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Of Prematurity (of + prematurity)
Kinds of Of Prematurity Selected AbstractsSeeing is Believing: Evidence-Based Strategies for Reduction in Retinopathy of PrematurityJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2010Newborn Care No abstract is available for this article. [source] Nursing Update on Retinopathy of PrematurityJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2007Kristi Coe One of the problems that plagues premature infants is retinopathy of prematurity, a potentially blinding disease that occurs because the retina is immature before 34 weeks gestation and must develop in a suboptimal environment when a baby is born early. Prevention by minimizing oxygen exposure has been somewhat effective, but survival of the tiniest babies has led to a recent resurgence in cases. Oxygen targeting and early surgery show promise to reduce the risk of blindness in the smallest premature infants. Nurses play an important role in oxygen management and parental support. JOGNN, 36, 288-292; 2007. DOI: 10.1111/J.1552-6909.2007.00151.x [source] Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 24-month experience with telemedicine screeningACTA OPHTHALMOLOGICA, Issue 3 2010Yohko Murakami Abstract. Purpose:, To report the 24-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative. Methods:, Retrospective analysis of the SUNDROP archival data gathered between 1 December 2005 and 30 November 2007 to evaluate this diagnostic technology for ROP screening. One hundred and sixty consecutively enrolled infants meeting ROP examination criteria were screened with the RetCam II and evaluated by the SUNDROP reading centre at Stanford University. Nurses obtained five or six images in each eye. All patients also received a dilated examination within 1 week of discharge. Outcomes included treatment-warranted retinopathy of prematurity (TW-ROP) and anatomical outcomes. Results:, In the initial 24-month period, the SUNDROP telemedicine initiative has not missed any TW-ROP. A total of 160 infants (320 eyes) were imaged, resulting in 669 exams and 7556 images. Seven infants were identified with TW-ROP; six underwent laser photocoagulation and one regressed spontaneously. The sensitivity was 100%, with specificity of 99.4%. No patient progressed to retinal detachment or other adverse outcomes. Conclusion:, The SUNDROP telemedicine screening initiative for ROP has been proven to have a high degree of sensitivity and specificity for the identification of treatment-warranted disease. All cases of treatment-warranted disease were captured. There were no adverse outcomes. [source] Zone-I retinopathy of prematurity, progression and scheduling of treatmentACTA OPHTHALMOLOGICA, Issue 2009I AKKOYUN Purpose To evaluate the progression celerity and scheduling of suitable treatment time for Zone-I Retinopathy of Prematurity (ROP). Methods Records of 36 eyes (18 infants) with Zone-I ROP, which were screened for ROP at the Neonatal Intensive Care Unit of Baskent University, Ankara, Turkey, between January 2004-March 2009, were evaluated retrospectively. Birth weight ranged between 480-1000g, gestational age ranged from 24-28 weeks. First fundus examination was performed at 29-31 weeks gestational age, and was repeated once or more per week. The first treatment was performed using laser photocoagulation and the progression criteria for laser photocoagulation treatment were: (1) Zone-I ROP less than stage-3 with plus disease (ETROP-type 1); (2) Zone-I stage 3 ROP with or without plus disease (ETROP-type 1). Results Twenty eyes of 10 infants showed criterion (1) and 16 eyes of 8 infants criterion (2). Corneal opacity, pupillary rigidity, tunica vasculosa lentis and vitreous haze were observed until 31-33 weeks gestational age. The time period for the progression of stage-1 to stage-3 retinopathy ranged between 0.7-3.7 weeks. The mean age at the first treatment was 33 weeks (range 30-35 weeks). The mean time between the development of stage-1 retinopathy and the laser treatment was 9.8 days in mean (5-23 days), and 69.3 % of the infants were treated within 12 days after the diagnosis of stage-1 ROP. Additional treatments were performed in 7 eyes, scleral buckling+cryotherapy in 5 eyes, vitrectomy in 2 eyes. Thirty-two eyes had favorable and 4 eyes had unfavorable outcomes. Conclusion The diagnosis of Zone-I ROP requires close-meshed follow-up and immediate treatment. [source] Chronic lung disease: oxygen dogma revisitedACTA PAEDIATRICA, Issue 2 2001O D Saugstad Since the discovery of retrolental fibroplasia, and the role of oxygen in its development, oxygen has been considered a double-edged sword in neonatal medicine, the utmost care being exercised in order not to give too much oxygen (1). However, the important observation that hypoxaemia might induce pulmonary vasoconstriction (2) and airway constriction (3) in infants at risk for bronchopulmonary dysplasia has resulted in only a minor upward adjustment