Respiratory Complications in Infants with Retinopathy of Prematurity (ROP) Requiring Laser Photocoagulation

2021 ◽  
Author(s):  
Novisi Arthur ◽  
Emma Byrne ◽  
Folasade Kehinde ◽  
Vineet Bhandari ◽  
Vilmaris Quinones Cardona
Keyword(s):  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Laser Photocoagulation ◽  
Retrospective Chart Review ◽  
Respiratory Support ◽  
Maternal Characteristics ◽  
Neonatal Pain ◽  
Pain Scores ◽  
Sedation Scores ◽  
Respiratory Outcomes

Objective The objective of this paper was to describe peri-procedural events and complications of infants requiring laser photocoagulation for retinopathy of prematurity (ROP) in a level IV neonatal intensive care unit. Study Design A retrospective chart review was performed of neonates requiring ROP exams from January 2017 to August 2020. Baseline maternal and neonatal characteristics, ROP exam findings, and associated treatment were analyzed. Group characteristics were compared based on the need for laser photocoagulation. Subgroup analysis of the laser group including respiratory outcomes, cardiorespiratory index (CRI) scores, and pain scores was also performed. Results Neonatal and maternal characteristics in the laser (n = 27) and non-laser (n = 172) groups were assessed. Of the 81.5% (22/27) that required re-intubation for laser, 36% (8/22) had >1 intubation and 18% (4/22) had >1 extubation attempt. The average duration of intubation following laser was 2.46 ± 7.13 days, with 40% (9/22) needing peri-extubation steroids and 18% (4/22) racemic epinephrine to facilitate extubation. Mean total respiratory support time post-laser was 8.65 ± 15.23 days. Mean neonatal pain, agitation, and sedation scores after laser were zero immediately after the procedure, 0.09 ± 0.33 at 12 hours, 0.11 ± 0.47 at 24 hours, and 0.11 ± 0.51 at 48 hours. The mean CRI scores were 1 ± 0 immediately after the procedure, 1.17 ± 0.4 at 12 hours, 1.41 ± 0.20 at 24 hours, and 1 ± 0 at 48 hours. Conclusion Nearly all infants undergoing laser photocoagulation for ROP in our cohort required intubation and continued respiratory support. Despite stability during the procedure, complications from intubation were common. Key Points

Respiratory outcomes in children with congenital myotonic dystrophy

2021 ◽  
pp. 1-5
Author(s):  
Jaclyn C. Omura ◽  
Maida Chen ◽  
Miriam Haviland ◽  
Susan Apkon
Keyword(s):  
Respiratory Distress ◽  
Myotonic Dystrophy ◽  
Invasive Mechanical Ventilation ◽  
Retrospective Chart Review ◽  
Mortality Rates ◽  
Respiratory Support ◽  
Non Invasive ◽  
Congenital Myotonic Dystrophy ◽  
Respiratory Outcomes

PURPOSE: Congenital myotonic dystrophy (CDM) results in hypotonia and acute respiratory distress at birth. Previous studies show that prolonged periods of intubation (>4 weeks) correlate with increased mortality rates. The objective is to describe the use and duration of respiratory support in newborns with CDM and how these relate to mortality. METHODS: A retrospective chart review was performed at a tertiary pediatric hospital among children with confirmed diagnosis of CDM. The main outcome measures were: mortality, duration of invasive mechanical ventilation (IMV) and non-invasive partial pressure ventilation (NIPPV), along with long-term use of respiratory support and equipment. RESULTS: A total of 18 subjects met inclusion criteria, 83%.f which had documented respiratory distress at birth, 39%.equired NIPPV, and 50%.equired intubation in the neonatal period. The earliest NIPPV was initiated at day one of life, and the latest extubation to NIPPV was at 17 days of life. CONCLUSION: This cohort required IMV for shorter periods with earlier transitions to NIPPV which suggests a possible change in practice and earlier transition to NIPPV recently. Further data are needed to determine if there is a possible correlation between the need for NIPPV/IMV and mortality rates.

scholarly journals COVID-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach

