Early Risk Factors for Retinopathy of Prematurity in Very and Extremely Preterm Chinese Neonates

Monitoring and evaluation of hypotension in the extremely preterm

With the development of neonatal medicine, more and more extremely preterm infants have been treated. How to deal with hypotension is a big challenge for neonatologist in the process of diagnosis and treatment. The lack of uniformity in the definition of hypotension, challenges in measuring blood pressure accurately, and insufficient consistency between digital hypotension and hypoperfusion are the primary causes. How to check for hypotension and monitor blood pressure is thoroughly explained in the article. To give neonatologists a resource for the clinical management of hypotension in extremely preterm.

Analysis of trends in retinopathy of prematurity over 5 years in a tertiary neonatal intensive care unit

AIM

The aim of the study was to look at the incidence and trend of retinopathy of prematurity (ROP) between 2017 and 2021 in a tertiary neonatal intensive care unit (NICU) in Australia and to compare potential modifiable risk factors of ROP between preterm infants who required treatment for ROP and who did not need treatment.

METHODS

This retrospective study used the data of newborn infants who were <31 weeks gestational age (GA) or birth weight (BW) of <1250 g born between 2017 and 2021 at a tertiary NICU in Australia (n = 261). Univariate analysis using t test for continuous data, Fischer exact test for categorical data and multiple logistic regression analysis were undertaken to identify any significant differences between two groups.

RESULTS

A total number of 261 infants were studied. 55.9% of infants developed any type of ROP (146 infants out of 261 infants), type 1 ROP was 5.4% (14 out of 261) and aggressive ROP (AROP) was 3% (8 out of 261). Out of 146 infants who were diagnosed with ROP, 22 (15%) of them required treatment. Mean GA for those who underwent ROP treatment was 25.6 (±1.47) weeks and for those who did not require treatment was 27.6 (±1.95) weeks. The mean BWs for those who needed treatment was 764 (±189.32) g and for those who did not need treatment was 1039 (±306.06) g. The mean duration of invasive ventilation for infants with ROP requiring treatment and those who did not require treatment were 23.95 (±22.41) days and 9.89 (±17.2) days. The total duration of oxygen requirement was 235.54 (±160.5) days and 121.11 (±117.34) days for those who needed treatment and those who did not need treatment respectively. Among infants who required treatment for ROP, 68.18% required blood transfusion whereas among those who did not need treatment, 24.19% required blood transfusion.

CONCLUSION

Lower GA, lower BW, longer duration of invasive ventilation, longer total duration of oxygen requirement and blood transfusion in first 2 weeks of life were significant in preterm infants who required treatment for ROP compared with those who did not.

The differential associative relationship between early risk factors, neonatal morbidities and early neurodevelopmental outcome in preterm infants <29 weeks' gestation

BACKGROUND

Very preterm infants of <29 weeks' gestation are at high risk for adverse neurodevelopment due to multiple risk factors in the early stages of life. There is little information regarding the associative effects of risk factors in early life, neonatal morbidities and subsequent neurodevelopmental outcomes.

AIMS

Investigate the association of early neurodevelopmental outcomes, neonatal complications and the risk factors in the early hours of life in a cohort of preterm infants <29 weeks' gestational age.

METHODS

We enrolled all surviving preterm neonates born at gestation <29 weeks between January 2015 and June 2021 in the University of Hong Kong-Shenzhen Hospital. Demographic and clinical characteristics were collected from a database of the neonatal intensive care unit. Neurodevelopmental outcomes of the survivors were evaluated using the Ages and Stages Questionnaire (ASQ-3) which were measured at the adjusted age of 12 to 18 months. The multivariate linear regression model was used to determine correlation presented as β coefficient (β) with 95 % confidence intervals (CI).

RESULTS

In this cohort of 56 survivors <29 weeks' gestation, urine output within the first 12 h of life and Apgar score at 5 min were positively associated with different domains of ASQ-3 score, however male sex and highest fraction of inspired oxygen (FiO2) in the first 12 h of life were negatively related with at least one of neurocognitive domains of ASQ-3 at adjusted age of 12 to 18 months. During hospitalization, in addition to the frequency of packed red cell transfusions, the development of severe necrotizing enterocolitis was inversely associated with both neuromotor and neurocognitive skills (gross motor domain: β = -16.93, CI: -32.04, -1.82; fine motor domain: β = -16.42, CI: -28.82, -4.02; problem solving domain: β = -13.14, CI: -24.45, -1.83; all P < 0.05), whereas severe intraventricular hemorrhage had adverse effects on gross motor only (β = -13.04, CI: -24.42, -1.65; P = 0.03). Bronchopulmonary dysplasia and retinopathy of prematurity were not related with ASQ-3.

CONCLUSIONS

In this small cohort study of very preterm neonates born at <29 weeks' gestation, risk factors in the early hours of life and neonatal morbidities during hospitalization had differential associative relationships with ASQ-3 at 12-18 months adjusted age. This information may be important for parental counseling and management including early diagnosis and intervention.

Application of Artificial Intelligence in the Early Detection of Retinopathy of Prematurity: Review of the Literature

Retinopathy of prematurity (ROP) is a potentially blinding disease in premature neonates that requires a skilled workforce for diagnosis, monitoring, and treatment. Artificial intelligence is a valuable tool that clinicians employ to reduce the screening burden on ophthalmologists and neonatologists and improve the detection of treatment-requiring ROP. Neural networks such as convolutional neural networks and deep learning (DL) systems are used to calculate a vascular severity score (VSS), an important component of various risk models. These DL systems have been validated in various studies, which are reviewed here. Most importantly, we discuss a promising study that validated a DL system that could predict the development of ROP despite a lack of clinical evidence of disease on the first retinal examination. Additionally, there is promise in utilizing these systems through telemedicine in more rural and resource-limited areas. This review highlights the value of these DL systems in early ROP diagnosis.