of oxygen supplementation in many neonatal units. Since oxygen toxicity has long been linked not only to retinopathy of prematurity but also to bronchopulmonary dysplasia (4), it is relevant to ask whether an increased FiO2 might have any detrimental effects on babies. [source] Ophthalmological problems of the premature infantDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2002Michael X. Repka Abstract Preterm infants are more likely than term infants to have significant abnormalities of all parts of the visual system leading to reduced vision. The most common problem is retinopathy of prematurity (ROP). The frequency and severity of this disorder is inversely related to gestational age. Damage ranges from minor to catastrophic. Preterm infants also have higher rates of amblyopia, strabismus, refractive error, and cortical visual impairment. The later problem is largely associated with neonatal brain injury. Years later, these children may develop glaucoma and retinal detachments. MRDD Research Reviews 2002;8:249,257. © 2002 Wiley-Liss, Inc. [source] Nursing Update on Retinopathy of PrematurityJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2007Kristi Coe One of the problems that plagues premature infants is retinopathy of prematurity, a potentially blinding disease that occurs because the retina is immature before 34 weeks gestation and must develop in a suboptimal environment when a baby is born early. Prevention by minimizing oxygen exposure has been somewhat effective, but survival of the tiniest babies has led to a recent resurgence in cases. Oxygen targeting and early surgery show promise to reduce the risk of blindness in the smallest premature infants. Nurses play an important role in oxygen management and parental support. JOGNN, 36, 288-292; 2007. DOI: 10.1111/J.1552-6909.2007.00151.x [source] Outcome and hospital cost for infants weighing less than 500 grams: A tertiary centre experience in TaiwanJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2007Wu-Shiun Hsieh Aim: To determine the outcome and hospital cost for infants weighing ,500 g at a tertiary centre in Taiwan. Methods: We retrospectively reviewed the medical records of infants who were born alive with birthweight ,500 g at the National Taiwan University Hospital from 1997 to 2004. Their outcome and hospital cost were analysed. Results: A total of 168 infants were included for analysis that 146 of them died after compassionate care in the delivery room and 22 received postnatal resuscitation. The infants who received resuscitation were more likely to have higher birthweights, older gestational ages and multiple births compared with those who received compassionate care. After resuscitation, five of the infants died and 17 were admitted to neonatal intensive care unit (NICU) for further management. Subsequently, 12 infants died and five infants survived to discharge. Two infants were discharged against advice and died within days. After exclusion of those receiving compassionate care, the NICU survival rate was 22.7% and the long-term survival rate was 13.6%. The most common early morbidities were respiratory distress syndrome, intraventricular haemorrhage and patent ductus arteriosus, whereas the late morbidities included cholestatic jaundice, retinopathy of prematurity and chronic lung disease. The average total hospital costs for the NICU survivors with birthweight ,500 g was US$ 42 411 and the average hospital cost per day was US$ 350. Conclusion: Exclusive compassionate care was given to the majority of the infants weighing ,500 g in Taiwan. The survival rate remained low in these marginally viable infants. [source] Retinopathy of prematurity: Mutations in the Norrie disease gene and the risk of progression to advanced stagesPEDIATRICS INTERNATIONAL, Issue 2 2001Mohammad Z Haider AbstractBackground: Retinopathy of prematurity (ROP) is a retinal vascular disease that occurs in infants with short gestational age and low birth weight and may lead to retinal detachment and blindness. Missense mutations in the Norrie disease (ND) gene have been associated with the risk of progression to advanced stages in cases of ROP from the US and also in clinically similar ND and familial exudative vitreoretinopathy. Methods: We have screened two ND gene mutations, namely A105T and Val60Glu, by polymerase chain reaction,restriction fragment length polymorphism (PCR-RFLP) and allele-specific PCR methods, respectively, in 210 Kuwaiti premature newborns to replicate these findings in a different ethnic group. Results: In the Kuwaiti premature newborn cohort, 115 of 210 babies had no eye problems and served as controls, while 95 were cases of ROP. In 71 of 95 ROP cases, the disease regressed spontaneously on or before stage 3, while in 24 of 95 ROP cases the disease progressed to advanced stages 4 and 5. In case of missense mutation (A105T), the AA genotype was detected in 96% of controls compared with 87% of ROP cases (NS); similarly no significant