Evaluation of Risk Factors for Retinopathy of Prematurity in Preterm Neonates

Document Type: Original Article

Authors

1 Shahid Beheshti University of Medical Sciences, Mahdieh Hospital, Tehran, Iran

2 Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Shahid Beheshti University of Medical Sciences, Shohada Hospital, Tehran, Iran

4 Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: The most common cause of preventable blindness in children is retinopathy of prematurity (ROP). The most important risk factors for this disease are preterm delivery and low birth weight (LBW). This research was performed to evaluate the prevalence ofand risk factors for ROP in preterm neonates.
Methods: Our research was a cross-sectional descriptive and retrospective study conducted on preterm neonates in the Neonatal Intensive Care Unit (NICU) of Mahdieh Hospital in Tehran, Iran, in 2015. All neonates with a gestational age of < 32 weeks and birth weight of < 1,500 g were enrolled. Demographic data and risk factors for ROP were evaluated. Statistical analysis was conducted by SPSS (version 20) with a 95% confidence interval and. P-value less than 0.05 was considered statistically significant.
Results: Our study was conducted on 154 patients. Mean gestational age and birth weight of the newborns were 28.69±1.82 weeks (range: 23-32 weeks) and 1114.94±240.982 g (range: 550-1500 g). The ROP was detected in 76 (49.4%) patients, 55.26%, 34.2%, and 10.53% of whom had stages I, II, and III of ROP. Stages IV and V were not seen in our patients. The incidence of ROP was significantly affected by low gestational age and birth weight, delivery room resuscitation, prolonged oxygen therapy and mechanical ventilation, and repeated packed cell transfusion.
Conclusion: Despite the improvement in the care of preterm infants in the NICUs, the prevalence rate of ROP was high. Therefore, it is critical to adopt better care for disease prevention, timely screening, and appropriate treatment programs for the neonates who are at the risk of this disease.

Keywords


1. Zin A, Gole GA. Retinopathy of prematurityincidence today. Clin Perinatol. 2013; 40(2):185- 200.

2. Sarikabadayi YU, Aydemir O, Ozen ZT, Aydemir C, Tok L, Oguz SS, et al. Screening for retinopathy of prematurity in a large tertiary neonatal intensive care unit in Turkey: frequency and risk factors. Ophthalmic Epidemiol. 2011; 18(6):269-74.

3. Hakeem AH, Mohamed GB, Othman MF. Retinopathy of prematurity: a study of prevalence and risk factors. Middle East Afr J Ophthalmol. 2012; 19(3):289-94.

4. Karkhaneh R, Mousavi SZ, Riazi-Esfahani M, Ebrahimzadeh SA, Roohipoor R, Kadivar M, et al. Incidence and risk factors of retinopathy of prematurity in a tertiary eye hospital in Tehran. Br J Ophthalmol. 2008; 92(11):1446-9.

 5. Lad EM, Hernandez-Boussard T, Morton JM, Moshfeghi DM. Incidence of retinopathy of prematurity in the United States: 1997 through 2005. Am J Ophthalmol. 2009; 148(3):451-8.

6. Blencowe H, Lee AC, Cousens S, Bahalim A, Narwal R, Zhong N, et al. Preterm birth–associated neurodevelopmental impairment estimates at regional and global levels for 2010. Pediatr Res. 2013; 74(Suppl 1):17-34.

 7. Kamath BD, MacGuire ER, McClure EM, Goldenberg RL, Jobe AH. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics. 2011; 127(6):1139-46. 8. Soleimani F, Zaheri F, Abdi F. Long-term neurodevelopmental outcomes after preterm birth. Iran Red Crescent Med J. 2014; 16(6):e17695.

9. Wang H, Gao X, Liu C, Yan C, Lin X, Yang C, et al. Morbidity and mortality of neonatal respiratory failure in China: surfactant treatment in very immature infants. Pediatrics. 2012; 129(3):e731-40.

10. Rasoulinejad SA, Montazeri M. Retinopathy of prematurity in neonates and its risk factors: a seven year study in northern Iran. Open Ophthalmol J. 2016; 10:17-21.

11. Sapieha P, Joyal JS, Rivera JC, Kermorvant-Duchemin E, Sennlaub F, Hardy P, et al. Retinopathy of prematurity: understanding ischemic retinal vasculopathies at an extreme of life. J Clin Invest. 2010; 120(9):3022-32.

12. Shah V, Yeo C, Ling Y, Ho L. Incidence, risk factors of retinopathy of prematurity among very low birth weight infants in Singapore. Ann Acad Med Singapore. 2005; 34(2):169-78.

13. Tin W, Gupta S. Optimum oxygen therapy in preterm babies. Arch Dis Child Fetal Neonatal Ed. 2007; 92(2):F143-7.

14. Seiberth V, Linderkamp O. Risk factors in retinopathy of prematurity. A multivariate statistical analysis. Ophthalmologica. 2000; 214(2):131-5.

