Survival rate dependent variations in retinopathy of prematurity treatment rates in very low birth weight infants

Abstract

As increased oxidative stress causes increased mortality and morbidities like bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in very low birth weight infants (VLBWIs), the conundrum of improved survival but increased ROP observed with the high oxygen saturation target range of 91–95% is difficult to explain. To determine the survival rate-dependent variation in ROP treatment rate, 6292 surviving eligible VLBWIs registered in the Korean Neonatal Network were arbitrarily grouped according to the survival rate of infants at 23–24 weeks’ gestation as group I (> 70%, n = 1626), group II (40–70%, n = 2984) and group III (< 40%, n = 1682). Despite significantly higher survival and lower BPD rates in group I than in groups II and III, the ROP treatment rate was higher in group I than in groups II and III. However, the adjusted odds ratios for ROP treatment were not significantly different between the study groups, and the ROP treatment rate in the infants at 23–24 weeks’ gestation was 21-fold higher than the infants at ≥ 27 weeks’ gestation. The controversial association between improved survival and reduced BPD reflecting quality improvement of neonatal intensive care but increased ROP treatment rate might be primarily attributed to the improved survival of the most immature infants.

No Survival or Morbidity Advantage Associated With Cesarean Section in VLBW Infants

“…Signi cantly higher mortality and morbidity in group 2 than in group 1 regardless of delivery mode in our present and previous studies [18][19][20][21][22][23][24] suggested that the improved quality of perinatal and neonatal intensive care by experienced and skillful neonatologists including better delivery room management and early admission care as evidenced by improved survival of peri-viable infants at 23-24 GW rather than the delivery mode was a prerequisite not only improving survival but also reducing morbidities of VLBWIs.…”

“…The Korean Neonatal Network (KNN) is an ongoing nationwide, multicenter, prospective and web-based cohort registry system for VLBWIs [18][19][20] . We previously reported that the survival rate of peri-viable infants born at 23-24 gestational weeks (GW) re ected the quality of perinatal and neonatal intensive care at each institution's neonatal intensive care unit (NICU) 18 , and improved infant survival at 23-24 GW from < 50% to ≥ 50% with signi cantly improved survival and less morbidity in more mature VLBWIs at 25-34 GW 19,[21][22][23][24] .…”

YY1 lactylation in microglia promotes angiogenesis through transcription activation-mediated upregulation of FGF2

“…Elevated lactate and lactylation levels are associated with retinal neovascularization ROP is a severe vision-threatening disease that may cause childhood blindness worldwide. With improved neonatal care, the survival rate of premature infants has been greatly increased, but the incidence of ROP has also increased 23,24 . We compared the lactate content in the arterial blood of ROP infants with non-ROP infants by arterial blood gas analysis, which is a regular test for premature infants.…”

Role of Oxidative Stress in Retinal Disease and the Early Intervention Strategies: A Review

“…Oxidative stress is a physiological redox imbalance caused by excessive ROS/ RNS. It plays a key role in the pathogenesis of ROP and significantly increases the mortality and morbidity of ROP in very LBWs (Figure 5) [119,121,122]. There are two phases of ROP: (1) abnormal retinal neovascularization motivated by hypoxia and (2) delayed growth of retinal vascularization induced by supplemental oxygen [123][124][125].…”