difference was found between spontaneously regressed ROP cases and those who progressed to advanced stages. For the Val60Glu mutation, no significant association was detected between the genotype and progression of ROP to advanced stages. Conclusions: Unlike data from the US, our findings from a Kuwaiti cohort of ROP cases and controls suggest a lack of association between the two ND gene mutations (A105T and Val60Glu) and ROP and the risk of progression of the disease to advanced stages. [source] Retinal and Optic Nerve DiseasesARTIFICIAL ORGANS, Issue 11 2003Eyal Margalit Abstract:, A variety of disease processes can affect the retina and/or the optic nerve, including vascular or ischemic disease, inflammatory or infectious disease, and degenerative disease. These disease processes may selectively damage certain parts of the retina or optic nerve, and the specific areas that are damaged may have implications for the design of potential therapeutic visual prosthetic devices. Outer retinal diseases include age-related macular degeneration, pathologic myopia, and retinitis pigmentosa. Although the retinal photoreceptors may be lost, the inner retina is relatively well-preserved in these diseases and may be a target for retinal prosthetic devices. Inner retinal diseases include retinal vascular diseases such as diabetic retinopathy, retinal venous occlusive disease, and retinopathy of prematurity. Other retinal diseases such as ocular infections (retinitis, endophthalmitis) may affect all retinal layers. Because the inner retinal cells, including the retinal ganglion cells, may be destroyed in these diseases (inner retinal or whole retinal), prosthetic devices that stimulate the inner retina may not be effective. Common optic nerve diseases include glaucoma, optic neuritis, and ischemic optic neuropathy. Because the ganglion cell nerve fibers themselves are damaged, visual prosthetics for these diseases will need to target more distal portions of the visual pathway, such as the visual cortex. Clearly, a sound understanding of retinal and optic nerve disease pathophysiology is critical for designing and choosing the optimal visual prosthetic device. [source] Protective effects of triamcinolone acetonide upon the upregulation and phosphorylation of GAP 43 in an animal model of retinopathy of prematurityACTA OPHTHALMOLOGICA, Issue 6 2010In Y. Chung Acta Ophthalmol. 2010: 88: e217,e221 Abstract. Purpose:, The aim of the current study was to investigate the effects of triamcinolone acetonide (TA) upon the expression and phosphorylation of growth-associated protein 43 (GAP 43) in the retinas of oxygen-induced retinopathy (OIR) rats. Methods:, Oxygen-induced retinopathy was induced by exposing Sprague-Dawley rats to hyperoxia (80% oxygen) from postnatal (P) days 2,14 and then returning the rats to normoxic conditions. Triamcinolone acetonide or a conditioned saline (control) was injected intravitreally into the right or left eye, respectively, of OIR rats at P15. We then assessed the molecular and histological changes in the expression of GAP 43 and phospho-GAP 43 in OIR and control rat retinas, and also after treatment with TA by RT-PCR, Western blotting and immunohistochemistry. Results:, Growth-associated protein 43 mRNA levels were found to be increased by 1.6-fold (p = 0.001, n = 5) in the retinas of P18 OIR rats compared with the control rats. The protein levels of GAP 43 and phospho-GAP43 were found to be elevated in the retina of P18 OIR rats (2.40- and 2.39-fold greater than each control, p<0.001, n = 5, respectively). Immunoreactivities of GAP 43 and phospho-GAP 43 were stronger in the inner plexiform layer in OIR rat retinas compared with the control. However, treatment with TA attenuated GAP 43 and phospho-GAP 43 upregulation in the OIR retinas. Conclusion:, Our results indicate that GAP 43 and phospho-GAP 43 participate in retinal (potentially pathologic) changes following oxygen-induced damage. Triamcinolone acetonide protects the retinal damage in relatively hypoxic retinas of OIR rats. Therefore, TA treatment does not induce the expression and phosphorylation of GAP 43 in OIR rat retinas. [source] Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 24-month experience with telemedicine screeningACTA OPHTHALMOLOGICA, Issue 3 2010Yohko Murakami Abstract. Purpose:, To report the 24-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative. Methods:, Retrospective analysis of the SUNDROP archival data gathered between 1 December 2005 and 30 November 2007 to evaluate this diagnostic technology for ROP screening. One hundred and sixty consecutively enrolled infants meeting ROP examination criteria were screened with the RetCam II and evaluated by the SUNDROP reading centre at Stanford University. Nurses obtained five or six images in each eye. All patients also received a dilated examination within 1 week of discharge. Outcomes included treatment-warranted retinopathy of prematurity (TW-ROP) and anatomical outcomes. Results:, In