegalovirus (CMV) retinitis leads to better visual outcomes in areas with limited HIV care, where patients may have long-standing retinitis before they are diagnosed with HIV.MethodsTwenty-four eyes of 17 patients with CMV retinitis who were seen at an urban HIV clinic in Chiang Mai, Thailand, were included in this retrospective cohort study. Participants were divided into two groups based on the amount of time from the first documented CD4 count below 100 cells/mm3 to the first eye examination for CMV retinitis. Average visual acuity in each group was calculated at the time CMV retinitis was first detected, and then at 3, 6 and 12 months after diagnosis.ResultsThe group of patients who received an eye examination within approximately 4 months of the initial low CD4 count measurement had better baseline visual acuity (median 20/30,IQR 20/20 to 20/60) compared with patients who presented later (median 20/80, 20/60 to hand motion); p=0.03). Visual acuity did not change significantly during the 12-month study period in either the early group (p=0.69) or late group (p=0.17).ConclusionIn this study, patients who were examined sooner after a low CD4 count had better vision than patients who were examined later. Routine early screening of patients with CD4 counts under below 100 cells/mm3 may detect earlier disease and prevent vision loss.
Collapse
|
49
|
Liang J. Systematic review and meta-analysis of the negative outcomes of retinopathy of prematurity treated with laser photocoagulation. Eur J Ophthalmol 2018; 29:223-228. [PMID: 30022693 DOI: 10.1177/1120672118770557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION: Retinopathy of prematurity is a leading cause of potentially avertable childhood blindness around the world. And laser photocoagulation is currently performed as a gold standard for retinopathy of prematurity treatment, but it may contribute to elevated myopia and decreased visual field. Therefore, the objective of this meta-analysis is to explore the negative impact of laser photocoagulation for retinopathy of prematurity in terms of anatomic outcomes and structural outcomes. METHODS: Studies were retrieved through literature searches in PubMed and EMBASE from 1990 to 2017 in English. Case-control studies that reported anatomic and structural changes or significant complications after laser coagulation or cryotherapy for retinopathy of prematurity were eligible. RESULTS: This meta-analysis included eight original studies related to laser treatment for retinopathy of prematurity at any stages. A total of 1422 infants were participated, of which 1156 documented subthreshold or threshold retinopathy of prematurity without laser treatment were selected as comparison group and the rest treated with diode or argon laser coagulation were chosen for experiment group. Taking all included studies into account, spherical equivalent (mean difference -2.53, 95% confidence interval: -5.23 to 0.18, I2 = 96%, P < 0.00001), anterior chamber depth (mean difference -0.52, 95% confidence interval: -0.76 to -0.28, I2 = 55%, P = 0.11), astigmatism (odds ratio 3.19, 95% confidence interval: 1.61 to 6.32, I2 = 0%, P = 0.54), and myopia (odds ratio 8.08, 95% confidence interval: 3.79 to 17.23, I2 = 37%, P = 0.21) were associated with laser treatment for retinopathy of prematurity. Axial length (mean difference -0.01, 95% confidence interval: -0.28 to 0.27, I2 = 0%, P = 0.62) and anisometropia (odds ratio 4.21, 95% confidence interval: 0.54 to 33.17, I2 = 1%, P = 0.31) had no statistical significance on laser coagulation for retinopathy of prematurity. CONCLUSION: This meta-analysis showed that spherical equivalent, anterior chamber depth, astigmatism, and myopia were associated with the negative outcomes of laser coagulation, while axial length and anisometropia had no statistical importance on the defects of laser coagulation. Therefore, patients treated with laser coagulation should follow periodic cycloplegic refraction and receive early optical correction.
Collapse
Affiliation(s)
- Jing Liang
- Department of Ophthalmology, Tianjin 4th Center Hospital, Tianjin, China
| |
Collapse
|
50
|
Kang EYC, Lien R, Wang NK, Lai CC, Chen KJ, Hwang YS, Lin CM, Wu WC, Hsu KH. Retinopathy of Prematurity Trends in Taiwan: A 10-Year Nationwide Population Study. ACTA ACUST UNITED AC 2018; 59:3599-3607. [DOI: 10.1167/iovs.18-24020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Reyin Lien
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York, United States
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ciao-Ming Lin
- Laboratory for Epidemiology, Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Laboratory for Epidemiology, Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital, Linkou, Taiwan
| |
Collapse
|