2020 ◽  
Vol 37 (08) ◽  
pp. 780-791 ◽  
Author(s):  
Wissam Shalish ◽  
Satyanarayana Lakshminrusimha ◽  
Paolo Manzoni ◽  
Martin Keszler ◽  
Guilherme M. Sant'Anna
Keyword(s):  
Neonatal Intensive Care ◽  
Discharge Planning ◽  
Control Strategies ◽  
Young Patients ◽  
Perinatal Transmission ◽  
Respiratory Support ◽  
Current Evidence ◽  
Respiratory Care ◽  
Novel Coronavirus ◽  
Respiratory Outcomes

The novel coronavirus disease 2019 (COVID-19) pandemic has urged the development and implementation of guidelines and protocols on diagnosis, management, infection control strategies, and discharge planning. However, very little is currently known about neonatal COVID-19 and severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2) infections. Thus, many questions arise with regard to respiratory care after birth, necessary protection to health care workers (HCW) in the delivery room and neonatal intensive care unit (NICU), and safety of bag and mask ventilation, noninvasive respiratory support, deep suctioning, endotracheal intubation, and mechanical ventilation. Indeed, these questions have created tremendous confusion amongst neonatal HCW. In this manuscript, we comprehensively reviewed the current evidence regarding COVID-19 perinatal transmission, respiratory outcomes of neonates born to mothers with COVID-19 and infants with documented SARS-CoV-2 infection, and the evidence for using different respiratory support modalities and aerosol-generating procedures in this specific population. The results demonstrated that to date, neonatal COVID-19 infection is uncommon, generally acquired postnatally, and associated with favorable respiratory outcomes. The reason why infants display a milder spectrum of disease remains unclear. Nonetheless, the risk of severe or critical illness in young patients exists. Currently, the recommended respiratory approach for infants with suspected or confirmed infection is not evidence based but should include all routinely used types of support, with the addition of viral filters, proper personal protective equipment, and placement of infants in isolation rooms, ideally with negative pressure. As information is changing rapidly, clinicians should frequently watch out for updates on the subject. Key Points

A Comparison of Respiratory Outcomes after Treating Retinopathy of Prematurity with Laser Photocoagulation or Intravitreal Bevacizumab

2020 ◽  
Vol 4 (12) ◽  
pp. 1202-1208 ◽  
Author(s):  
Gerard P. Barry ◽  
Kate A. Tauber ◽  
Scott Greenberg ◽  
Juliann Lajoie ◽  
Farzana Afroze ◽  
...  
Keyword(s):  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Intravitreal Bevacizumab ◽  
Respiratory Outcomes

scholarly journals Treatment for Retinopathy of Prematurity in an Infant with Adenoviral Conjunctivitis

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Murat Gunay ◽  
Gokhan Celik ◽  
Rahim Con
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Laser Photocoagulation ◽  
Pediatric Population ◽  
Neonatal Intensive Care Units

Retinopathy of prematurity (ROP) has been a major problematic disorder during childhood. Laser photocoagulation (LPC) has been proven to be effective in most of the ROP cases. Adenoviral conjunctivitis (AVC) is responsible for epidemics among adult and pediatric population. It has also been reported to be a cause of outbreaks in neonatal intensive care units (NICU) several times. We herein demonstrate a case with AVC who underwent LPC for ROP. And we discuss the treatment methodology in such cases.

Opioid Infusions in the Neonatal Intensive Care Unit

2010 ◽  
Vol 15 (2) ◽  
pp. 142-146
Author(s):  
Amanda Suarez ◽  
David C. Knoppert ◽  
David S. C. Lee ◽  
Donna Pletsch ◽  
Jamie A. Seabrook
Keyword(s):  
Pain Assessment ◽  
Neonatal Intensive Care ◽  
Assessment Tool ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Primary Objective ◽  
Procedural Pain ◽  
Opioid Use ◽  
Neonatal Pain ◽  
Scale Scores