the initial 24-month period, the SUNDROP telemedicine initiative has not missed any TW-ROP. A total of 160 infants (320 eyes) were imaged, resulting in 669 exams and 7556 images. Seven infants were identified with TW-ROP; six underwent laser photocoagulation and one regressed spontaneously. The sensitivity was 100%, with specificity of 99.4%. No patient progressed to retinal detachment or other adverse outcomes. Conclusion:, The SUNDROP telemedicine screening initiative for ROP has been proven to have a high degree of sensitivity and specificity for the identification of treatment-warranted disease. All cases of treatment-warranted disease were captured. There were no adverse outcomes. [source] Update on risk factors and future perspectives for preterm infantsACTA OPHTHALMOLOGICA, Issue 2009A HELLSTRöM Purpose To give an update on risk factors for retinopathy of prematurity with special focus on postnatal growth and growth factors Methods The relationship between birth weight, serum levels of IGF-I as well as postnatal longitudinal growth and ROP will be presented. Preventive measures will be discussed. Results Birth weight data on 451 infants demonstrated initially a significant difference in BW between different ROP stages but when taking gestational age and sex into account the significance was eliminated. Recently, a new diagnostic tool based on weekly neonatal measurements of body weight and serum insulin-like growth factor 1 (IGF-I) levels, was shown to be predictive for ROP development. The algorithm "Weight IGF-I Neonatal ROP" (WINROPÔ) predicted early (mean 10 weeks) all infants who later developed proliferative ROP requiring treatment. The WINROP algorithm was then taken one step further using only serial weight measurements (n=700), excluding blood sampling for measuring IGF-I. With this approach WINROP predicted all infants who later developed proliferative ROP requiring treatment (100% sensitivity) and correctly identified 75% of those who did not develop proliferative ROP, and thus would not need any ophthalmologic screening. We have also shown a close relationship between postnatal growth, severe ROP and poor brain development. Conclusion For decades, neonatal intensive care has focused on survival of the most immature babies. Time has come to find methods to ameliorate the nutrition for the children born very preterm. It is known that IGF-I is essential for growth and development of the immature vasculature of the eye. Intervention with substitution of IGF-I to the very preterm babies to raise IGF-I up to normal intrauterine levels might be beneficial. Commercial interest [source] Recent developments in retinopathy of prematurityACTA OPHTHALMOLOGICA, Issue 2009B MORTEMOUSQUE The retinopathy remains the principal severe ophthalmologic complication of neonates with a gestationalage of 32 weeks or less. It's a major cause of lifelong blindness beginning in infancy. As many other ocular pathologies, including diabetic retinopathy, and age-related macular degeneration, result in vision loss because of aberrant neoangiogenesis. A common feature of these conditions is the presenceof hypoxic areas and overexpression of the proangiogenic vascular endothelialgrowth factor (VEGF). Its prevantion can be made by a better management of the oxygenation of these children but also by a better knowledge of the other risk factors. The prevailing current treatment, laser ablation of the retina, is destructive and only partially effective. Preventive and less destructive therapies are much more desirable. So, Angiogenesis, or the formation of new retinal blood vessels is a key feature of many proliferative retinal diseases including diabetic retinopathy,retinal vein occlusions, and retinopathy of prematurity. [source] Zone-I retinopathy of prematurity, progression and scheduling of treatmentACTA OPHTHALMOLOGICA, Issue 2009I AKKOYUN Purpose To evaluate the progression celerity and scheduling of suitable treatment time for Zone-I Retinopathy of Prematurity (ROP). Methods Records of 36 eyes (18 infants) with Zone-I ROP, which were screened for ROP at the Neonatal Intensive Care Unit of Baskent University, Ankara, Turkey, between January 2004-March 2009, were evaluated retrospectively. Birth weight ranged between 480-1000g, gestational age ranged from 24-28 weeks. First fundus examination was performed at 29-31 weeks gestational age, and was repeated once or more per week. The first treatment was performed using laser photocoagulation and the progression criteria for laser photocoagulation treatment were: (1) Zone-I ROP less than stage-3 with plus disease (ETROP-type 1); (2) Zone-I stage 3 ROP with or without plus disease (ETROP-type 1). Results Twenty eyes of 10 infants showed criterion (1) and 16 eyes of 8 infants criterion (2). Corneal opacity, pupillary rigidity, tunica vasculosa lentis and vitreous haze were observed until 31-33 weeks gestational age. The time period for the progression of stage-1 to stage-3 retinopathy ranged