Retinopathy of Prematurity and other Ocular Problems in Premature Infants Weighing less than 1500 g at Birth

2002 ◽  
Vol 12 (6) ◽  
pp. 506-511 ◽  
Author(s):  
I.C. Asproudis ◽  
S.K. Andronikou ◽  
E.A. Hotoura ◽  
C.D. Kalogeropoulos ◽  
G.K. Kitsos ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Ocular Motility ◽  
Refractive Errors ◽  
Ophthalmological Examination ◽  
Retinal Hemorrhages

Purpose To estimate the incidence of retinopathy of prematurity and other ocular problems in a population of preterm infants. Methods This retrospective study included all infants with gestational age (GA) <32 weeks and birth weight (BW) <1500 g cared for in the neonatal intensive care unit (NICU) over a period of nine years (1992–2000). Ophthalmological examination was started the 4th week of life and included refractive examination, examination of the cornea and funduscopy under mydriasis. An ocular motility test was done after the 2nd month. Results The study included 194 infants. Stage I and II retinopathy occurred in 51 infants but regressed spontaneously. Five of the 194 (2.5%) had to undergo cryopexy. Optic disc atrophy was observed in association with peri-intraventricular hemorrhage (PIIVH) (grade IV) in seven infants. Fifteen infants (7.7%) had retinal hemorrhages which were absorbed by three months of age. Almost 20% of the study infants developed high refractive errors and 13.4% strabismus. Conclusions Not only retinopathy of prematurity, but other serious ocular problems were observed in this population of preterm infants. The role of PIIVH III-IV in the pathogenesis of certain ocular problems needs further elucidation.

The role of intracranial hypotension in neonatal intraventricular hemorrhage

1983 ◽  
Vol 58 (2) ◽  
pp. 204-209 ◽  
Author(s):  
E. Scott Conner ◽  
Antonio V. Lorenzo ◽  
Keasley Welch ◽  
Brent Dorval
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Intracranial Hypotension ◽  
Intraventricular Hemorrhage ◽  
Rabbit Model ◽  
Germinal Matrix ◽  
Content Type ◽  
Ventricular Hemorrhage ◽  
Fine Print

✓ Most preterm infants develop transient intracranial hypotension, which reaches its lowest level on the 2nd day of life. This corresponds to the time when most neonatal intraventricular hemorrhage (IVH) occurs. In order to test the hypothesis that intracranial hypotension may have an etiological role in the development of IVH in premature infants, the authors induced intracranial hypotension in the preterm rabbit by the intraperitoneal injection of glycerol. The rabbit model is well suited for this study because this animal is at risk of developing spontaneous germinal matrix and ventricular hemorrhage. Compared to control littermates, the glycerol-treated animals exhibited a greater than 3.5-fold incidence of germinal matrix and intraventricular hemorrhage.

scholarly journals Identification of candidate genes and pathways in retinopathy of prematurity by whole exome sequencing of preterm infants enriched in phenotypic extremes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Jin Kim ◽  
◽  
Kemal Sonmez ◽  
Ryan Swan ◽  
J. Peter Campbell ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Preterm Infants ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Smooth Endoplasmic Reticulum ◽  
Enrichment Analysis ◽  
Retinal Disease ◽  
Gene Set Enrichment Analysis ◽  
Whole Exome

AbstractRetinopathy of prematurity (ROP) is a vasoproliferative retinal disease affecting premature infants. In addition to prematurity itself and oxygen treatment, genetic factors have been suggested to predispose to ROP. We aimed to identify potentially pathogenic genes and biological pathways associated with ROP by analyzing variants from whole exome sequencing (WES) data of premature infants. As part of a multicenter ROP cohort study, 100 non-Hispanic Caucasian preterm infants enriched in phenotypic extremes were subjected to WES. Gene-based testing was done on coding nonsynonymous variants. Genes showing enrichment of qualifying variants in severe ROP compared to mild or no ROP from gene-based tests with adjustment for gestational age and birth weight were selected for gene set enrichment analysis (GSEA). Mean BW of included infants with pre-plus, type-1 or type 2 ROP including aggressive posterior ROP (n = 58) and mild or no ROP (n = 42) were 744 g and 995 g, respectively. No single genes reached genome-wide significance that could account for a severe phenotype. GSEA identified two significantly associated pathways (smooth endoplasmic reticulum and vitamin C metabolism) after correction for multiple tests. WES of premature infants revealed potential pathways that may be important in the pathogenesis of ROP and in further genetic studies.