ABSTRACT OBJECTIVES The primary objective of this study was to compare the use of opioid infusions to that proposed in guidelines published in an in-house medication handbook. Secondary objectives were to assess the documented use of a standardized neonatal pain assessment tool and to describe the supplemental use of opioids concurrent with an opioid infusion. METHODS A retrospective chart review was performed for all patients in the NICU who received opioid infusions between November 1, 2005, and November 30, 2006. Data collected included patient characteristics, opioid infusion dosing and duration, supplemental opioid use, and pain assessment documentation. RESULTS Of the110 neonates who received morphine or fentanyl during the study period, 65 patients met inclusion criteria. Reasons for starting an opioid infusion included nonsurgical sedation and/or analgesia (51%), postoperative pain (17%), and procedural pain (1%). No reason was documented for 31% of patients. Thirtyeight percent of neonates received a loading dose of opioid before initiation of the infusion. The median dose was 100 mcg/kg (IQR=48.2) for morphine and and 1 mcg/kg (IQR=0.8) for fentanyl. The mean ± SD starting rates of morphine and fentanyl infusions were 12.3 ± 4.7 mcg/kg/hr and 1.5 ± 1.7 mcg/kg/hr, respectively. Supplemental opioid doses were given to 46% of neonates during the infusion period. Supplemental doses were given for procedures (69%) and pain/agitation/sedation (26%). No reason was documented for 5% of patients. The Neonatal Pain, Agitation and Sedation Scale scores were only documented 9% of the time for each day that the patient received an opioid infusion. CONCLUSIONS Dosing of opioids generally was within the recommendations that are described in the in-house medication handbook. A substantial percentage of neonates received supplemental opioid doses while on opioid infusions, mostly for procedural pain management. Documentation of the reason for using opioid infusions and the assessment of neonatal pain was poor.

scholarly journals Severity of respiratory disease is correlated with time of first oral feeding and need for a gastrostomy tube at discharge in premature infants born at <30 weeks of gestation

2021 ◽  
Author(s):  
Emily Anderson ◽  
Matthew Gregoski ◽  
Daniel Gehle ◽  
William Head ◽  
Thomas Hardy ◽  
...  
Keyword(s):  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Retrospective Chart Review ◽  
Oral Feeding ◽  
Gastrostomy Tube ◽  
Respiratory Support ◽  
Respiratory Parameters ◽  
Postmenstrual Age ◽  
Highly Correlated ◽  
Different Levels

Background: Premature infants who cannot achieve full oral feeds may need a gastrostomy tube (GT) to be discharged from the neonatal intensive care unit (NICU). We previously developed a model to predict which infants born <30 weeks (w) gestational age (GA) will require a GT before discharge. Here we report the detailed respiratory variable data to describe the general respiratory course for infants in the NICU <30w GA at birth and the association between different levels of respiratory support with postmenstrual age (PMA) at the time of first oral feeding attempt (PMAff), including later need for GT for discharge. Methods: Retrospective chart review of 391 NICU admissions comprising test (2015-2016) and validation (2017-2018) cohorts. Data, including respiratory support, were collected on 204 infants, 41 GT and 163 non-GT, in the test cohort, and 187 infants, 37 GT and 150 non-GT, in the validation cohort. Results: Respiratory data were significantly different between GT and non-GT infants. Infants who required GT for discharge were on significantly higher respiratory support at 30 days of age, 32w PMA, and 36w PMA. Respiratory parameters were highly correlated with PMAff. Conclusion: Respiratory status predicts PMAff, which was the variable in our previously described model that was most predictive of failure to achieve full oral feeing. These data provide a catalyst to develop strategies for improving oral feeding outcome for infants requiring prolonged respiratory support in the NICU.

scholarly journals Posterior Pole Sparing Laser Photocoagulation Combined with Intravitreal Bevacizumab Injection in Posterior Retinopathy of Prematurity

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Rebecca Kim ◽  
Yu Cheol Kim
Keyword(s):  
Laser Ablation ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Intravitreal Bevacizumab ◽  
Retrospective Chart Review ◽  
Posterior Pole ◽  
Intravitreal Bevacizumab Injection ◽  
Premature Babies ◽  
Postmenstrual Age ◽  
Bevacizumab Injection