between 0.7-3.7 weeks. The mean age at the first treatment was 33 weeks (range 30-35 weeks). The mean time between the development of stage-1 retinopathy and the laser treatment was 9.8 days in mean (5-23 days), and 69.3 % of the infants were treated within 12 days after the diagnosis of stage-1 ROP. Additional treatments were performed in 7 eyes, scleral buckling+cryotherapy in 5 eyes, vitrectomy in 2 eyes. Thirty-two eyes had favorable and 4 eyes had unfavorable outcomes. Conclusion The diagnosis of Zone-I ROP requires close-meshed follow-up and immediate treatment. [source] Inner retinal ischaemia: current understanding and needs for further investigationsACTA OPHTHALMOLOGICA, Issue 4 2009Toke Bek Abstract. Inner retinal ischaemia is involved in the pathogenesis of major vision-threatening diseases such as retinal vein thrombosis, diabetic retinopathy and retinopathy of prematurity. However, the pathogenesis of inner retinal ischaemia has not been fully elucidated, which represents an impediment to the development and improvement of techniques to prevent and treat these diseases on a rational basis. This paper provides a comprehensive review of current knowledge of the pathophysiology of inner retinal ischaemia, including clinical, anatomical and physiological aspects of disease development. It is suggested that chronic inner retinal ischaemia caused by capillary occlusion may develop secondary to an increase in hydrostatic pressure in the vessels. Further knowledge of the pathophysiology of inner retinal ischaemia can be obtained by identifying the mechanisms that lead to increased hydrostatic pressure in the capillary bed and establishing the structural and functional basis for the different response patterns in the central and peripheral areas of the retina that develop secondary to this increased hydrostatic pressure. Further elucidation of these unknown response patterns requires both in vitro and in vivo studies of retinal vascular pathophysiology. It is conceivable that a more detailed knowledge of these response patterns may help in the design of new treatments for retinal ischaemia and its vision-threatening consequences. [source] Digital image analysis of plus disease in retinopathy of prematurityACTA OPHTHALMOLOGICA, Issue 4 2009Tariq Aslam Abstract. An accurate assessment of retinopathy of prematurity (ROP) is essential in ensuring correct and timely treatment of this potentially blinding condition. Current modes of assessment are based upon clinical grading by expert examination of retinal changes. However, this may be subjective, unreliable and difficult and there has been significant interest in alternative means of measurement. These have been made possible through technological advancements in image capture and analysis as well as progress in clinical research, highlighting the specific importance of plus disease in ROP. Progress in these two fields has highlighted the potential for digital image analysis of plus disease to be used as an objective, reliable and valid measurement of ROP. The potential for clinical and scientific advancement through this method is argued and demonstrated in this article. Along with the potential benefits, there are significant challenges such as in image capture, segmentation, measurement of vessel width and tortuosity; these are also addressed. After discussing and explaining the challenges involved, the research articles addressing digital image analysis of ROP are critically reviewed. Benefits and limitations of the currently published techniques for digital ROP assessment are discussed with particular reference to the validity and reliability of outcome measures. Finally, the general limitations of current methods of analysis are discussed and more diverse potential areas of development are discussed. [source] Function of macular area in retinopathy of prematurityACTA OPHTHALMOLOGICA, Issue 2007AM SHAMSHINOVA Purpose: To assess the bioelectric activity of the retina at different stages of the retinopathy of prematurity (RP). Methods: 21 children with RoP (stage 1-4, 6-14 years old, born at 27-32 week of gestation with the birth weight of 730-1800g) were examined. In 4 of children the prophylactic laser coagulation of avascular retina was performed in the active phase. Visual acuity (VA) at the stage 1 of RoP amounted to 0,75; at the stage 2: 0,5; at the stage 3: 0,25 and at the stage 4: 0,02. Macular (MBN Moscow) and mf ERG( Roland Concult Germany) were examined. Results: There was no correlation between VA values and parameters of multifocal (mf) and macular (m) ERG. Patients with RP of stage1 showed a moderate reduction of b-wave magnitude of mERG at its normal latency. This correlated with mfERG data in central hexagons 15 degrees. The magnitude and latency of mERG were changed to a great extent in RP patients of stages 2-3. The waves N1 and P1 of mERG were also heavily decreased at normal latency. The patients with severe retinal abnormalities, like retinal detachment, have