Effects of fetal haemoglobin on systemic oxygenation in preterm infants and the development of retinopathy of prematurity PacIFiHER Report No. 2

2021 ◽  
pp. bjophthalmol-2021-319546
Author(s):  
Kim Jiramongkolchai ◽  
Michael X Repka ◽  
Jing Tian ◽  
Sue W Aucott ◽  
Jennifer Shepard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Preterm Infants ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Blood Gas ◽  
Dissociation Curve ◽  
Fetal Haemoglobin ◽  
Oxyhaemoglobin Dissociation Curve ◽  
Increased Risk ◽  
Oxygenation Indices

Background/aimsFetal haemoglobin (HbF) has an oxyhaemoglobin dissociation curve that may affect systemic oxygenation and the development of retinopathy of prematurity (ROP). The study aim is to characterise the effects of HbF levels on systemic oxygenation and ROP development.MethodsProspective study conducted from 1 September 2017 through 31 December 2018 at the Johns Hopkins NICU. Preterm infants with HbF measured at birth, 31, 34 and 37 weeks post-menstrual age (PMA), complete blood gas and SpO2 recorded up to 42 weeks PMA, and at least one ROP exam were included.ResultsSixty-four preterm infants were enrolled. Higher HbF was associated with significantly higher SpO2, lower PCO2, lower FiO2 from birth to 31 weeks PMA and 31 to 34 weeks PMA (rs=0.51, rs=−0.62 and rs=−0.63; p<0.0001 and rs=0.71, rs=−0.58 and rs=−0.79; p<0.0001, respectively). To maintain oxygen saturation goals set by the neonatal intensive care unit, higher median FiO2 was required for HbF in the lowest tercile from birth compared with HbF in the highest tercile to 31 weeks and 31 to 34 weeks PMA; FiO2=35 (21–100) versus 21 (21–30) p<0.006 and FiO2=30 (28–100) versus 21 (21–30) p<0.001, respectively. Preterm infants with ROP had poorer indices of systemic oxygenation, as measured by median levels of SpO2 and PCO2, and lower levels of HbF (p<0.039 and p<0.0001, respectively) up to 34 weeks PMA.ConclusionLow HbF levels correlated with poor oxygenation indices and increased risk for ROP. O2 saturation goals to prevent ROP may need to incorporate relative amount of HbF.

Nonpharmacological Techniques to Reduce Pain in Preterm Infants Who Receive Heel-Lance Procedure: A Randomized Controlled Trial

2014 ◽  
Vol 28 (4) ◽  
pp. 335-348 ◽  
Author(s):  
Piera Bergomi ◽  
Michele Chieppi ◽  
Antonella Maini ◽  
Tiziana Mugnos ◽  
Debora Spotti ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Preterm Infants ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Wolfgang Amadeus Mozart ◽  
Controlled Trial ◽  
Standard Procedure ◽  
Blood Collection ◽  
Randomized Controlled ◽  
Heel Lance

Introduction: The heel-lance (HL) method for blood collection from the newborn is controversial for the pain it causes. This is the first randomized controlled trial on the management and reduction of pain using the music of Wolfgang Amadeus Mozart (“Sonata K. 448”) in premature infants hospitalized in a neonatal intensive care unit (NICU). This study has compared nonpharmacological techniques with standard procedure for reducing pain during HL procedure. Methods: Thirty-five premature infants were enrolled, each for 3 HL procedures, of which each was randomized to 1 of the 3 study arms. Arms were then compared in terms of the Premature Infant Pain Profile (PIPP) changes by analysis of variance (ANOVA). Results: One hundred five HL procedures were available for analysis (35 standard procedure, 35 music, 35 glucose). Median baseline PIPP was 3, and median PIPP after the HL procedure was 5. PIPP scale change was +3 in the control arm, +1 in the glucose arm, +2 in the music arm (p = .008). Discussion: Both glucose and music were safe and effective in limiting pain increase when compared to standard procedure in HL procedures in preterm infants.

