THE PREVALENCE OF RETINOPATHY OF PREMATURITY UNDER THE CONDITIONS OF THE PERINATAL CENTER BASED AT THE CHILDREN’S MULTI-DISCIPLINARY HOSPITAL

Introduction. Retinopathy of prematurity remains one of the most challenging problems in neonatal ophthalmology and the leading cause of blindness and disability in the young children. Purpose. The objective of the present study was to evaluate the prevalence of retinopathy of prematurity and the effectiveness of its treatment under the present conditions of nursing the preterm infants. Materials and methods. We carried out the ophthalmological observations and treatment of 393 premature children admitted to the Perinatal Centre of the Saint Petersburg State Pediatric Medical University during the period from 2014 to 2016 for the provision of the specialized care needed to manage various obstetric and perinatal pathological conditions. The patients included the children born with a body weight from 450 to 2500 g (average weight of 1056 ± 301,9 g) at the 23d to 33d weeks of gestation (mean age at birth 28,77 ± 2,37 weeks). Results. The frequency of retinopathy of prematurity and dynamics of its clinical course as well as the need for its laser and surgical treatment in such patients differed during these three years. The number of children with retinopathy of prematurity in the group with the extremely low birth weight increased from 75.0% in 2014 to 96.3% in 2016 largely due to the rise in the occurrence of the early stages of the disease among the preterm infants in combination with severe concomitant cardiosurgical and neurosurgical pathologies. 77.8% of the children in this group needed to be treated with the use of preventive retinal laser photocoagulation. However, only every third infant born at the 28-33d week of gestation actually received the required surgical treatment. The effectiveness of retinal laser photocoagulation increased from 85% in 2014 to 95% in 2016. Conclusion. The management of the preterm children presenting with retinopathy of prematurity based at the perinatal centre with the integrated maternity hospital and the multidisciplinary children’s hospital creates the optimal conditions for the comprehensive treatment of such patients

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‘NOPAIN-ROP’ trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial

BMJ Open ◽

10.1136/bmjopen-2020-046235 ◽

2021 ◽

Vol 11 (9) ◽

pp. e046235

Author(s):

Shamnad Madathil ◽

Deena Thomas ◽

Parijat Chandra ◽

Ramesh Agarwal ◽

M Jeeva Sankar ◽

...

Keyword(s):

Preterm Infants ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Bolus Dose ◽

Tertiary Care ◽

Randomised Trial ◽

Haemodynamic Instability ◽

Intravenous Bolus ◽

Intravenous Fentanyl ◽

Intravenous Ketamine

ObjectivesTo investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP).DesignOpen-label randomised trial.SettingTertiary care institution.ParticipantsPreterm infants who underwent laser photocoagulation for ROP.InterventionsInfants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase.Main outcome measuresProportion of infants with adequate analgesia defined as the presence of both: (1) all the Premature Infant Pain Profile-Revised scores measured every 15 min less than seven and (2) proportion of the procedure time the infant spent crying less than 5%.Secondary outcomes included apnoea, cardiorespiratory or haemodynamic instability, feed intolerance and urinary retention requiring catheterisation during and within 24 hours following the procedure.ResultsA total of 97 infants were randomised (fentanyl=51, ketamine=46). The proportions of infants with adequate analgesia were 16.3% (95% CI 8.5% to 29%) with fentanyl and 4.5% (95% CI 1.3% to 15.1%) with ketamine. Ten infants (19.6%) in the fentanyl group and seven infants (15.2%) in the ketamine group had one or more side effects. In view of inadequate analgesia with both the regimens, the study steering committee recommended using a higher dose of intravenous fentanyl and intravenous ketamine. Consequently, we enrolled 27 infants (fentanyl=13, ketamine=14). With revised regimens, the proportions of infants with adequate analgesia were higher: 23.1% (95% CI 8.2% to 50.2%) with fentanyl and 7.1% (95% CI 1.3% to 31.5%) with ketamine. However, higher proportions of infants developed apnoea (n=4; 30.7%), need for supplemental oxygen (n=5, 38.4%) and change in cardiorespiratory scores (n=7; 53.8%) with fentanyl but none with ketamine.ConclusionsFentanyl-based and ketamine-based drug regimens provided adequate analgesia only in a minority of infants undergoing laser photocoagulation for ROP. More research is needed to find safe and effective regimens that can be employed in resource constrained settings.Trial registration numberCTRI/2018/03/012878.