subnormal mERG-values with prolonged latency, and moderate decrease of retinal density in the central ring and considerable changes with eccentricity in mfERG. Conclusions: RP patients 1-4 stages showed considerable impairment of macular function independent of the ophthalmoscopic changes. Even occult or weak-manifested of the diseases in the macula might be accompanied with the moderate decrease of macular bioelectric activity, including the abrupt abnormalities of the electrogenesis and neuronal interactions in the macular area. Decline VA d'not always had relation with RP. The pathophysiologic rationale of the latter needs to be elucidated in the future studies. [source] Ophthalmological follow-up at 2 years of age of all children previously screened for retinopathy of prematurity: is it worthwhile?ACTA OPHTHALMOLOGICA, Issue 5 2006Anna-Lena Hård Abstract. Purpose:, To evaluate the extent to which ophthalmological follow-up at 2 years of age of children born before 32 weeks gestation identifies obvious visual problems, strabismus and significant ametropia (target conditions). Methods:, Of 172 children born during a period of 2.5 years from January 2000, 142 underwent an ophthalmological examination at a median age of 2.33 years. This included evaluation of visual behaviour, cover testing and autorefractometry in cycloplegia. For children with the target conditions, we investigated whether the child had been followed in the eye clinic or referred before 2 years of age, or whether the abnormality was detected as a result of the follow-up examination. Results:, None of the target conditions were found in 117 children. None of four children with obviously abnormal visual behaviour, two of 10 children with strabismus and four of 11 with large refractive errors were detected in the follow-up examination. Thus the target conditions were detected at the follow-up examination in only six of 142 children (4.2%). Conclusions:, Although ophthalmic abnormalities are common in children born prematurely, most of them are identified because high-risk children are followed regularly in eye clinics and because parents and primary health care personnel detect strabismus. Ophthalmological follow-up of all children born before 32 weeks appears not to be worthwhile and is therefore only recommended for high-risk children. [source] Retinopathy of prematurity in a Copenhagen high-risk sample 1997,98ACTA OPHTHALMOLOGICA, Issue 3 2000The allover surveillance for ROP appears more, more complete ABSTRACT. Purpose: From two recent materials to describe the present clinical status regarding retinopathy of prematurity in Denmark, and to outline trends over time. Methods: A) Results of regular ophthalmic surveillance of 201 clinically selected (higher risk of ROP than average) pre-term infants of birth year 1997,98 taken care of in the two greater Copenhagen tertiary neonatal units, in an intended prospective design. Gestational age range was 24,32 weeks at delivery; birth weights 490,2200 g. Median values 28 weeks and 1090 g. B) A brief account of the latest ROP-associated registrations of visual impairment in Danish children aged 0,17 years (n=138). Results: A) ROP was observed in 31.3% (n=201). Retinal cryotherapy was given to eleven ,own' cases and to two from elsewhere (n=13, gestational age at delivery 25,31 weeks). Five had cryotherapy twice. Four of the 13 were later registered for visual impairment. B) Comparing the first and the latest third of the registrations, visual impairment has dropped in frequency and severity over the period from 1981 till now. Conclusions: Compared to previous data the present clinical profile of ROP in Denmark indicates a relatively lower overall frequency of ROP and a decrease in eventual severe visual impairment. Undoubtedly, the continued refinement of neonatal care has been of relevance, but the definite decline in visual impairment further reflects a more complete ophthalmic surveillance, on a national basis. The advanced cases are generally detected in time and retinal ablation therapy offered. [source] Oral D-penicillamine for the prevention of retinopathy of prematurity in very low birth weight infants: a randomized, placebo-controlled trialACTA PAEDIATRICA, Issue 9 2010Manjari Tandon Abstract Purpose:, To compare prophylactic enteral D-penicillamine (DPA) with placebo for prevention of ,retinopathy of prematurity (ROP) or death' among very low birth weight (VLBW) infants. Methods:, This was a double-blind, single-centre, randomized, placebo-controlled trial with stratification (for birth weight <1250 and ,1250 g) and blocking. Inborn neonates with birth weight 750,1500 g, gestation ,32 weeks, age ,5 days, who tolerated feeds were eligible. Neonates with gastro-intestinal malformations, life-threatening malformations and necrotizing enterocolitis were excluded. Enrolled subjects were randomly allocated to receive oral DPA suspension at 100 mg/kg/dose 8 h for 3 days, followed by 50 mg/kg/day for another 