Retrolental Fibroplasia: Further Clinical Evidence and Ultrastructural Support for Efficacy of Vitamin E in the Preterm Infant

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 423-432 ◽  
Author(s):  
Helen Mintz Hittner ◽  
Louis B. Godio ◽  
Michael E. Speer ◽  
Arnold J. Rudolph ◽  
Martha M. Taylor ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Birth Weight ◽  
Vitamin E ◽  
Gap Junction ◽  
Gestational Age ◽  
Plasma Membranes ◽  
Tocopheryl Acetate ◽  
Plasma Vitamin ◽  
Retrolental Fibroplasia ◽  
Spindle Cells

To further evaluate the efficacy of oral vitamin E in preventing the development of severe retrolental fibroplasia (RLF) in very low-birth-weight infants, 100 infants treated with 100 mg/kg/d of vitamin E (dl-α-tocopheryl acetate) were compared with 75 infants treated with 5 mg/kg/d of vitamin E (dl-α-tocopherol) in the same nursery during the previous year. All 175 infants weighed ≤1,500 g at birth and required supplemental oxygen. A total of 120 infants (69 treatment; 51 control) survived ≥ 10 weeks. Multivariate analysis of the control population identified five risk factors (P ≤ .10): gestational age, level and duration of oxygen administration, intraventricular hemorrhage, sepsis, and birth weight. When multivariate analysis was applied to both control and treatment groups, the severity of RLF was found to be significantly reduced in infants given the treatment dose of vitamin E(P = .003). Ultrastructural analyses of 58 pairs of whole-eye donations from high-risk infants surviving less than 10 weeks suggest that the initial morphologic event is gap junction increases between the plasma membranes of adjacent spindle cells of the vanguard retina. Such extensively gap junction-linked spindle cells are apparently removed from the vasoformative process as early as 4 days of life, forming a barrier to further normal vascular development and triggering retinal and vitreal neovascularizations approximately 8 weeks later. These events are maximally suppressed by elevated plasma vitamin E levels in infants ≥27 weeks gestational age.

Intraventricular Hemorrhage and Vitamin E in the Very Low-Birth-Weight Infant: Evidence for Efficacy of Early Intramuscular Vitamin E Administration

PEDIATRICS ◽  
1984 ◽  
Vol 74 (6) ◽  
pp. 1107-1112
Author(s):  
Michael E. Speer ◽  
Cindy Blifeld ◽  
Arnold J. Rudolph ◽  
Prabhujett Chadda ◽  
M. E. Blair Holbein ◽  
...  
Keyword(s):  
Birth Weight ◽  
Vitamin E ◽  
Intraventricular Hemorrhage ◽  
Very Low Birth Weight ◽  
Medium Chain Triglyceride ◽  
Tocopheryl Acetate ◽  
Oral Vitamin ◽  
Double Blind ◽  
Retrolental Fibroplasia ◽  
Oral Supplementation

To determine whether early intramuscular vitamin E supplementation influences the incidence of intraventricular hemorrhage (IVH) in infants with birth weight ≤1,500 g, data were analyzed from 134 infants enrolled on a protocol to evaluate the efficacy of intramuscular plus oral vitamin E v oral supplementation alone in the treatment of retrolental fibroplasia. All 134 infants received, via nasogastnic tube, 100 mg/kg/d of vitamin E daily (dl-α-tocopheryl acetate in MCT [medium-chain triglyceride] oil; 150 mosM) for at least 8 weeks with the first dose administered within the first eight hours of life. Sixty-four patients received, in addition, intramuscular vitamin E on days 1, 2, 4, and 6 of life and 70 patients received placebo injections in a randomized double-blind fashion. In the first week, vitamin E plasma levels were significantly higher in the 64 patients given intramuscular vitamin E. In spite of this difference no change in the incidence of sepsis or necrotizing enterocolitis was observed. Both the incidence and severity of intraventricular hemorrhage were reduced significantly in the patients given intramuscular vitamin E as compared to the patients given placebo (P = .013 and P = .04, respectively). The data suggest that vitamin E, a natural antioxidant, may play an important role in protecting the CNS microcirculation from the effects of hypoxic/ischemic injury.