Purpose. To report the results of the posterior pole sparing laser photocoagulation combined with intravitreal bevacizumab injection (IVB) in retinopathy of prematurity (ROP).Methods. A retrospective chart review of premature babies with ROP, all of whom received laser photocoagulation with IVB. Eleven eyes of 6 infants with advanced zone I ROP underwent laser ablation sparing posterior pole with concurrent IVB. The results were compared with those of full-laser treatment combined with IVB to 8 eyes of 5 infants with advanced ROP without involvement of the posterior pole.Results. The posterior pole sparing laser with IVB was performed with zone I, stage 3+ ROP at the mean postmenstrual age of 36 weeks and 5 days. The plus sign decreased significantly at postoperative day 1, the neovascular proliferation regressed by postoperative week 1, and the normal vascularization started at postoperative day 32 on the average. Two months after treatment, vascularization of the spared avascular area was completed. There was no macular dragging, tractional retinal detachment, foveal destruction by laser scars, or any other adverse event. No significant anatomical differences were identified from those of full-laser ablation combined with IVB.Conclusions. Posterior pole sparing laser with IVB can give favorable results without destruction of posterior pole retina.

scholarly journals Incidence and risk factors of retinopathy of prematurity in Goa, India: a report from tertiary care centre

2019 ◽  
Vol 6 (3) ◽  
pp. 1228
Author(s):  
Sarvesh Kossambe ◽  
Shilpa Joglekar ◽  
Annely D'lima ◽  
M. P. Silveira
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Laser Photocoagulation ◽  
Very Low Birth Weight ◽  
Care Center ◽  
Tertiary Care ◽  
Preterm Neonates ◽  
Tertiary Care Centre

Background: To report the incidence and risk factors leading to the development of retinopathy of prematurity (ROP) from a tertiary care center in the western Indian state of Goa, India.Methods: This was a prospective observational study carried out in a level II neonatal intensive care unit (NICU) for a period of 18 months. Babies born at < 34 weeks’ gestation and having a birth weight of <1500gm were screened for ROP and laser photocoagulation was done for those who developed threshold ROP. Group differences between any ROP and threshold ROP were analysed using the chi-square test.Results: Out of the 244 preterm neonates screened, 37 developed ROP (15.16%), and 14 out of them (5.73%) developed threshold ROP requiring laser photocoagulation. Very low birth weight, prematurity, apnea, anemia, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, blood transfusions, exchange transfusions and days taken to reach full enteral feeds and regain birth weight were significantly associated with the development of ROP.Conclusions: This is the first report of ROP from Goa where less than 1 in 5 babies developed ROP. This is similar to that reported across the rest of the country. Judicious oxygen use, ventilation strategies, transfusions guidelines, control of sepsis, early enteral feeds and adequate nutrition may help prevent the development of ROP in the future.

Lack of Association of Intraventricular Hemorrhage with Retinopathy of Prematurity

2018 ◽  
Vol 17 (06) ◽  
pp. 219-222
Author(s):  
Ivan Hand ◽  
Eric Shrier
Keyword(s):  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Retrospective Chart Review ◽  
Kings County ◽  
Stage 4 ◽  
Very Low Birthweight Infants ◽  
Stage 1

Objective Retinopathy of prematurity (ROP) is the primary cause of visual impairment in premature infants. Our objective was to study the relationship between ROP and intraventricular hemorrhage (IVH) in the premature infant. Methods This study was a retrospective chart review of very low birthweight infants of 1,500 g or less admitted to Kings County Hospital Center's neonatal intensive care unit who were screened for ROP over a 6-year period. Results Of 335 infants screened for ROP, 85 infants were identified to have ROP. Of these, 50 (56%) infants had stage 1 ROP, 25 (29%) had stage 2 ROP, 7 (8%) had stage 3 ROP, and 3 (4%) had stage 4 ROP. The incidence of IVH in our population was 14%. Multiple logistic regression demonstrated a significant association between ROP and gestational age (p = 0.001). There was no significant association between ROP stage and IVH grade. There was also no significant association between birthweight, ethnicity, or 5-minute Apgar score. Conclusions Our data demonstrated no association between IVH and severity of ROP. There was a statistically significant association between ROP and gestational age. We speculate that these data may be a reflection of improvement in neonatal care, with a declining incidence of IVH as well as increased ROP screening efforts.

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