11 days or placebo. The primary outcome was ,any ROP or death'. Secondary outcomes included any ROP, treatable ROP, adverse effects and feed intolerance. Results:, A total of 88 subjects were enrolled. Baseline characteristics were similar with the exception of multiple gestation. There were no significant differences in primary and secondary outcomes, even after adjusting for multiple gestation and on sub-group analysis. No adverse reaction was noted. Conclusion:, Prophylactic enterally administered DPA suspension in a dose 100 mg/kg/dose 8 h for 3 days, followed by 50 mg/kg once per day for next 11 days, does not prevent ,any stage ROP or death' or ,ROP requiring treatment' in VLBW infants. DPA is well tolerated and does not have any major short-term adverse effects. [source] Inflammation and retinopathy of prematurityACTA PAEDIATRICA, Issue 7 2010Olaf Dammann No abstract is available for this article. [source] Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)ACTA PAEDIATRICA, Issue 7 2010The EXPRESS Group Abstract Aims:, The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods:, Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004,2007. Results:, Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ,3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion:, Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted. [source] Smoking in pregnancy: a risk factor for adverse neurodevelopmental outcome in preterm infants?ACTA PAEDIATRICA, Issue 7 2010U Kiechl-Kohlendorfer Abstract Aim:, To assess whether smoking in pregnancy influences neurodevelopmental outcome at 2-years of age in preterm infants with a gestational age <32 weeks. Methods:, Between January 2003 and December 2005 we prospectively enrolled 181 infants born alive between 23 and 32 weeks of gestation; 142 infants (78.5%) completed the follow-up visit. The association between candidate risk factors and delayed motor or mental development (Bayley Scales of Infant Development II; psychomotor or mental developmental index <85) was analysed by means of logistic regression analysis. Results:, Low maternal age, smoking in pregnancy, low gestational age, low birth weight, small for gestational age, chronic lung disease, intracerebral haemorrhage, periventricular leucomalacia, and retinopathy of prematurity (stages 3 and 4) all were associated with an increased risk for delayed development (p < 0.05, each). Smoking in pregnancy, small for gestational age and chronic lung disease maintained significance in a multivariable analysis. Conclusion:, Smoking in pregnancy emerged as a risk predictor for adverse neurodevelopmental outcome in our study. Strategies to reduce smoking in pregnancy should be further endorsed. [source] Health and the use of health care services in 5-year-old very-low-birth-weight infantsACTA PAEDIATRICA, Issue 7 2010L Rautava Abstract Aim:, We aimed to study the effect of prematurity, time of birth and level of birth hospital on morbidity and the use of health care services at age 5. Methods: This national study included all very-low-birth-weight infants (VLBWI, <32 gestational weeks or birth weight ,1500 g) born in Finnish level II or III hospitals in 2001,2002 (n = 918), and full-term controls (n = 381). Parental questionnaires and register data were used to compare morbidity, and the use of health care services between VLBWI and full-term controls, and within VLBWI according to the time of birth and birth hospital level. Results:, Cerebral palsy, retinopathy of prematurity, other ophthalmic problems, respiratory infections, asthma or chronic lung disease, and inguinal hernia were overrepresented in VLBWI compared with the controls. VLBWI had more outpatient and inpatient days than the controls. The time of birth and birth hospital level were not associated with the use of services or with prematurity-related morbidity. Conclusion:, Although morbidity and the use of health care services were increased in the surviving VLBWI, the average use of services was relatively small at age 5. In surviving VLBWI, the time of birth and the birth hospital level did not affect morbidity or the use of services. [source] Pain management during eye examinations for retinopathy of prematurity: what about procedural adaptations to blunt the pain response?ACTA PAEDIATRICA, Issue 4 2010K Allegaert No abstract is available for this article. [source] A convenient alternative approach to screen for retinopathy of prematurityACTA PAEDIATRICA, Issue 4 2010Sylvain Chemtob No abstract is available for this article. [source] New insights into the development of retinopathy of prematurity , importance of early weight gainACTA PAEDIATRICA, Issue 4 2010A Hellström Abstract Evidence is accumulating that one of the strongest predictors of retinopathy of prematurity (ROP), in addition to low gestational age, is poor weight gain during the first weeks of life. In infants born preterm, the retina is not fully vascularised. The more premature the child, the larger is the avascular