 15. Wallace DK, Kylstra JA, Phillips SJ, Hall JG. Poor postnatal weight gain: a risk factor for severe retinopathy of prematurity. J AAPOS. 2000; 4(6):343-7.

16. Holmström G, Broberger U, Thomassen P. Neonatal risk factors for retinopathy of prematurity-a population-based study. Acta Ophthalmol Scand. 1998; 76(2):204-7.

 17. Elmehelmy EM, Mohamed KM, Eldin ZE, Mahdy HA. Risk factors of retinopathy of prematurity. Invest Ophthalmol Visual Sci. 2002; 43(13):1236.

 18. Zhou J, Shukla VV, John D, Chen C. Human milk feeding as a protective factor for retinopathy of prematurity: a meta-analysis. Pediatrics. 2015; 136(6):e1576-86.

 19. Penn JS, Madan A, Caldwell RB, Bartoli M, Caldwell RW, Hartnett ME. Vascular endothelial growth factor in eye disease. Prog Retin Eye Res. 2008; 27(4):331-71.

20. Foos RY. Retinopathy of prematurity: pathologic correlation of clinical stages. Retina. 1987; 7(4): 260-76.

21. Gariano RF, Kalina RE, Hendrickson AE. Normal and pathological mechanisms in retinalvascular development. Surv Ophthalmol. 1996; 40(6):481-90.

22. Auten RL, Davis JM. Oxygen toxicity and reactive oxygen species: the devil is in the details. Pediatr Res. 2009; 66(2):121-7.

23. Smith LE. Pathogenesis of retinopathy of prematurity. Sem Neonatol. 2003; 8(6):469-73.

24. Gole GA, Ells AL, Katz X, Holmstrom G, Fielder AR, Capone Jr A, et al. The international classification of retinopathy of prematurity revisited. JAMA Ophthalmol. 2005; 123(7):991-9.

25. Reynolds JD. Insights in ROP. Am Orthopt J. 2014; 64(1):43-53.

 26. Law JC, Recchia FM, Morrison DG, Donahue SP, Estes RL. Intravitreal bevacizumab as adjunctive treatment for retinopathy of prematurity. J AAPOS. 2010; 14(1):6-10.

27. Reynolds JD. Retinopathy of prematurity. Int Ophthalmol Clin. 2010; 50(4):1-13.

28. Fielder AR, Gilbert C, Quinn G. Can ROP blindness be eliminated? Bio Neonate. 2005; 88(2):98-100.

29. Sola A, Chow L, Rogido M. Retinopathy of prematurity and oxygen therapy: a changing relationship. An Pediatr (Barc). 2005; 62(1):48-63.

30. Fulton AB, Hansen RM, Moskowitz A, Akula JD. The neurovascular retina in retinopathy of prematurity. Prog Retin Eye Res. 2009; 28(6):452-82.

31. Ricard CA, Dammann CE, Dammann O. Screening tool for early postnatal prediction of retinopathy of prematurity in preterm newborns (STEP-ROP). Neonatology. 2017; 112(2):130-6.

32. Morrison D, Shaffer J, Binenbaum G. Complications following ROP treatment in the postnatal growth and retinopathy of prematurity (G-ROP) study. J Am Assoc Pediatr Ophthalmol Strabismus. 2016; 20(4):e8.

33. Mechoulam H, Pierce EA. Retinopathy of prematurity. Am J Pharmacogenomics. 2003; 3(4):261-77.

 34. Jefferies AL; Canadian Paediatric Society, Fetus and Newborn Committee. Retinopathy of prematurity: an update on screening and management. Paediatr Child Health. 2016; 21(2):101-8.

 35. Maroufizadeh S, Almasi-Hashiani A, Samani RO, Sepidarkish M. Prevalence of retinopathy of prematurity in Iran: a systematic review and metaanalysis. Int J Ophthalmol. 2017; 10(8):1273-9.

36. Alajbegovic-Halimic J, Zvizdic D, AlimanovicHalilovic E, Dodik I, Duvnjak S. Risk factors for retinopathy of prematurity in premature born children. Med Arch. 2015; 69(6):409-13.

 37. Manzoni P, Farina D, Maestri A, Giovannozzi C, Leonessa M, Arisio R, et al. Mode of delivery and threshold retinopathy of prematurity in pre-term ELBW neonates. Acta Paediatr. 2007; 96(2):221-6. 38. Chow LC, Wright KW, Sola A; CSMC Oxygen Administration Study Group. Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics. 2003; 111(2):339-45.

39. Podraza W, Podraza H, Jezierska K, Szwed J, Modrzejewska M, Rudnicki J, et al. The role of hemoglobin variant replacement in retinopathy of prematurity. Indian J Pediatr. 2011; 78(12): 1498-502.

 40. Howarth C, Banerjee J, Aladangady N. Red blood cell transfusion in preterm infants: current evidence and controversies. Neonatology. 2018; 114(1):7-16.