Modifiable Risk Factors and Preventative Strategies for Severe Retinopathy of Prematurity

Prasad, Minali; Ingolfsland, Ellen C.; Christiansen, Stephen P.

doi:10.3390/life13051075

Cited by 2 publications

(3 citation statements)

References 181 publications

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“…Likely, additional risk factors may have played a role in these critically ill patients in promoting ROP progression. 29 The data in this interim analysis comprise only a part of the planned study sample size of 146 patients; therefore, a positive effect of CB-RBC transfusions in preventing ROP progression could not be conclusively assessed. Moreover, the number of patients evaluated prevented adjusting for any centerrelated variability, and possible confounders due to local practices could not be excluded.…”

Section: Discussionmentioning

confidence: 99%

“…7 Modifying conditions that exacerbate hyperoxia in the rst phase, or hypoxia in the second one, might reduce the risk for ROP development and progression. 29 Among modi able risk factors, research has focused on the role of RBC transfusions and premature exposure to the adult form of hemoglobin, which has lower oxygen a nity than HbF. Using continuous near-infrared spectroscopy (NIRS) monitoring, we previously showed that CB-RBC and A-RBC transfusions are associated with different kinetics of cerebral regional oxygen saturation (crSO2) and cerebral fraction of tissue oxygen extraction (cFTOE).…”

Section: Discussionmentioning

confidence: 99%

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Cord Blood Transfusions in Extremely Low Gestational Age Neonates in Italy: Results of a Prespecified Interim Analysis of the Randomized Born Trial.

Teofili,

Papacci,

Dani

et al. 2024

Preprint

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Background Preterm infants are at high risk for retinopathy of prematurity (ROP), with potential life-long visual impairment. Low fetal hemoglobin (HbF) levels have been associated with ROP, but it is presently unknown if preventing the HbF decrease also reduces ROP. Case presentation: BORN is an ongoing multicenter double-blinded randomized controlled trial investigating whether transfusing HbF-enriched cord blood-red blood cells (CB-RBCs) instead of RBC units from adult donors (A-RBCS) reduces the incidence of severe ROP. Neonates born before 28 weeks of gestation are enrolled. Neonates are randomized 1:1 to receive adult donor-RBCs (A-RBCs, arm A) or allogeneic CB-RBCs (arm B) from birth to the postmenstrual age (PMA) of 31 + 6 weeks. The main outcome is the rate of severe ROP at 40 weeks of PMA or discharge. A prespecified interim analysis was scheduled after the first 58 patients were enrolled. Results in the intention-to-treat and per-protocol sets of analyses are reported. Twenty-eight patients were in arm A and 30 in arm B. Overall, 104 A-RBC units and 49 CB-RBC units were transfused, with a high rate of protocol deviations. A total of 336 adverse events were recorded, with similar incidence and severity in the two arms. By per-protocol analysis, patients receiving A-RBCs or both RBC types experienced more adverse events than non-transfused patients or those transfused exclusively with CB-RBCs, and suffered from more severe forms of bradycardia, pulmonary hypertension, and hemodynamically significant patent ductus arteriosus. Serum potassium, lactate, and pH were similar after CB-RBC or A-RBC transfusions. Fourteen patients died and 44 were evaluated for ROP. Ten of them developed severe ROP, with no differences between arms. At per-protocol analysis each A-RBC transfusion carried a relative risk for severe ROP of 1.66 (95% CI 1.06–2.20) in comparison with CB-RBCs. The area under the curve of HbF suggested that HbF decrements before the PMA of 30 weeks are critical for severe ROP development. Importantly subsequent CB-RBC transfusions do not lessen the ROP risk. Conclusions CB-RBC transfusions in preterm neonates are safe and, if early adopted, may help protect them from severe ROP. Trial registration: ClinicalTrials.gov Identifier: NCT05100212, Registered 29 October 2021

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cord Blood Transfusions in Extremely Low Gestational Age Neonates in Italy: Results of a Prespecified Interim Analysis of the Randomized Born Trial.

Teofili,

Papacci,

Dani

et al. 2024

Preprint

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“…Numerous studies have explored risk factors for ROP to identify a way to screen for ROP early. Several perinatal (3) and postnatal factors, such as elevated maternal leukocyte count and clinical chorioamnionitis, have been associated with ROP, and the most common and well-studied perinatal and neonatal risk factors for the development of severe ROP are hyperoxemia, hypoxia, and prolonged respiratory support (4). The current screening criteria for ROP, birth weight (BW) and gestational age (GA), have high sensitivity but low speci city (5), and others use postnatal weight gain or insulin-like growth factor 1 (IGF-1) levels to screen for ROP.…”

Section: Introductionmentioning

confidence: 99%

Association between Hematocrit in the First Two Hours of Life and Retinopathy during Prematurity: A Retrospective Study from DRYAD

Kong,

Wang,

Yang

et al. 2024

Preprint

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Introduction: Our study investigated the association between hematocrit in the first two hours (HCT2h) of life and retinopathy of prematurity (ROP). Methods Data were obtained from an observational study of the DRYAD database. The study was conducted at the Santa Clara Valley Medical Center (SCVMC). Data on preterm babies whose gestational age (GA) was < 34 weeks were collected prospectively from January 2008 to February 2014. Logistic regression was applied to explore the association between HCT2h and ROP. Results A total of 326 very preterm infants born at or earlier than 34 weeks were included. The incidence of any ROP was 23.9%, and the incidence of severe ROP was 4.6%. The HCT2h, birth weight, GA, Apgar1 min, and Apgar5 min of any ROP group were significantly lower than those of preterm babies without ROP (p < 0.001). Sex differences, the rate of multiples, and delivery mode between the two groups were not statistically significant (p > 0.05). We classified HCT2h into three levels, and after multivariate logistic regression, we found that high HCT2h remained a significant protective factor against ROP (p < 0.001). Through subgroup analysis, we observed that among preterm infants with a GA of 28 weeks or more, there was a significant inverse association between a 1% increase in HCT2h and a 17% reduction in the occurrence of ROP. Conclusion We found that a greater HCT2h was associated with a lower incidence of ROP among preterm infants born between 28 and 34 weeks of gestation. Trial registration: This was a retrospective study and the data were from the DRYAD database. Santa Clara Valley Medical Center’s (SCVMC) ethical committee reviewed and approved the studies involving human participants. The participants provided their written informed consent to participate in this study. We did not perform any extra interventions.

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Modifiable Risk Factors and Preventative Strategies for Severe Retinopathy of Prematurity

Cited by 2 publications

References 181 publications

Cord Blood Transfusions in Extremely Low Gestational Age Neonates in Italy: Results of a Prespecified Interim Analysis of the Randomized Born Trial.

Cord Blood Transfusions in Extremely Low Gestational Age Neonates in Italy: Results of a Prespecified Interim Analysis of the Randomized Born Trial.

Association between Hematocrit in the First Two Hours of Life and Retinopathy during Prematurity: A Retrospective Study from DRYAD

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