The Discovery of Retrolental Fibroplasia and the Role of Oxygen: A Historical Review, 1942–1956

2004 ◽  
Vol 23 (2) ◽  
pp. 31-38 ◽  
Author(s):  
Elizabeth Reedy
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Historical Review ◽  
Retrolental Fibroplasia ◽  
History Of ◽  
To Come ◽  
The 1960S ◽  
Prematurely Born Infants ◽  
The U.S

Nearly 50 years after it was thought to be conquered, retinopathy of prematurity (ROP) continues to cause vision disturbances and blindness among prematurely born infants. During the 1940s and early 1950s, researchers and caregivers first identified and struggled to eliminate this problem, which seemed to come from nowhere and was concentrated among the most advanced premature nurseries in the U.S. Research studies initially identified many potential causes, none of which could be proved conclusively. By the mid-1950s, oxygen was identified as the culprit, and its use was immediately restricted. The rate of blindness among premature infants decreased significantly. ROP was not cured, however. By the 1960s, it had reappeared. The history of ROP serves to remind us that, despite our best intentions, the care and treatment of premature newborns will always carry with it the possibility of iatrogenic disease. This caution is worth remembering as we work to expand the quality and quantity of clinical research.

Prematurity and Intraventricular Hemorrhage

2019 ◽  
pp. 19-29
Author(s):  
Catherine A. Mazzola ◽  
Tatiana Huk Sikorskyj
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Imaging Modality ◽  
Treatment Options ◽  
Infantile Hydrocephalus ◽  
Cerebrospinal Fluid Diversion ◽  
Radiologic Imaging ◽  
Evidence Based Guidelines ◽  
Symptoms And Signs

Intraventricular hemorrhage caused by bleeding in the germinal matrix is a complication often seen in premature infants. Variations in cerebral blood flow may lead to rupture of the fragile, immature blood vessels due to their inability to autoregulate or accommodate changes in cerebral perfusion. Post-hemorrhagic hydrocephalus (PHH) may lead to significant neurologic compromise and can be diagnosed by assessing for symptoms and signs of infantile hydrocephalus, followed by radiologic imaging. Treatment options may include temporary and permanent cerebrospinal fluid diversion. Head ultrasound is a common imaging modality used for hydrocephalus surveillance in infants during their postnatal hospital stay in the neonatal intensive care unit. Evidence-based guidelines for the treatment of PHH have been published by the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

scholarly journals Investigation of the relationship between umbilical cord pH and intraventricular hemorrhage of infants delivered preterm

2019 ◽  
Vol 65 (5) ◽  
pp. 647-656
Author(s):  
Ali Mazouri ◽  
Mahtab Massahi ◽  
Nasrin Khalesi ◽  
Ladan Younesi asl ◽  
Mandana Kashaki
Keyword(s):  
Umbilical Cord ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Blood Gases ◽  
Blood Gas ◽  
The Third ◽  
The Relationship ◽  
Type Of Delivery ◽  
Control Study

SUMMARY OBJECTIVE: We measured the level of pH gases in premature infants at birth, and examined the relationship between brain ultrasonography on the third and seventh day after birth. A case-control study conducted at the Neonatal Intensive Care Unit (NICU) of Shahid Akbar Abadi Hospital, Iran, during the years 2016-2017. METHODS: All premature infants who were admitted to NICU were enrolled in the current study. At birth, a blood gas sample was taken from the umbilical cord of the infants. On the third and seventh day after birth, an ultrasound of the brain of each neonate was performed by a radiologist. The umbilical cord was evaluated for blood gases in 72 neonates (mostly boys). RESULTS: Sixty-six newborns had normal sonography, and 16.7% (12 cases) had anomalies. A total of 75% of the 8 infants with intravenous bleeding were girls, which were significantly different from those in the non-hemodynamic group (62.5% male) (P 0.049). However, the type of delivery, mean weight, height, head circumference, the circumference of the chest, and Apgar score did not differ between the two groups. Mean pH, HCO3– and PCO2 in umbilical cord blood gas samples were not significantly different between the two groups with or without intraventricular hemorrhage (IVH). Although it was not related to gender and type of delivery in newborns CONCLUSION: Blood gases do not help in determining the occurrence of IVH in infants. Nevertheless, it is associated with immaturity and fetal age.