d-Penicillamine and Retinopathy of Prematurity

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 951-952
Author(s):  
LAJOS LAKATOS
Keyword(s):  
Birth Weight ◽  
Vitamin E ◽  
Low Birth Weight ◽  
Retinopathy Of Prematurity ◽  
Very Low Birth Weight ◽  
Marked Decrease ◽  
Neonatal Period ◽  
Low Birth Weight Infants ◽  
Retrolental Fibroplasia ◽  
Clinical Observations

To the Editor.— The letter to the editor by Johnson et al1 and studies by others regarding vitamin E prophylaxis for retinopathy of prematurity suggest that further research into the prevention of retinopathy of prematurity should not be limited to vitamin E. On the basis of clinical observations we reported that d-penicillamine treatment in the neonatal period was associated with a marked decrease in the incidence of severe retrolental fibroplasia among the very low birth weight infants.2

Retrolental Fibroplasia and Vitamin E in the Preterm Infant—Comparison of Oral Versus Intramuscular:Oral Administration

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 238-249
Author(s):  
Helen M. Hittner ◽  
Michael E. Speer ◽  
Arnold J. Rudolph ◽  
Cindy Blifeld ◽  
Prabhujeet Chadda ◽  
...  
Keyword(s):  
Vitamin E ◽  
Very Low Birth Weight ◽  
Plasma Vitamin ◽  
Oral Vitamin ◽  
Low Birth Weight Infants ◽  
Retrolental Fibroplasia ◽  
Intramuscular Injections ◽  
Significant Difference ◽  
Plasma Vitamin E ◽  
Vitamin E Supplementation

To evaluate the efficacy of four early intramuscular injections of vitamin E given in addition to continuous minimal oral vitamin E supplementation, 168 very low-birth-weight infants (≤1,500 g) have enrolled in a randomized, double-masked, clinical study. All infants received vitamin E orally, 100 mg/kg/d. In addition, on days 1, 2, 4, and 6, seventy-nine infants received vitamin E intramuscularly, 15, 10, 10, and 10 mg/kg, respectively. On the same days, 89 control infants received placebo intramuscular injections. Multivariate analysis of the 135 infants who survived ≥10 weeks showed no significant difference in the development of severe retrolental fibroplasia between these two supplementation schedules (P = .86). Plasma vitamin E levels never exceeded a mean of 3.3 mg/100 mL, and no toxicity was observed. Ultrastructural analyses of seven pairs of whole eye donations from infants receiving IM vitamin E demonstrated identical kinetics of gap junction formation between adjacent spindle cells as compared with 13 pairs of whole eye donations from control infants (P > .3). Therefore, oral vitamin E supplementation affords retinal protection against the development of severe retrolental fibroplasia when initiated on the first day of life and maintained continuously until retinal vascularization is complete.

28-Day Survival Rates of 6676 Neonates With Birth Weights of 1250 Grams or Less

PEDIATRICS ◽  
1991 ◽  
Vol 87 (1) ◽  
pp. 7-17
Author(s):  
Dale L. Phelps ◽  
David R. Brown ◽  
Betty Tung ◽  
George Cassady ◽  
Richard E. McClead ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
Survival Advantage ◽  
Lower Birth Weight ◽  
Single Birth

Survival rates specific for birth weight, gestational age, sex, and race are described for 6676 inborn neonates who weighed less than 1251 g at birth and were born during 1986 through 1987. Overall 28-day survival increased with gestational age and birth weight, from 36.5% at 24 weeks' gestation to 89.9% at 29 weeks' gestation, or from 30.0% for neonates of 500 through 599 g birth weight to 91.3% for neonates of 1200 through 1250 g. The expected birth weight-specific survival advantage for female neonates and black neonates diminished when the data were controlled for gestational age, showing that certain previously reported survival advantages are based on lower birth weight for a given gestational age. Multivariate analysis showed that all tested variables were significant predictors for survival, in order of descending significance: gestational age and birth weight, sex, race, single birth, and small-for-gestational-age status. The powerful effect of gestational age on survival highlights the need for an accurate neonatal tool to assess the gestational age of very low birth weight neonates after birth.

