Increased frequency of retinopathy of prematurity over the last decade and significant regional differences

Holmström, Gerd; Törnqvist, Kristina; Al-Hawasi, Abbas; Nilsson, A.-M.; Wallin, Agneta; Hellström, Ann

doi:10.1111/aos.13549

Cited by 55 publications

(52 citation statements)

References 18 publications

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“…Fortunately, the meta-analyses did not show more blindness in spite of more severe ROP in the high saturation target group although some studies report increased blindness after new guidelines recommending higher target saturations were published. In a Swedish region, a significant 2.2-fold increase in treated ROP was found after changing recommendations to higher targets [29]. However, alarm limits were not tightly defined.…”

Section: Discussionmentioning

confidence: 99%

Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits

Saugstad¹

2018

Neonatology

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Background: For 70 years, there has been a search for the optimal oxygenation of premature infants. In spite of the lack of evidence, guidelines have successively reduced oxygenation targets during these years. Objectives: (1) To present a summary of previously published meta-analyses of 5 randomized studies (NeOProM) which tested a low (85–89%) versus a high (91–95%) oxygen saturation target the first weeks after birth on outcome of immature newborn infants. (2) To present international recommendations for oxygenation the first weeks after birth. Methods: Data were retrieved from meta-analyses and reviews of these studies. Results: Mortality and necrotizing enterocolitis (NEC) are significantly higher in patients with a low saturation target (relative risk, RR 1.16 and 1.24, respectively), while severe retinopathy of prematurity (ROP) is reduced (RR 0.74), fortunately without a change in the rate of blindness. Severe intraventricular hemorrhage, patent ductus arteriosus, and bronchopulmonary dysplasia (defined physiologically) were not significantly affected by the oxygen targets in the range of these studies. Based on these data, it is recommended that SpO₂ targets from birth to 36 weeks postconceptional age for infants < 28 weeks gestational age (GA) should be between 90 and 94% (with alarm limits of 89 and 95%), respectively. It is recommended to keep infants small for GA well oxygenated within the suggested targets avoiding fluctuations. Conclusions: The ideal oxygen saturation targets for infants < 28 weeks GA are not known. Mortality, ROP, and NEC seem to be particularly oxygen-sensitive outcome variables. The optimal oxygen saturation for premature infants > 28 weeks GA has not been carefully studied.

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Section: Discussionmentioning

confidence: 99%

Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits

Saugstad¹

2018

Neonatology

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“…A Cochrane review of all 5 trials, comprising nearly 5,000 infants, confirmed an increased risk of death at [18][19][20][21][22][23][24] [8]. It is likely that concerns about increasing the risk of ROP is one reason why not all NICUs have adopted higher SpO 2 targets [21][22][23]. However, our survey suggests that whilst many NICUs did change to higher SpO 2 targets, some with initial upper limits > 95% changed to an upper limit of ≤95%, most notably in Japan.…”

Section: Discussionmentioning

confidence: 99%

Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey

et al. 2018

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Background: Rates of retinopathy of prematurity (ROP) and ROP treatment vary between neonatal intensive care units (NICUs). Neonatal care practices, including oxygen saturation (SpO₂) targets and criteria for the screening and treatment of ROP, are potential contributing factors to the variations. Objectives: To survey variations in SpO₂ targets in 2015 (and whether there had been recent changes) and criteria for ROP screening and treatment across the networks of the International Network for Evaluating Outcomes in Neonates (iNeo). Methods: Online prepiloted questionnaires on treatment practices for preterm infants were sent to the directors of 390 NICUs in 10 collaborating iNeo networks. Nine questions were asked and the results were summarized and compared. Results: Overall, 329/390 (84%) NICUs responded, and a majority (60%) recently made changes in upper and lower SpO₂ target limits, with the median set higher than previously by 2–3% in 8 of 10 networks. After the changes, fewer NICUs (15 vs. 28%) set an upper SpO₂ target limit > 95% and fewer (3 vs. 5%) a lower limit < 85%. There were variations in ROP screening criteria, and only in the Swedish network did all NICUs follow a single guideline. The initial retinal examination was carried out by an ophthalmologist in all but 6 NICUs, and retinal photography was used in 20% but most commonly as an adjunct to indirect ophthalmoscopy. Conclusions: There is considerable variation in SpO₂ targets and ROP screening and treatment criteria, both within networks and between countries.

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“…CP is a condition that occurs globally, with a similar ratio among both developed and undeveloped countries. However, the etiology differs according to the socioeconomic status of the countries [5]. Congenital hemiplegia is the most common form of CP among children born at term and second to diplegia among children born prematurely [6].…”

Section: Introductionmentioning

confidence: 99%

Pattern of Cerebral Palsy Among Sudanese Children Less Than 15 Years of Age

Salih

2020

Cureus

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Background: Cerebral palsy (CP) is a non-progressive, everlasting neurological disorder of movement, posture, and physical activities, with a prevalence of 2.2-3.3/1,000. CP is a condition that occurs globally, with a similar prevalence in both developed and undeveloped countries. However, the etiology differs according to the socioeconomic status of the countries. The objective is to determine the pattern and the contributing factors of CP among Sudanese children. Methods: This was a retrospective hospital-based study conducted over a period of three years in a pediatric referral hospital in Khartoum, Sudan. One hundred and eight patients of CP were enrolled, of whom 59 (54.6%) were males and 49 (45.4%) were females. Results: Spastic quadriplegic CP was the most common type. Most cases were from lower social classes. Prenatal, antenatal, and unclassified CP were found in 45 (41.7%), 31 (28.7.%), 23 (21.3%), and 9 (8.3%) cases, respectively. Birth asphyxia, neonatal jaundice, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus infections (TORCH), and sepsis (acquired) were the main causative factors. Conclusion: Spastic quadriplegia is the most common type of CP. Most of the cases had a direct positive relationship with socioeconomic status. The prenatal period was the most common period for the development of CP.

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Increased frequency of retinopathy of prematurity over the last decade and significant regional differences

Abstract: The Swedish national ROP register revealed an increased incidence of ROP during an 8-year period and significant regional differences regarding the incidence of ROP and frequency of treatment.

Cited by 55 publications

References 18 publications

Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits

Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits

Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey

Pattern of Cerebral Palsy Among Sudanese Children Less Than 15 Years of Age

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