Eusebio Angulo-Castellanos

Prediction of Retinopathy of Prematurity Using the Screening Algorithm WINROP in a Mexican Population of Preterm Infants

OBJECTIVE To retrospectively validate the WINROP (weight, insulin-like growth factor I, neonatal, retinopathy of prematurity [ROP]) algorithm in identification of type 1 ROP in a Mexican population of preterm infants. METHODS In infants admitted to the neonatal intensive care unit at Hospital Civil de Guadalajara from 2005 to 2010, weight measurements had been recorded once weekly for 192 very preterm infants (gestational age [GA] <32 weeks) and for 160 moderately preterm infants (GA ≥32 weeks). Repeated eye examinations had been performed and maximal ROP stage had been recorded. Data are part of a case-control database for severe ROP risk factors. RESULTS Type 1 ROP was found in 51.0% of very preterm and 35.6% of moderately preterm infants. The WINROP algorithm correctly identified type 1 ROP in 84.7% of very preterm infants but in only 5.3% of moderately preterm infants. For infants with GA less than 32 weeks, the specificity was 26.6%, and for those with GA 32 weeks or more, it was 88.3%. CONCLUSIONS In this Mexican population of preterm infants, WINROP detected type 1 ROP early in 84.7% of very preterm infants and correctly identified 26.6% of infants who did not develop type 1 ROP. Uncertainties in dating of pregnancies and differences in postnatal conditions may be factors explaining the different outcomes of WINROP in this population.

Unusual branchial arch, dermoepidermal and nervous system anomalies in a neonate with VACTERL-H syndrome

RESUMEN El sindrome VACTERL-H es un trastorno complejo de malformaciones congenitas que implica vertebras, ano, corazon, traquea, esofago, rinones, extremidades (del ingles limbs) e hidrocefalia. Su etiologia se ha identificado solo en algunos pacientes debido, en gran medida, a su naturaleza esporadica, asi como a su alto grado de heterogeneidad clinica. En este informe se presenta a un neonato con el sindrome VACTERL-H, al que se asocian anomalias inusuales del arco branquial, dermoepidermicas y del sistema nervioso, que se comparan con las descritas en la bibliografia medica. Segun nuestra experiencia, esta presentacion no solo amplia el conocimiento del espectro de anomalias que se puede presentar en el sindrome VACTERL-H, sino que tambien podria ser util en la identificacion de pacientes con este fenotipo heterogeneo. Palabras clave: sindrome VACTERL-H, heterogeneo, anomalias arco branquial. SUMMARY VACTERL-H syndrome is a complex disorder of congenital malformations that implies vertebrae, anus, heart, trachea, esophagus, kidneys, limbs and hydrocephalus. Its etiology has been identified in a fraction of patients largely due to their sporadic nature and its high degree of clinical heterogeneity. This report presents a newborn with VACTERL-H syndrome, associated with unusual branchial arch, dermoepidermal and nervous system anomalies, which are compared with those described in the medical literature. Based on our experience, the presentation of this case not only expands the knowledge of the spectrum of anomalies that can occur in VACTERL-H syndrome, but also can be useful in identifying patients with this heterogeneous phenotype.

The Utility of Non-ophthalmologist Examination of Eyes at Risk for Serious Retinopathy of Prematurity

Background: Retinopathy of Prematurity (ROP) is the main cause of preventable blindness in premature babies. Currently, there is a shortage of trained ophthalmologists, which has resulted in an alarming increase in cases of vision loss and related complications. This study’s aim was to determine the utility of examinations conducted by non-ophthalmologist physicians to assess posterior pole vessel abnormalities in eyes at risk for ROP. Method: Non-ophthalmologist physicians (pediatrician and neonatologist) were trained to use an indirect ophthalmoscope to view the posterior pole of babies at risk for ROP. Examinations were conducted on both eyes of premature infants born before 35 weeks gestational age (GA) starting at the third week after birth and weekly thereafter. The presence of Plus disease was identified by the non-ophthalmologist and results compared to the clinical examination by a pediatric ophthalmologist experienced in ROP detection and treatment. Chi-square was used for proportions and the Mann Whitney U test for medians. Fagan’s nomogram was determined for diagnostic usability. The Kappa index was used to rate inter-observer agreement. Results: Results of 228 examinations performed on 150 premature infants were analyzed to determine the correlation of the non-ophthalmologist findings and the eye examination. For any vascular change in posterior pole diagnostic, findings were 87% and 87% accuracy for pediatrician and neonatologist, 82% and 83% sensitivity, 90% and 90% specificity respectively. There was no significant difference found in the detection of Plus disease for the examinations performed by the ophthalmologist compared to those performed by the non-ophthalmologist (P < 0.05). Conclusions: After training in the use of an indirect ophthalmoscope, non-ophthalmologist physicians can reliably detect posterior pole retinal vessel changes for ROP diagnosis.

Higher prolactin and vasoinhibin serum levels associated with incidence and progression of retinopathy of prematurity

Background:Retinopathy of prematurity (ROP) is a potentially blinding, retinal neovascular disease. Systemic prolactin accesses the retina to regulate blood vessels. Prolactin is proangiogenic and can be cleaved to antiangiogenic vasoinhibins. We investigated whether circulating prolactin and vasoinhibins associate with incidence and progression of ROP.Methods:A prospective, longitudinal, case–control study covering postnatal weeks 1 to 9 measured serum prolactin, vasoinhibins, and vascular endothelial growth factor (VEGF) weekly in 90 premature infants diagnosed as ROP or control.Results:Prolactin levels were higher in ROP than in control patients before (106.2 ± 11.3 (SEM) vs. 64.7 ± 4.9 ng/ml, postnatal week 1) and during (120.6 ± 10 vs. 84.7 ± 7.5ng/ml, postnatal week 5) ROP diagnosis. Prolactin, but not gestational age, birth weight, Apgar score, sepsis, or ventilation time, correlated with ROP. The relative risk (RR) of developing ROP increased if Prolactin (PRL) levels were higher than thresholds of 80 ng/ml (RR = 1.55, 95% CI: 1.06–2.28), 100 ng/ml (RR = 1.63, 95% CI: 1.14–2.34), or 120 ng/ml (RR = 1.95, 95% CI: 1.41–2.68). Vasoinhibin levels were 39.7% higher (95% CI: 4.5–77.5) in the circulation of ROP than in control patients at postnatal week 1 and similar thereafter, whereas VEGF serum levels were always similar.Conclusion:High serum prolactin and vasoinhibin levels predict and may impact ROP progression.

Asociación VACTERL-H con agenesia tibial. ¿Expansión del fenotipo clínico?

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