Characteristics of Infants With Severe Retinopathy of Prematurity in Countries With Low, Moderate, and High Levels of Development: Implications for Screening Programs

Gilbert, Clare; Fielder, Alistair R.; Gordillo, Luz; Quinn, Graham E.; Semiglia, Renato; Visintín, Patricia; Zin, Andréa

doi:10.1542/peds.2004-1180

Cited by 653 publications

(614 citation statements)

References 25 publications

(7 reference statements)

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“…7 The annual number of new cases of ROP appears to be increasing worldwide, likely because of the constantly improving ability of modern neonatology to save smaller and more immature neonates. 7,8 Laser ablation of the abnormal retinal vessels is the most common surgical procedure performed on neonates with ROP, in an attempt to stop the disease progression to retinal detachment and blindness. 9 It is typical for anesthesiologists or respiratory therapists to support neonates undergoing ROP surgery by using endotracheal intubation and mechanical ventilation.…”

Section: Resultsmentioning

confidence: 99%

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity

et al. 2007

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Objective: Respiratory support of neonates during and following laser surgery for retinopathy of prematurity (ROP) is commonly accomplished using endotracheal intubation and mechanical ventilation. However, most patients undergoing ROP surgery have been weaned off mechanical ventilation days or weeks before the surgery. When they are electively re-intubated for ROP surgery, it can be difficult to extubate them postoperatively. One of the three level III neonatal intensive care units (NICUs) in the Intermountain Healthcare system initiated a program of using nasopharyngeal prongs, rather than endotracheal intubation, for respiratory support during ROP surgery. Methods:We performed an historic cohort analysis of all neonates undergoing ROP surgery during their NICU stay at the three level III NICU's between 1 January 2002 and 31 March 2006. Data collected included birth weight, gestational age at delivery and corrected gestational age at ROP surgery, whether or not they were intubated in the days immediately preceding the ROP surgery, whether or not they were electively intubated for the ROP surgery, the respiratory modality used during and the 3 days following ROP surgery, and all blood gas determinations and respiratory charges during this period.Results: Fifty-four patients underwent ROP surgery during this period. All 23 from NICUs 'A' and 'B' had endotracheal intubation for surgery, while in NICU 'C' 24 were managed using nasopharyngeal prongs. The birth weights of those intubated for surgery (661±180 g, mean±s.d.) were similar to those not intubated (732±180 g). Similarly, the gestational age at birth did not differ between those intubated for surgery (25.2±1.3 week) and those not (25.6±2.1 week). The day following surgery, 77% (23/30) of those who had been intubated for surgery remained intubated and on mechanical ventilation, whereas only one (4%) of those not intubated for surgery was intubated in the postoperative period (P<0.001). On day 3 following surgery, 50% (15/30) of those intubated for surgery remained intubated and on mechanical ventilation, whereas none of those not intubated for surgery were intubated (P<0.001). Management with nasopharyngeal prongs did not result in higher PCO 2 s, or lower pH values, during or after surgery. Respiratory charges for the 3 days following surgery were $1762±678 (mean±s.d.)/ patient among those intubated versus $357±352/patient for those managed with nasopharyngeal prongs (P<0.001).Conclusions: Neonates undergoing laser surgery for ROP can often be supported intraoperatively and postoperatively using nasopharyngeal prongs, thus avoiding the need for endotracheal intubation.

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Section: Resultsmentioning

confidence: 99%

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity

et al. 2007

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“…The disease is also emerging as a major cause of childhood blindness in middle-income countries like Brazil and in many other places in Latin America, Asia, and Eastern Europe, owing to the increasing survival rates among ELBW and VLBW prematures. 5,[10][11][12] Survival rates among preterm babies born with GA of 27-28 weeks have been reported to be as high as 90%, although the numbers vary widely across countries. 13 Studies suggest that the incidence and severity of ROP show an inverse relationship with BW and GA, 14 with few cases diagnosed in babies weighing over 1500 g or babies whose GA was 432 weeks at birth.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

Filho

Eckert

Procianoy

et al. 2007

Eye

102

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Aims To analyse the incidence and risk factors for retinopathy of prematurity (ROP) and survival rates among extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants. Methods A prospective cohort study of 352 infants admitted at a teaching hospital, Hospital de Clinicas de Porto Alegre, Brazil, between October 2002 and December 2006, was screened for ROP. The ELBW group comprised infants whose birth weight (BW) was p1000 g and the VLBW group comprised those infants whose BW were 41000 g and p1500 g. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Results Of the 352 neonates screened, 88 were ELBW babies. Survival rates among ELBW and VLBW were 47.8 and 88.7%, respectively. ROP affected 48.9% of ELBW infants and 18.2% of VLBW babies. Threshold disease occurred in 21 patients, 15 of whom were born weighing o1000 g. Only 2.3% of the neonates born with more than 1000 g developed treatable disease. Univariate analysis showed that gestational age (GA), BW, use of indomethacin and erythropoietin, blood transfusions, and intraventricular haemorrhage were associated with ROP. After logistic regression, the most important adjusted risk factors were BW (OR: 1.002;95% CI: 1.001-1.003; P ¼ 0.003), GA (OR: 1.254;95% CI: 1.082-1.455; P ¼ 0.003), and use of erythropoietin (OR: 2.486;95% CI: 1.182-5.231; P ¼ 0.016). ConclusionThis study showed reduced survival rates, high incidence of ROP, and a greater need of treatment among ELBW infants as compared to VLBW babies admitted in this institution.

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“…This explosion has been referred to as the third epidemic, as babies with severe ROP have characteristics of first epidemic babies (ie birth weights averaging 1300 g) as well as second epidemic babies (ie mean birth weight of around 750 gs). 19 The implications are that programmes for detecting babies with treatable disease need to include bigger, more mature babies, which significantly increases the number of babies that need to be examined. In many countries, this is occurring against a backdrop of an absolute, or relative lack of ophthalmologists with the necessary skills, motivation or time.…”

Section: Development and Blindness In Childrenmentioning

confidence: 99%

Changing challenges in the control of blindness in children

Gilbert

2007

Eye

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One cannot address issues of control of blindness in children without first considering the epidemiology, as this allows priorities to be determined and appropriate strategies to be delineated. Control does not occur within a vacuum, and so it is also important to understand the context in which programmes are to be implemented, particularly in relation to development and povertyFthe distal risk factors that are powerful determinants of the incidence of disease in populations. Interventions need to be considered from the perspective of patients as well as providers if services are to be acceptable and appropriate.

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Characteristics of Infants With Severe Retinopathy of Prematurity in Countries With Low, Moderate, and High Levels of Development: Implications for Screening Programs

Cited by 653 publications

References 25 publications

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity

Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

Changing challenges in the control of blindness in children

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