scholarly journals Factors Affecting the Weaning from Nasal CPAP in Preterm Neonates

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Shantanu Rastogi ◽  
Hariprem Rajasekhar ◽  
Anju Gupta ◽  
Alok Bhutada ◽  
Deepa Rastogi ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Birth Weight ◽  
Gestational Age ◽  
Retrospective Review ◽  
Univariate Analysis ◽  
Preterm Neonates ◽  
Factors Affecting ◽  
Factors Influencing ◽  
Successful Weaning ◽  
Postmenstrual Age

Objective. Identification of the weight and postmenstrual age (PMA) at successful weaning of NCPAP in preterm neonates and the factors influencing the successful wean.Study Design. Retrospective review of 454 neonates ≤32 weeks of gestational age (GA) who were placed on NCPAP and successfully weaned to room air was performed.Results. Neonates had a mean birth weight (BW) of grams with a mean GA of weeks. Neonates were weaned off NCPAP at mean weight of grams and mean PMA of weeks. Univariate analysis showed that chorioamnionitis, intubation, surfactant use, PDA, sepsis/NEC, anemia, apnea, GER and IVH were significantly associated with the time to NCPAP wean. On multivariate analysis, among neonates that were intubated, BW was the only significant factor () that was inversely related to time to successful NCPAP wean. Amongst non-intubated neonates, along with BW (), chorioamnionitis (), anemia (), and GER () played a significant role in weaning from NCPAP.Conclusion. Neonates were weaned off NCPAP at mean weight of grams and mean PMA of weeks. BW significantly affects weaning among intubated and non-intubated neonates, though in neonates who were never intubated chorioamnionitis, anemia and GER also significantly affected the duration on NCPAP.

scholarly journals Higher Incidence of Hypospadias in Monochorionic Twins

2015 ◽  
Vol 18 (5) ◽  
pp. 591-594 ◽  
Author(s):  
Remco Visser ◽  
Nienke C. M. Burger ◽  
Erik W. van Zwet ◽  
Yvonne Hilhorst-Hofstee ◽  
Monique C. Haak ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Birth Weight ◽  
Confidence Interval ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Medical Records ◽  
Odds Ratio ◽  
Age Group ◽  
Monochorionic Twins ◽  
Appropriate For Gestational Age

Background:Hypospadias is associated with twinning. The incidence of hypospadias in monochorionic and dichorionic male twins is, however, yet to be determined.Methods:All medical records of monochorionic and dichorionic twins admitted to our neonatal nursery between January 2004 and August 2013 were reviewed for the presence of hypospadias.Results:A total of 350 monochorionic and 303 dichorionic male twins were included in the study. The incidence of hypospadias in monochorionic and dichorionic groups was 4% (14/350) and 1% (3/303) (p= .016) respectively. In 11 of the 15 twin couples, hypospadias occurred in the twin with the lowest birth weight. The rate of hypospadias in twin infants small-for-gestational-age group was 10% (6/60) compared with 2% (11/593) in the appropriate-for-gestational-age group (p= .002). In a multivariate analysis, both monochorionicity and small-for-gestational-age were independently associated with hypospadias, odds ratio 4.1 (95% confidence interval (CI): 1.1–14.7) and 6.1 (95% CI: 2.2–17.2) respectively.Conclusions: The incidence of hypospadias is four-fold higher in monochorionic twins compared with dichorionic twins. Hypospadias is also independently associated with small-for-gestational-age.

Retrolental Fibroplasia and Factors Influencing Oxygen Transport

PEDIATRICS ◽  
1977 ◽  
Vol 59 (6) ◽  
pp. 916-918
Author(s):  
David Lechner ◽  
Robert E. Kalina ◽  
W. Alan Hodson
Keyword(s):  
Birth Weight ◽  
Premature Infants ◽  
Oxygen Transport ◽  
Gestational Age ◽  
Oxygen Therapy ◽  
Blood Transfusions ◽  
Hospital Records ◽  
Retrolental Fibroplasia ◽  
Factors Influencing ◽  
Significant Difference

The hospital records of 58 premature infants in whom proliferative retrolental fibroplasia (RLF) developed were matched with the records of 58 infants without RLF for birth weight, gestational age, and duration of oxygen therapy. The two groups were compared for factors likely to influence tissue delivery of oxygen by blood. No significant difference was found in incidence of blood transfusions or exchange transfusions, use of phototherapy, or occurrence of acidosis.