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Assessment of Outcomes With a Sedation Protocol During Laser Photocoagulation in Preterm Infants With Retinopathy of Prematurity

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-23.5.410 ◽

2018 ◽

Vol 23 (5) ◽

pp. 410-416 ◽

Cited By ~ 1

Author(s):

Jennifer F. Dannelley ◽

Peter N. Johnson ◽

Michael P. Anderson ◽

Kari Oestreich ◽

R. Michael Siatkowski ◽

...

Keyword(s):

Logistic Regression ◽

Retrospective Study ◽

Adverse Events ◽

Clinical Response ◽

Preterm Infants ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Primary Objective ◽

Sedation Protocol ◽

Midazolam Infusion

OBJECTIVES To evaluate the success of a sedation protocol of fentanyl and midazolam infusions for infants undergoing laser photocoagulation for retinopathy of prematurity. METHODS This retrospective study included infants receiving a sedation protocol for laser photocoagulation during a 4-year period. The primary objective was protocol success, defined as completion without interruption, absence of protocol dose deviations, and absence of interventions. Secondary objectives compared outcomes between those with and without opioid/benzodiazepine exposure. A logistic regression was used to assess the effect of prior opioid/benzodiazepine exposure on requirement for fentanyl infusion increases. RESULTS Twenty-six infants were included. Seven (26.9%) had protocol success. Sixteen (61.5%) had protocol success, excluding dose deviations. Seventeen (65.4%) experienced ≥1 cardiopulmonary adverse events. Photocoagulation was completed in all cases. CONCLUSIONS Most achieved protocol success, when eliminating dosing deviations. These data indicate that flexibility is needed in fentanyl and midazolam infusion titration, based on clinical response.

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Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in extremely low birth weight preterm infants after extubation: a single centre randomized controlled trial

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20204404 ◽

2020 ◽

Vol 7 (11) ◽

pp. 2125

Author(s):

Dhilli Ravindranath Gangu ◽

Seshagiri Koripadu

Keyword(s):

Preterm Infants ◽

Positive Airway Pressure ◽

Supplemental Oxygen ◽

Extremely Low Birth Weight ◽

Average Weight ◽

High Flow Nasal Cannula ◽

Non Invasive ◽

Nasal Injury ◽

Duration Of Hospitalization ◽

Average Weight Gain

Background: The objective of the study was to assess the indications, frequency of usage, clinical efficacy, and safety of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in extremely low birth weight preterm infants (ELBWI) after extubation.Methods: Hospital based prospective randomized control study involving ELBWI with respiratory distress admitted in NICU. In this study, all selected preterm infants were placed on one of the non-invasive respiratory supports (HHHFNC or NCPAP), after a period of positive pressure ventilation (post-extubation). Reintubation rate within 72 hours after initial extubation, duration of invasive ventilation, duration of non-invasive respiratory support, duration of supplemental oxygen, and time to reach full feeds were the primary outcome measures. Duration of total enteral feeding, average weight gain rate, duration of hospitalization, and complications including nasal injury, IVH, BPD, NEC, ROP, and PDA, were the secondary outcomes.Results: A sample size of 46 ELBWI were included. HHHFNC effectively reduced the incidence of nasal injury and NEC (p<0.05) along with the decreased duration of supplementary oxygen. Additionally, HHHFNC achieved a significant advance in time to reach full enteral feeding; increased the average weight gain before discharge; reduced the duration of hospitalization (p<0.05).Conclusions: HHHFNC was effective in preventing extubation failure in mechanically ventilated preterm ELBWI compared to NCPAP. HHHFNC shortens the duration of supplemental oxygen and significantly reduces the incidence of nasal injury and necrotizing enterocolitis; moreover, it can also reduce the duration of hospitalization and its cost.

