New insights into the development of retinopathy of prematurity – importance of early weight gain

CONTEXT AND OBJECTIVE: Retinopathy of prematurity (ROP) is a known cause of blindness in which diagnosis and timely treatment can prevent serious harm to the child. This study aimed to evaluate the incidence of ROP and its association with known risk factors. DESIGN AND SETTING: Longitudinal incidence study in the neonatal intensive care unit (NICU) of Universidade Estadual de Montes Claros. METHODS: Newborns admitted to the NICU with gestational age less than 32 weeks and/or birth weight less than 1,500 grams, were followed up over a two-year period. The assessment and diagnosis of ROP were defined in accordance with a national protocol. The chi-square test or Fisher's exact test were used to determine associations between independent variables and ROP. Analysis on the independent effect of the variables on the results was performed using multiple logistic regression. RESULTS: The incidence of ROP was 44.5% (95% confidence interval, CI = 35.6-46.1) in the study population. The risk factors associated with the risk of developing the disease were: birth weight less than 1,000 grams (odds ratio, OR = 4.14; 95% CI = 1.34-12.77); gestational age less than 30 weeks (OR = 6.69; 95% CI = 2.10-21.31); use of blood derivatives (OR = 4.14; 95% CI = 2.99-8.99); and presence of sepsis (OR = 1.99; 95% CI = 1.45-2.40). CONCLUSIONS: The incidence of ROP was higher than that found in the literature. The main risk factors were related to extreme prematurity. RESUMO CONTEXTO E OBJETIVO:A retinopatia da prematuridade (ROP) é causa conhecida de cegueira e diagnóstico e tratamento oportunos podem evitar graves danos à criança. Este estudo objetivou avaliar a incidência da ROP e sua associação com fatores de risco conhecidos.

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“…9,18,19 The results from these studies showed that both gestational age and birth weight were associated with ROP.…”

Section: Discussionmentioning

confidence: 84%

“…This finding has also been reported by several authors in the literature. 5,9,19 It is believed that fetal hemoglobin has a greater affinity to oxygen than does adult hemoglobin. Thus, a transfusion of adult hemoglobin could generate possible hyperoxia due to increased oxygen delivery to tissues.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for retinopathy of prematurity in a Brazilian reference service

et al. 2014

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“…Feeding intolerance and NEC are important factors contributing to insufficient enteral nutrition. 16 In our cohort of VLBW infants, several well-defined morbidities of prematurity, such as PDA, NEC, respiratory support, and transfusion requirement were more common in infants with poor postnatal weight gain. Relation of poor postnatal weight gain and ROP may be attributed to common postnatal risk factors causing them.…”

Section: Discussionmentioning

confidence: 99%

Adjusted poor weight gain for birth weight and gestational age as a predictor of severe ROP in VLBW infants

Aydemir

Sarikabadayi

Aydemir

et al. 2011

Eye

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Aim To analyze relative weight gain by 2-week intervals up to 6 weeks after birth in order to predict the development of retinopathy of prematurity (ROP) requiring treatment among very low birth weight (BW) infants. Methods A prospective study including infants with BW r1500 g born in a single tertiary intensive care unit over 1-year period was conducted. Body weight measurements were recorded weekly and relative weight gains (g/kg/day) were calculated. The main outcome was development of ROP requiring treatment. Results Mean BW and gestational age (GA) of the whole cohort were 1165±223 g and 29.3 ± 2.3 weeks, respectively. Relative weight gain at 2 weeks and 4 weeks postnatal age were significantly lower in infants with severe ROP (P ¼ 0.041 and P ¼ 0.017, respectively). Relative weight gain at 6 weeks was not different between groups. Infants with severe ROP gained 6.7±4 g/kg/day in the first 4 weeks of life, compared with 9.3±4.5 g/kg/day for those with mild or no ROP. After adjusted for BW and GA in logistic regression poor relative weight gain in the first 4 weeks was found to be related to severe ROP (P ¼ 0.015). When all the other risk factors significant for severe ROP were included in the logistic regression poor weight gain did not arise as an independent risk factor. Conclusion Poor postnatal weight gain in the first 4 weeks of life is the end result of several comorbidities rather than being an independent risk factor. Poor weight gain can be an additional predictor of severe ROP in very low BW infants.

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“…Alternatively, a "catch-up" process with abundant availability of nutrients may cause capillary hyperpruning. 59 Follow-up studies on the neonatal cohort described by D'Souza et al 58 have to be awaited to decide on this hypothesis.…”

Section: Microcirculatory Dysfunction: Cause or Consequence Of Hypertmentioning

confidence: 99%

Phenotyping the Microcirculation

et al. 2012

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New insights into the development of retinopathy of prematurity – importance of early weight gain

Abstract: This review will focus on the mechanisms leading to ROP by exploring factors responsible for poor early weight gain and abnormal vascularisation of the eye of the preterm infant.

Cited by 82 publications

References 59 publications

Incidence and risk factors for retinopathy of prematurity in a Brazilian reference service

Incidence and risk factors for retinopathy of prematurity in a Brazilian reference service

Adjusted poor weight gain for birth weight and gestational age as a predictor of severe ROP in VLBW infants

Phenotyping the Microcirculation

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