Incidence and Early Course of Retinopathy of Prematurity

Palmer, Earl A.; Flynn, John T.; Hardy, Robert J.; Phelps, Dale L.; Phillips, Cynthia L.; Schaffer, David B.; Tung, Betty

doi:10.1016/j.ophtha.2020.01.034

Cited by 72 publications

(78 citation statements)

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“…Surprisingly, the momentary risk of ROP treatment peaked at 12 weeks' postnatal age regardless of GA at birth, while no specific pattern was observed for postmenstrual age. This observation is particularly interesting because the ETROP study 27 found that the progression of prethreshold ROP was highly associated with postmenstrual age, similar to the finding in the CRYO-ROP (Cryotherapy for ROP) study 28 15 years earlier. However, it should be emphasized that infants included in the CRYO-ROP study were born at higher GA, and no GA-specific hazard functions were studied for ROP outcome.…”

Section: Discussionsupporting

confidence: 63%

Individual Risk Prediction for Sight-Threatening Retinopathy of Prematurity Using Birth Characteristics

et al. 2020

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IMPORTANCE To prevent blindness, repeated infant eye examinations are performed to detect severe retinopathy of prematurity (ROP), yet only a small fraction of those screened need treatment. Early individual risk stratification would improve screening timing and efficiency and potentially reduce the risk of blindness. OBJECTIVES To create and validate an easy-to-use prediction model using only birth characteristics and to describe a continuous hazard function for ROP treatment. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, Swedish National Patient Registry data from infants screened for ROP (born between January 1, 2007, and August 7, 2018) were analyzed with Poisson regression for time-varying data (postnatal age, gestational age [GA], sex, birth weight, and important interactions) to develop an individualized predictive model for ROP treatment (called DIGIROP-Birth [Digital ROP]). The model was validated internally and externally (in US and European cohorts) and compared with 4 published prediction models. MAIN OUTCOMES AND MEASURES The study outcome was ROP treatment. The measures were estimated momentary and cumulative risks, hazard ratios with 95% CIs, area under the receiver operating characteristic curve (hereinafter referred to as AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS Among 7609 infants (54.6% boys; mean [SD] GA, 28.1 [2.1] weeks; mean [SD] birth weight, 1119 [353] g), 442 (5.8%) were treated for ROP, including 142 (40.1%) treated of 354 born at less than 24 gestational weeks. Irrespective of GA, the risk for receiving ROP treatment increased during postnatal weeks 8 through 12 and decreased thereafter. Validations of DIGIROP-Birth for 24 to 30 weeks' GA showed high predictive ability for the model overall (AUC, 0.90 [95% CI, 0.89-0.92] for internal validation, 0.94 [95% CI, 0.90-0.98] for temporal validation, 0.87 [95% CI, 0.84-0.89] for US external validation, and 0.90 [95% CI, 0.85-0.95] for European external validation) by calendar periods and by race/ethnicity. The sensitivity, specificity, PPV, and NPV were numerically at least as high as those obtained from CHOP-ROP (Children's Hospital of Philadelphia-ROP), OMA-ROP (Omaha-ROP), WINROP (weight, insulinlike growth factor 1, neonatal, ROP), and CO-ROP (Colorado-ROP), models requiring more complex postnatal data. CONCLUSIONS AND RELEVANCE This study validated an individualized prediction model for infants born at 24 to 30 weeks' GA, enabling early risk prediction of ROP treatment based on birth characteristics data. Postnatal age rather than postmenstrual age was a better predictive variable for the temporal risk of ROP treatment. The model is an accessible online application that appears to be generalizable and to have at least as good test statistics as other models requiring longitudinal neonatal data not always readily available to ophthalmologists.

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Section: Discussionsupporting

confidence: 63%

Individual Risk Prediction for Sight-Threatening Retinopathy of Prematurity Using Birth Characteristics

et al. 2020

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“…An example of retinal damage commonly found in babies born preterm is ROP, a proliferative retinal vascular disease . Since the 1940s, ROP has been identified as a major cause of visual impairment in children born very preterm and oxygen supplementation has been recognised as an important risk factor in ROP development .…”

Section: Retinopathy Of Prematuritymentioning

confidence: 99%

“…Since the 1940s, ROP has been identified as a major cause of visual impairment in children born very preterm and oxygen supplementation has been recognised as an important risk factor in ROP development . Up to 65 per cent of babies born with a birth weight ≤1,250 grams develop ROP . The disorder is characterised by abnormal growth of peripheral retinal blood vessels in response to altered retinal oxygen concentrations when a baby is born very preterm …”

Section: Retinopathy Of Prematuritymentioning

confidence: 99%

“…After birth, the baby is exposed to a relatively hyperoxic environment compared to in utero and this downregulates vascular endothelial growth factor (VEGF) production and halts the growth of the blood vessels in the peripheral retina . As the retina becomes more metabolically active after approximately 31 weeks GA, the existing blood vessels cannot adequately meet the oxygen demands, which upregulates VEGF production in the retina, resulting in uncontrolled proliferation of blood vessels . These new blood vessels extend from the retina into the vitreous as extraretinal fibrovascular proliferations, which, in turn, can lead to retinal detachment and subsequent vision loss .…”