Screening for retinopathy of prematurity in North China

PURPOSE

To analyze the incidence and severity of retinopathy of prematurity (ROP) in north China, and to evaluate the effectiveness of different ROP screening criteria.

PATIENTS AND METHODS

The screening data of premature infants were collected from 2016 to 2021. The severity of ROP was graded according to the International Classification of Retinopathy of Prematurity (2005). And the treatment for ROP followed the Early Treatment for Retinopathy of Prematurity Cooperative Group. The effects of gestational age (GA) and birth weight (BW) on the incidence and severity of ROP were evaluated. The screening data were also analyzed using different ROP screening guidelines.

RESULTS

A total of 4069 infants underwent ROP screening, and 728 infants (17.9%) were diagnosed with ROP. Of those, 78 infants (1.9%) received treatments. Gestational age and BW showed significant differences between infants with and without ROP (29.1 ± 2.1w vs. 32.9 ± 2.6w, p < 0.001; 1362.7 ± 427.3 g vs. 1751.9 ± 509.4 g, p < 0.001; respectively). Fifty-six infants (7.69%), 188 infants (25.82%), and 104 infants (14.29%) in all infants with ROP would have been missed according to the China, USA, and UK screening guidelines respectively. If GA ≤ 33 weeks and/or BW ≤ 2100 g were considered as screening criteria, only one infant (0.14%) with critical systemic illness was missed diagnosed with severe ROP.

CONCLUSION

Gestational age and BW are major risk factors for the incidence and severity of ROP. And the incidence and treatment rate of ROP in Tianjin is similar to that reported in the other regions of China. Modified ROP screening criteria were considered to be more effective in Tianjin.

A Family-Centered, Multidisciplinary Clinic for Early Diagnosis of Neurodevelopmental Impairment and Cerebral Palsy in China-A Pilot Observation

BACKGROUND

Comprehensive multidisciplinary assessment of neurodevelopmental outcomes of high-risk neonates may have significant challenges in low- and middle-income countries, in addition to socio-cultural barriers. We aimed to compare the time to diagnosis of neurodevelopmental impairment (NDI) and cerebral palsy (CP) in preterm neonates (<29 weeks) at a multidisciplinary assessment and care (MDAC) clinic with that of a conventional high-risk infant follow-up clinic in China.

METHODS

All eligible surviving very preterm neonates born at <29 weeks gestation at the University of Hong Kong-Shenzhen Hospital between January 2015 and December 2019 were followed up in conventional (2015-2017) and MDAC (2018-2020) clinics up to 2 years corrected age with clinical demographic information collected in a prospective database. The MDAC team used standardized developmental assessments. The rates and timing of diagnosing NDI and CP in two epochs were compared.

RESULTS

The rates of NDI and CP were not different in two epochs [NDI: 12 (50%) vs. 12 (41%); CP: 3 (12%) vs. 2 (7%) of 24 and 29 surviving infants assessed in conventional and MDAC clinics, respectively]. Infants in the MDAC clinic were diagnosed with NDI and CP earlier than those in the pre-MDAC epoch (6 vs. 14 months corrected age, respectively, P < 0.05).

CONCLUSION

High-risk preterm neonates can be followed more effectively in a family-centered, child-friendly multidisciplinary clinic, leading to an earlier diagnosis of NDI and CP. Early counseling and interventions could be implemented accordingly.

Haemoglobin Levels in Early Life among Infants with and without Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disorder attributed to an ischaemic stimulus in preterm infants. Haemoglobin, the main component for oxygen transportation, may be implicated in ROP development. This retrospective study compared the mean weekly haemoglobin levels between infants with and without ROP over the first six weeks of life. Premature infants of less than 32 weeks gestational age and less than 1.5 kg birth weight were grouped into age and birth weight-matched ROP cases and controls. Weekly mean haemoglobin levels were documented. An independent t-test was used to analyze the difference in mean haemoglobin levels between infants with ROP and infants without ROP. Adjustment for confounders was performed using one-way analysis of covariance. There was a statistically significant difference in adjusted mean haemoglobin levels between the ROP and non-ROP group during the first week of life (p = 0.038). No significant intergroup differences were observed at the other weeks. Haemoglobin monitoring during the first week of postnatal life may be useful to guide ROP screening in premature infants.

Comparison of Mean Platelet Counts in Preterm Infants with and without Retinopathy of Prematurity

Platelets are a primary source of pro- and anti-angiogenic cytokines. However, the evidence of their role in retinopathy of prematurity (ROP) is controversial. This retrospective study aimed to compare mean weekly platelet counts between infants with and without ROP over the first 6 weeks of life. A total of 93 infants matched by gestational age and birth weight were recruited (31 with ROP, 62 without ROP). Weekly mean platelet counts and other related risk factors were documented. The repeated measure analysis of variance (ANOVA) and the repeated measure analysis of covariance (ANCOVA) were used to compare mean platelet counts over time between the two groups, with and without adjusting for confounders. We found significant differences in the weekly mean platelet counts of infants with and without ROP over the first 6 weeks of life (p = 0.002). These differences disappeared after adjusting for covariates (p = 0.489). Lower mean platelet counts in ROP infants are not directly related to ROP, but rather to the presence of other risk factors for ROP, such as culture-proven sepsis, blood transfusion and bronchopulmonary dysplasia.