National Institues of Health Recommends the Routine Use of H2 Blockers in Preterm Infants be Carefully Evaluated

2006 ◽  
Vol 25 (3) ◽  
pp. 223-224 ◽  
Author(s):  
Elizabeth Pulsifer-Anderson ◽  
Ronnie Guillet
Keyword(s):  
Intensive Care ◽  
Preterm Infants ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Current Practice ◽  
Acid Reflux ◽  
National Institutes Of Health ◽  
Neonatal Intensive Care Units ◽  
New Findings ◽  
The U.S

ARETROSPECTIVE ANALYSIS OF data from 11,000 preterm infants in neonatal intensive care units (NICUs) in the U.S. found that infants receiving H2 blockers such as Zantac, Tagamet, Pepcid, and Axid were more likely to develop necrotizing enterocolitis (NEC).1 The study was funded by the National Institutes of Health (NIH). As a result of the findings of this study, Elias A. Zerhouni, MD, Director of the National Institutes of Health, issued a press release in February, 2006, stating, “This study strongly suggests that the current practice of prescribing H2 blockers to prevent or treat acid reflux in premature infants needs to be carefully reevaluated by all concerned in light of these new findings.”2

Intraventricular Hemorrhage: An Update

1993 ◽  
Vol 8 (4) ◽  
pp. 157-176 ◽  
Author(s):  
Karl C.K. Kuban ◽  
Joseph J. Volpe
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Single Agent ◽  
Survival Rates ◽  
Pharmacological Interventions ◽  
Germinal Matrix ◽  
Vascular Integrity ◽  
The Matrix ◽  
Prenatal Interventions

Although the incidence of intraventricular hemorrhage (IVH) has decreased in recent years, the increasing survival rates for the smallest premature infants indicate that the lesion will continue to be a major problem in neonatal intensive care facilities. We review prenatal, perinatal, and postnatal variables that have been associated with enhanced risk of IVH and address some of the methodological limitations of previously reported studies. The neuropa-thology is characterized by bleeding into the subependymal germinal matrix, with subsequent rupture into the lateral ventricle. The pathogenesis of IVH relates to intravascular, vascular, and extravascular factors. Intravas-cular factors are those that relate primarily to control of blood flow and pressure in the microcirculation of the germinal matrix. Vascular factors relate to the microcirculation of the matrix, the site of initial bleeding. A maturation-dependent alteration of vascular integrity and a vulnerability of matrix vessels to injury appear important. Extravascular factors include those relevant to mesenchy-mal and glial support for matrix vessels and to local fibrino-lytic activity in the germinal matrix. Prognosis in the setting of IVH relates to the mechanisms of brain injury, the most important of which is pcriventricular hemorrhagic infarction, often inappropriately called grade IV IVH and often associated with subsequent motor and cognitive deficits. Prevention of IVH remains the most important goal. Prenatal interventions include prevention of premature birth, transportation of premature infants to a tertiary facility in utero rather than after birth, possibly prenatal administration of phenobarbital or vitamin K, and optimal management of labor and deliver. Postnatal interventions include careful newborn resuscitation, correction or prevention of major hemodynamic disturbances, and correction of abnormalities of coagulation. Postnatal pharmacological interventions that have been studied in detail include phenobarbital, indomethacin, ethamsylate, and vitamin E. No single agent among this group has been shown consistently to lead to a decrease in incidence and severity of IVH.

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