Vitamin E and the Prevention of Retinopathy of Prematurity

PEDIATRICS ◽  
1985 ◽  
Vol 76 (2) ◽  
pp. 315-316
Author(s):  
Keyword(s):  
Birth Weight ◽  
Vitamin E ◽  
Retinopathy Of Prematurity ◽  
Animal Studies ◽  
Very Low Birth Weight ◽  
Controlled Trial ◽  
The United States ◽  
Supplemental Oxygen ◽  
Retrolental Fibroplasia ◽  
Effective Prophylaxis

In spite of numerous human and animal studies, the etiology of retinopathy of prematurity (previously called retrolental fibroplasia) remains obscure. Prevention attempts with judicious use and careful monitoring of supplemental oxygen, while decreasing the incidence, have not eradicated this complication of prematurity. Currently, retinopathy of prematurity is a condition that cannot be prevented in certain infants, especially those of very low birth weight. One controlled trial suggested that the prophylactic oral administration of 100 mg/kg/d of free vitamin E to babies at highest risk, while not decreasing the incidence of retinopathy of prematurity, decreases the severity in affected infants.1 Three other controlled trials showed a lower incidence of severe retinopathy of prematurity in treated groups (25 mg/kg intramuscular or 25 mg/d oral, or variable intravenous doses), but none of these differences were statistically significant.2-4 These observations have led some authors to suggest that vitamin E be routinely administered to all infants weighing less than 1,500 g at birth.5,6 It must be noted that any effective prophylaxis with vitamin E in the United States would require that 22,000 surviving infants of birth weight less than 1,500 g be treated annually to prevent approximately 2,000 infants from developing the cicatricial sequelae of retinopathy of prematurity.7 The treatment of 20,000 infants who would not develop retinopathy of prematurity would be acceptable if it were certain that the administration of vitamin E was completely safe or, at least, that the benefits of its use outweighed the risks by a substantial margin. Preliminary reports, however, suggest the possibility of complications associated with the administration of pharmacologic doses of vitamin E.8,9

scholarly journals Prevalence and Risk Factors of Retinopathy of Prematurity in Iran

2019 ◽  
Author(s):  
Mohammad Zarei ◽  
Fatemeh Bazvand ◽  
Nazanin Ebrahimiadib ◽  
Ramak Roohipoor ◽  
Reza Karkhaneh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Extremely Low Birth Weight ◽  
Increased Risk ◽  
Extremely Preterm ◽  
History Of

Purpose: The present study aimed to evaluate the frequency and risk factors of retinopathy of prematurity (ROP) among Iranian infants. Methods: A retrospective cohort study was conducted on infants who had undergone screening for ROP at Farabi Eye Hospital, between March 2016 and March 2017. Data were analyzed based on the presence of extreme prematurity (gestational age ≤ 28 weeks), extremely low-birth-weight (≤ 1000 g), and multiplegestation (MG) infants. Results: The prevalence of ROP was 27.28% (n = 543) among all screened infants, 74.4% for extremely preterm (EP) infants, 77.5% for extremely low birth weight (ELBW) babies, and 27.25% for infants from MG pregnancies. On multivariate analysis, gestational age, birth weight, and history of transfusion (P < 0.0001, P < 0.0001, and P = 0.04, respectively) were found to be significantly associated with ROP. More advanced stages of ROP (P < 0.0001) were observed in EP and ELBW infants. Birth weight (P = 0.088), history of transfusion (P = 0.066), and intubation (P = 0.053) were not associated with increased risk of ROP in EP infants, while gestational age (P = 0.037) and history of transfusion (P = 0.040) were significant risk factors for ROP in ELBW infants. Gestational age (P < 0.001) and birth weight (P = 0.001) were significantly associated with ROP in infants from MG pregnancies in multivariate analysis. Conclusion: ROP remains a commonly encountered disease, especially in ELBW and EP infants. The history of transfusion may have a role in stratifying the risk for ROP and guiding future screening guidelines.

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