area. In response to hypoxia, vascular endothelial growth factor (VEGF) is secreted. For appropriate VEGF-induced vessel growth, sufficient levels of insulin-like growth factor I (IGF-I) in serum are necessary. IGF-I is a peptide, related to nutrition supply, which is essential for both pre- and post-natal general growth as well as for growth of the retinal vasculature. In prematurely born infants, serum levels are closely related to gestational age and are lower in more prematurely born infants. At preterm birth the placental supply of nutrients is lost, growth factors are suddenly reduced and general as well as vascular growth slows down or ceases. In addition, the relative hyperoxia of the extra-uterine milieu, together with supplemental oxygen, causes a regression of already developed retinal vessels. Postnatal growth retardation is a major problem in very preterm infants. Both poor early weight gain and low serum levels of IGF-I during the first weeks/months of life have been found to be correlated with severity of ROP. Conclusion: This review will focus on the mechanisms leading to ROP by exploring factors responsible for poor early weight gain and abnormal vascularisation of the eye of the preterm infant. [source] Serum levels of IGF1 are a useful predictor of retinopathy of prematurityACTA PAEDIATRICA, Issue 4 2010A Pérez-Muñuzuri Abstract Objective:, To ascertain whether insulin-like growth factor 1 (IGF1) is associated with retinopathy of prematurity (ROP) and is a useful predictor of the disease. Although its aetiopathogenesis is multifactorial, development of the disease appears to be related to a deficiency in IGF1, a hormone that acts together with vascular endothelial growth factor in the normal angiogenesis in the retina. Design:, Prospective study for a 30-month period. Participants:, A total of 74 premature newborn babies, of less than 1500 g and/or 32 weeks' gestational age or less. Testing:, To determine the development and severity of ROP. Main outcome measures:, Serum levels of IGF1 were measured once a week from birth until 40 weeks corrected gestational age in each subject. Results:, Of our subjects, 32.4% developed some form of ROP, and all those ROP patients had the following characteristics at birth (median ± standard deviation scores): low weight (1098 ± 188 vs. 1393 ± 285 g), short length (36.74 ± 1.77 vs. 38.89 ± 3.08 cm), small cranial perimeter (26.03 ± 1.74 vs. 27.93 ± 1.81 cm) and young gestational age (29.7 ± 1.78 vs. 31.3 ± 1.79 weeks) (p < 0.05). Other factors previously associated with ROP that were also observed with statistically significant frequency in our ROP patients were bronchopulmonary dysplasia, intracranial haemorrhage, the need for erythrocyte transfusion or treatment with erythropoietin and sepsis (all p < 0.05). Levels of IGF1 at the 3rd week post-partum, independent of gestational age at birth, were clearly lower in the group who developed ROP (29.13 vs. 43.16 ng/mL, p < 0.05). A value of 30 ng/mL of IGF1 in the third week post-partum was found to have a 90% sensitivity in the diagnosis of ROP. A rapid rise in IGF1 levels between the 3rd and 5th weeks appeared to be related to the development of a higher stage of ROP. Conclusion: Determination of IGF1 serum levels in the 3rd week post-partum, independent of gestational age at birth, provides a sufficient and reliable prognostic tool and allows the identification of a group of patients at high risk of developing the disease. [source] Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic reviewACTA PAEDIATRICA, Issue 3 2010X. Sun Abstract Aim:, To assess whether non-pharmacological and/or pharmacological measures lead to decreased pain during an eye examination in preterm infants. Methods:, . Design:, Systematic review. Subjects:, Premature infants meeting the criteria for screening eye examination for retinopathy. Intervention:, Databases were searched through the Ovid interface. Randomized and quasi-randomized controlled trials were included. Data were assessed independently by three reviewers. Main outcome measures:, Pain assessed by Premature Infant Pain Profile (PIPP) or physiological changes. Results:, Eight studies were included and grouped according to intervention: oral sucrose (group 1), anaesthetic eye drops (group 2) and non-pharmacological measures (group 3). For group 1, the mean PIPP score with sucrose was 1.38 (WMD) (95% CI: 0.41,2.35) lower than that of placebo (p = 0.005). For group 2, one study showed a reduction of two points on the PIPP score with topical proparacaine, whereas another showed no benefit. For group 3, developmental care improved developmental scores and salivary cortisol in one study. Conclusion:, Sucrose reduced pain during the eye examination, whereas the efficacy of proparacaine was not consistent in the studies included. However, PIPP scores remained relatively high in all the studies; thus further research is required to delineate better pain reduction strategies. [source] | ||||||||||