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Surgical Treatment of Photocoagulation Uveal Complications in Retinopathy of Prematurity

Russian ophthalmology of children ◽

10.25276/2307-6658-2019-1-5-10 ◽

2019 ◽

pp. 5-10

Author(s):

Y.D. Kuznetsova ◽

◽

I.B. Astasheva ◽

I.E. Khatsenko ◽

E.V. Gamayunova ◽

...

Keyword(s):

Surgical Treatment ◽

Retinopathy Of Prematurity

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Study to Assess the Efficacy, Safety, and Tolerability of Intravitreal Aflibercept Compared to Laser Photocoagulation in Patients With Retinopathy of Prematurity

Case Medical Research ◽

10.31525/ct1-nct04101721 ◽

2019 ◽

Author(s):

Keyword(s):

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Intravitreal Aflibercept

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

Scientific Reports ◽

10.1038/s41598-021-83552-y ◽

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.

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Is intravenous fish oil associated with the neurodevelopment of extremely low birth weight preterm infants on parenteral nutrition?

Clinical Nutrition ◽

10.1016/j.clnu.2021.02.036 ◽

2021 ◽

Author(s):

Chiara Biagetti ◽

Alessio Correani ◽

Rita D’Ascenzo ◽

Enrica Ferretti ◽

Cecilia Proietti ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Parenteral Nutrition ◽

Fish Oil ◽

Preterm Infants ◽

Extremely Low Birth Weight

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Risk Factors Associated with Retinopathy of Prematurity in Very and Extremely Preterm Infants

Medicina ◽

10.3390/medicina57050420 ◽

2021 ◽

Vol 57 (5) ◽

pp. 420

Author(s):

Claudia Ioana Borțea ◽

Florina Stoica ◽

Marioara Boia ◽

Emil Radu Iacob ◽

Mihai Dinu ◽

...

Keyword(s):

Risk Factors ◽

Preterm Infants ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Univariate Analysis ◽

Significant Risk ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Surfactant Administration ◽

Stage 1

Background and Objectives: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. We studied the relationship between different perinatal characteristics, i.e., sex; gestational age (GA); birth weight (BW); C-reactive protein (CRP) and lactate dehydrogenase (LDH) concentrations; ventilation, continuous positive airway pressure (CPAP), and surfactant administration; and the incidence of Stage 1–3 ROP. Materials and Methods: This study included 247 preterm infants with gestational age (GA) < 32 weeks that were successfully screened for ROP. Univariate and multivariate binary analyses were performed to find the most significant risk factors for ROP (Stage 1–3), while multivariate multinomial analysis was used to find the most significant risk factors for specific ROP stages, i.e., Stage 1, 2, and 3. Results: The incidence of ROP (Stage 1–3) was 66.40% (164 infants), while that of Stage 1, 2, and 3 ROP was 15.38% (38 infants), 27.53% (68 infants), and 23.48% (58 infants), respectively. Following univariate analysis, multiple perinatal characteristics, i.e., GA; BW; and ventilation, CPAP, and surfactant administration, were found to be statistically significant risk factors for ROP (p < 0.001). However, in a multivariate model using the same characteristics, only BW and ventilation were significant ROP predictors (p < 0.001 and p < 0.05, respectively). Multivariate multinomial analysis revealed that BW was only significantly correlated with Stage 2 and 3 ROP (p < 0.05 and p < 0.001, respectively), while ventilation was only significantly correlated with Stage 2 ROP (p < 0.05). Conclusions: The results indicate that GA; BW; and the use of ventilation, CPAP, and surfactant were all significant risk factors for ROP (Stage 1–3), but only BW and ventilation were significantly correlated with ROP and specific stages of the disease, namely Stage 2 and 3 ROP and Stage 2 ROP, respectively, in multivariate models.

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