Section: Retinopathy Of Prematuritymentioning

confidence: 99%

“…Visual deficits are measured and defined in various ways, so the exact prevalence is unknown. Damage to the retina from ROP is a common effect of very preterm birth . In addition, preterm birth can affect the development of brain structures that are involved in post‐retinal processing of visual information such as the optic nerves, optic radiations, primary visual cortex, extrastriate visual cortex and visuomotor integration areas …”

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confidence: 99%

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The effects of preterm birth on visual development

Leung

Thompson

Black

et al. 2018

Clinical and Experimental Optometry

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Children born very preterm are at a greater risk of abnormal visual and neurological development when compared to children born at full term. Preterm birth is associated with retinopathy of prematurity (a proliferative retinal vascular disease) and can also affect the development of brain structures associated with post‐retinal processing of visual information. Visual deficits common in children born preterm, such as reduced visual acuity, strabismus, abnormal stereopsis and refractive error, are likely to be detected through childhood vision screening programs, ophthalmological follow‐up or optometric care. However, routine screening may not detect other vision problems, such as reduced visual fields, impaired contrast sensitivity and deficits in cortical visual processing, that may occur in children born preterm. For example, visual functions associated with the dorsal visual processing stream, such as global motion perception and visuomotor integration, may be impaired by preterm birth. These impairments can continue into adolescence and adulthood and may contribute to the difficulties in learning (particularly reading and mathematics), attention, behaviour and cognition that some children born preterm experience. Improvements in understanding the mechanisms by which preterm birth affects vision will inform future screening and interventions for children born preterm.

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Effects ofMyo-inositol on Type 1 Retinopathy of Prematurity Among Preterm Infants <28 Weeks’ Gestational Age

Phelps¹,

Watterberg²,

Nolen³

et al. 2018

JAMA

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IMPORTANCE Previous studies of myo-inositol in preterm infants with respiratory distress found reduced severity of retinopathy of prematurity (ROP) and less frequent ROP, death, and intraventricular hemorrhage. However, no large trials have tested its efficacy or safety.OBJECTIVE To test the adverse events and efficacy of myo-inositol to reduce type 1 ROP among infants younger than 28 weeks' gestational age. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial included 638 infants younger than 28 weeks' gestational age enrolled from 18 neonatal intensive care centers throughout the United States from April 17, 2014, to September 4, 2015 final date of follow-up was February 12, 2016. The planned enrollment of 1760 participants would permit detection of an absolute reduction in death or type 1 ROP of 7% with 90% power. The trial was terminated early due to a statistically significantly higher mortality rate in the myo-inositol group.INTERVENTIONS A 40-mg/kg dose of myo-inositol was given every 12 hours (initially intravenously, then enterally when feeding; n = 317) or placebo (n = 321) for up to 10 weeks. MAIN OUTCOMES AND MEASURES Type 1 ROP or death before determination of ROP outcome was designated as unfavorable. The designated favorable outcome was survival without type 1 ROP. RESULTS Among 638 infants (mean, 26 weeks' gestational age; 50% male), 632 (99%) received the trial drug or placebo and 589 (92%) had a study outcome. Death or type 1 ROP occurred more often in the myo-inositol group vs the placebo group (29% vs 21%, respectively; adjusted risk difference, 7% [95% CI, 0%-13%]; adjusted relative risk, 1.41 [95% CI, 1.08-1.83], P = .01). All-cause death before 55 weeks' postmenstrual age occurred in 18% of the myo-inositol group and in 11% of the placebo group (adjusted risk difference, 6% [95% CI, 0%-11%]; adjusted relative risk, 1.66 [95% CI, 1.14-2.43], P = .007). The most common serious adverse events up to 7 days of receiving the ending dose were necrotizing enterocolitis (6% for myo-inositol vs 4% for placebo), poor perfusion or hypotension (7% vs 4%, respectively), intraventricular hemorrhage (10% vs 9%), systemic infection (16% vs 11%), and respiratory distress (15% vs 13%).CONCLUSIONS AND RELEVANCE Among premature infants younger than 28 weeks' gestational age, treatment with myo-inositol for up to 10 weeks did not reduce the risk of type 1 ROP or death vs placebo. These findings do not support the use of myo-inositol among premature infants; however, the early termination of the trial limits definitive conclusions.

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Incidence and Early Course of Retinopathy of Prematurity

Cited by 72 publications

References 0 publications

Individual Risk Prediction for Sight-Threatening Retinopathy of Prematurity Using Birth Characteristics

Individual Risk Prediction for Sight-Threatening Retinopathy of Prematurity Using Birth Characteristics

The effects of preterm birth on visual development

Effects ofMyo-inositol on Type 1 Retinopathy of Prematurity Among Preterm Infants <28 Weeks’ Gestational Age

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Incidence and Early Course of Retinopathy of Prematurity

Cited by 72 publications

References 0 publications

Individual Risk Prediction for Sight-Threatening Retinopathy of Prematurity Using Birth Characteristics

Individual Risk Prediction for Sight-Threatening Retinopathy of Prematurity Using Birth Characteristics

The effects of preterm birth on visual development

Effects ofMyo-inositol on Type 1 Retinopathy of Prematurity Among Preterm Infants &lt;28 Weeks’ Gestational Age

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Effects ofMyo-inositol on Type 1 Retinopathy of Prematurity Among Preterm Infants <28 Weeks’ Gestational Age