Abstract

Objective: To investigate the incidence of retinopathy of prematurity (ROP) and assess risk analysis in infants of birth weight (BW) ≥1500 grams.

Material and Methods: Retrospective, single-center, cohort included preterm intensive-care admissions who were screened for ROP between 2010-2019. Exclusion criteria were BW <1500 grams, congenital anomalies, death or postnatal transfers before ROP-screening. Data were extracted for maternal/neonatal characteristics, clinical features, retinopathy’s grade–zone, plus-disease and treatment. Multivariate regression analysis determined risk factors for developing retinopathy.

Results: ROP incidence was 7.6% in 1431 infants with the largest-one born 2450 grams at 36th gestational weeks (BW between 1500–1599 gr: 17.1%, 1600–1699 gr: 13.8%, 1700–1799 gr: 8.8%, 1800–1899 gr: 8.2%, 1900–1999gr: 2.9%, ≥2000 gr: 1.3%). Small for gestational age (SGA; OR:2.52, 95% CI:1.48-4.30), neonatal resuscitation (OR:3.23, 95% CI:1.87-5.57), low Apgar score (OR:2.08, 95% CI:1.03-4.20), congenital heart disease (OR:2.25, 95% CI:1.38-3.69), hemodynamic instability (OR:3.67, 95% CI:1.92-7.02), intraventricular hemorrhage (OR:2.86, 95% CI:1.40-5.86) were associated with ROP. In the multivariate logistic regression, prolonged mechanical ventilation (duration >2 days) and oxygen supplement (duration >9 days) were identified as independent risk factors that presented highest odds for retinopathy (OR:8.79, 95% CI: 5.53-13.99 and OR:4.67, 95% CI: 2.26-9.66). Therapy was warranted in 22 (1.5%) neonates (Type-1 ROP in eighteen, aggressive-ROP in four patients). Four infants with BW ≥1800 grams delivered ROP-treatment.

Conclusion: ROP incidence is 7.6% and treatment-warranted retinopathy is 1.5% in neonates born ≥1500 grams. Preterm-infants with SGA, neonatal resuscitation, congenital heart disease and hemodynamic instability requiring inotropes, intraventricular hemorrhage and the ones necessitating prolonged mechanical ventilation and oxygen supplement are more likely to develop ROP.

Keywords: Intravitreous injections, Photocoagulation, Retinopathy of prematurity, Risk factors

References

  1. Hellström A, Smith LE, Dammann O. Retinopathy of prematurity. Lancet 2013;26;382:1445-57.
  2. Lee AC, Katz J, Blencowe H, Cousens S, Kozuki N; CHERG SGA-preterm birth working group. National and regional estimates of term and preterm babies born small for gestational age in 138 low- income and middle-income countries in 2010. Lancet Glob Health 2013;1:26–36.
  3. Koç E, Yağmur Baş A, Özdek Ş, Ovalı F, Başmak H. Turkish Neonatal and Turkish Ophthalmology Societies consensus guideline on the retinopathy of prematurity. Turk Pediatri Ars 2018;53(Suppl 1): 151-60.
  4. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity. Arch Ophthalmol 2005;123:991–9.
  5. Dogra MR, Katoch D, Dogra M. An Update on Retinopathy of Prematurity (ROP). Indian J Pediatr 2017;84:930-6.
  6. Gilbert CE. Screening for retinopathy of prematurity: does one size fit all? Arch Dis Child Fetal Neonatal Ed 2016;101:F280–1.
  7. Bas AY, Demirel N, Koc E, Ulubas Isık D, İrfanoğlu İM; on behalf of the TR-ROP Study Group. Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units. Br J Ophthalmol 2018;102:1711–6.
  8. Bas AY, Koc E, Dilmen U; ROP Neonatal Study Group. Incidence and severity of retinopathy of prematurity in Turkey. Br J Ophthalmol 2015;99:1311-4.
  9. Fierson WM; American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics 2018;142: e20183061.
  10. Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. J Perinatol 1995;15:470–9.
  11. Romo-Aguas JC, León AG, Meraz-Gutiérrez MP, Martínez-Castellanos MA. Retinopathy of prematurity: incidence report of outliers based on international screening guidelines. Int J Retin Vitreous 2019;5(suppl 1):53.
  12. Freitas AM, Mörschbächer R, Thorell MR, Rhoden EL. Incidence and risk factors for retinopathy of prematurity: a retrospective cohort study. Int J Retina Vitreous 2018;4:20.
  13. Sanghi G, Dogra MR, Katoch D, Gupta A. Aggressive posterior retinopathy of prematurity: risk factors for retinal detachment despite confluent laser photocoagulation. Am J Ophthalmol 2013;155:159–64.
  14. Sharief L, Lightman S, Blum-Hareuveni T, Bar A, Tomkins-Netzer O. Clinical outcome of retinal vasculitis and predictors for prognosis of ischemic retinal vasculitis. Am J Ophthalmol 2017;177:206–12.
  15. Gunay M, Celik G, Tuten A, Karatekin G, Bardak H, Ovali F. Characteristics of Severe Retinopathy of Prematurity in Infants with Birth Weight above 1500 Grams at a Referral Center in Turkey. PloS one 2016;11:e0161692.
  16. Akçakaya AA, Yaylali SA, Erbil HH, Sadigov F, Aybar A, Aydin N, et al. Screening for retinopathy of prematurity in a tertiary hospital in Istanbul: incidence and risk factors. J Pediatr Ophthalmol Strabismus 2012;49:21–5.
  17. Küçükevcilioğlu M, Mutlu FM, Sarıcı SU, Ceylan OM, Altınsoy HI, Kılıç S, et al. Frequency, risk factors and outcomes of retinopathy of prematurity in a tertiary care hospital in Turkey. Turk J Pediatr 2013;55:467–74.
  18. Cerman E, Balci SY, Yenice OS, Kazokoglu H, Celiker H, Eraslan M. Screening for retinopathy of prematurity in a tertiary ophthalmology department in Turkey: incidence, outcomes, and risk factors. Ophthalmic Surg Lasers Imaging Retina 2014;45:550–5.
  19. 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;18:269–74.
  20. Kola M, Hacıoğlu D, Erdöl H, Türk A, Aslan Y. Determination of regional screening criteria for retinopathy ofprematurity in the Eastern Black Sea region of Turkey. Turk J Med Sci 2016;46:381–7.
  21. Alpay A, Uğurbaş SH. Incidence and risk factors for retinopathy of prematurity in the West Black Sea region, Turkey. Turk J Pediatr 2012;54:113–8.
  22. Mutlu FM, Altinsoy HI, Mumcuoglu T, Kerimoglu H, Kiliç S, Kul M, et al. Screening for retinopathy of prematurity in a tertiary care newborn unit in Turkey: frequency, outcomes, and risk factor analysis. J Pediatr Ophthalmol Strabismus 2008;45:291-8.
  23. Chen Y, Li XX, Yin H, Gilbert C, Liang JH, Beijing ROP Survey Group. Risk factors for retinopathy of prematurity in six neonatal intensive care units in Beijing, China. Br J Ophthalmol 2008;92:326–30.
  24. Shah PK, Narendran V, Kalpana N. Aggressive posterior retinopathy of prematurity in large preterm babies in South India. Arch Dis Child Fetal Neonatal Ed 2012;97:F371–5.
  25. Sachan A, Chandra P, Agarwal R, Vohra R, Chawla R, Sankar MJ, et al. Profile of Retinopathy of Prematurity in Outborn and Inborn Babies at a Tertiary Eye Care Hospital. Indian Pediatr 2020;57:1020-2.
  26. Hungi B, Vinekar A, Datti N, Kariyappa P, Braganza S, Chinnaiah S, et al. Retinopathy of Prematurity in a rural Neonatal Intensive Care Unit in South India—a prospective study. Indian J Pediatr 2012;79:911-5.
  27. Gantz MG, Carlo WA, Finer NN, Rich W, Faix RG, SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Achieved oxygen saturations and retinopathy of prematurity in extreme preterms. Arch Dis Child Fetal Neonatal Ed 2020;105:138-44.
  28. Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol 2018;63:618-37.
  29. Akkoyun I, Oto S, Yilmaz G, Gurakan B, Tarcan A, Anuk D, et al. Risk factors in the development of mild and severe retinopathy of prematurity. J AAPOS 2006;10:449–53.
  30. Yau GS, Lee JW, Tam VT, Liu CC, Chu BC, Yuen CY. Incidence and risk factors for retinopathy of prematurity in extreme low birth weight Chinese infants. Int Ophthalmol 2015;35:365-73.
  31. Thomas K, Shah PS, Canning R, Harrison A, Lee SK, Dow KE. Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units. J Neonatal Perinatal Med 2015;8:207-14.
  32. Smith LE, Hard AL, Hellström A. The biology of retinopathy of prematurity: how knowledge of pathogenesis guides treatment. Clin Perinatol 2013;40:201–14.
  33. Capozzi G, Santoro G. Patent ductus arteriosus: patho-physiology, hemodynamic effects and clinical complications. J Matern Fetal Neonatal Med 2011;24:15–6.
  34. Polito A, Piga S, Cogo PE, Corchia C, Carnielli V, Da Fre` M, et al. Increased morbidity and mortality in very preterm / VLBW infants with congenital heart disease. Intensive Care Med 2013;39:1104–12.
  35. Razak A, Faden M. Association of small for gestational age with retinopathy of prematurity: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2020;105:270-8.
  36. Kavurt S, Ozcan B, Aydemir O, Bas A, Demirel N. Risk of retinopathy of prematurity in small for gestational age premature infants. Indian Pediatr 2014;51:e804-e6.
  37. Boghossian NS, Geraci M, Edwards EM, Horbar JD. Morbidity and mortality in small for gestational age infants at 22 to 29 weeks’ gestation. Pediatrics 2018;141: e20172533.
  38. Giapros V, Drougia A, Krallis N, Theocharis P, Andronikou S. Morbidity and mortality patterns in small-for-gestational age infants born preterm. J Matern Fetal Neonatal Med 2012;25:153–7.
  39. Westby Wold SH, Sommerfelt K, Reigstad H, Rønnestad A, Medbø S, Farstad T, et al. Neonatal mortality and morbidity in extremely preterm small for gestational age infants: a population-based study. Arch Dis Child Fetal Neonatal Ed 2009;94:F363–7.
  40. American Academy of Pediatrics Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists Committee on Obstetric Practice. The Apgar Score. Pediatrics 2015;136:819–22.

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Copyright © 2021 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Ongun H, Özdemir Şahin S, Şam MT, Gözkaya O, Özyazıcı Özkan SE. Retinopathy in the Preterm Infant Born Over 1500 grams. Turk J Pediatr Dis. 2021;15(3):208-215. https://doi.org/10.12956/tchd.783448