Gabriela Unchalo Eckert

Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

AimsTo analyse the incidence and risk factors for retinopathy of prematurity (ROP) and survival rates among extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants.MethodsA prospective cohort study of 352 infants admitted at a teaching hospital, Hospital de Clinicas de Porto Alegre, Brazil, between October 2002 and December 2006, was screened for ROP. The ELBW group comprised infants whose birth weight (BW) was ⩽1000 g and the VLBW group comprised those infants whose BW were >1000 g and ⩽1500 g. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis.ResultsOf the 352 neonates screened, 88 were ELBW babies. Survival rates among ELBW and VLBW were 47.8 and 88.7%, respectively. ROP affected 48.9% of ELBW infants and 18.2% of VLBW babies. Threshold disease occurred in 21 patients, 15 of whom were born weighing <1000 g. Only 2.3% of the neonates born with more than 1000 g developed treatable disease. Univariate analysis showed that gestational age (GA), BW, use of indomethacin and erythropoietin, blood transfusions, and intraventricular haemorrhage were associated with ROP. After logistic regression, the most important adjusted risk factors were BW (OR: 1.002;95% CI: 1.001–1.003; P=0.003), GA (OR: 1.254;95% CI: 1.082–1.455; P=0.003), and use of erythropoietin (OR: 2.486;95% CI: 1.182–5.231; P=0.016).ConclusionThis study showed reduced survival rates, high incidence of ROP, and a greater need of treatment among ELBW infants as compared to VLBW babies admitted in this institution.

A predictive score for retinopathy of prematurity in very low birth weight preterm infants

AimsThis study describes the development of a score based on cumulative risk factors for the prediction of severe retinopathy of prematurity (ROP) comparing the performance of the score against the birth weight (BW) and gestational age (GA) in order to predict the onset of ROP.MethodsA prospective cohort of preterm infants with BW⩽1500 g and/or GA⩽32 weeks was studied. The score was developed based on BW, GA, proportional weight gain from birth to the 6th week of life, use of oxygen in mechanical ventilation, and need for blood transfusions from birth to the 6th week of life. The score was established after linear regression, considering the impact of each variable on the occurrences of any stage and severe ROP. Receiver operating characteristic (ROC) curves were used to determine the best sensitivity and specificity values for the score. All variables were entered into an Excel spreadsheet (Microsoft) for practical use by ophthalmologists during screening sessions.ResultsThe sample included 474 patients. The area under the ROC curve for the score was 0.77 and 0.88 to predict any stage and severe ROP, respectively. These values were significantly higher for the score than for BW (0.71) and GA (0.69) when measured separately.ConclusionsROPScore is an excellent index of neonatal risk factors for ROP, which is easy to record and more accurate than BW and GA to predict any stage ROP or severe ROP in preterm infants. The scoring system is simple enough to be routinely used by ophthalmologists during screening examination for detection of ROP.

Maternal Preeclampsia Protects Preterm Infants against Severe Retinopathy of Prematurity

OBJECTIVE To study the influence of maternal preeclampsia on the occurrence of retinopathy of prematurity. STUDY DESIGN A prospective cohort study of 324 preterm neonates with birth weight ≤ 1500 g and gestational age ≤ 32 weeks. Multiple maternal and perinatal factors were analyzed for association and confounding by multiple logistic regression analysis. RESULTS Mean birth weight was 1128 ± 240 g, and mean gestational age 29.7 ± 1.9 weeks. Twenty-four newborns (7.4%) had severe retinopathy of prematurity; 97 had any stage of retinopathy, and 227 had no retinopathy of prematurity. Preeclampsia and complete antenatal steroid treatment course reduced the risk for any stage of retinopathy of prematurity by 60% and 54%, respectively. Preeclampsia reduced the risk for severe retinopathy of prematurity by 80%. CONCLUSIONS Preeclampsia lowered the risk for occurrence of any stage and severe retinopathy of prematurity in very low birth weight infants.

Alterações tomográficas cerebrais em crianças com lesões oculares por toxoplasmose congênita

OBJETIVOS: avaliar a frequencia e o tipo de alteracoes tomograficas cerebrais em pacientes com diagnostico de toxoplasmose congenita, que apresentam alteracoes oftalmologicas. METODOS: neste trabalho prospectivo, os individuos estudados deveriam preencher um dos seguintes criterios: paciente com dosagem de IgM anti-T. gondii reagente ao nascimento e mae com sorologia reagente para toxoplasmose, ou menor de dez anos com exame clinico oftalmologico mostrando lesoes fundoscopicas bilaterais, compativeis com retinocoroidite toxoplasmica congenita, IgG anti-T. gondii reagente, e mae com sorologia compativel. Todos os pacientes foram submetidos a tomografia cerebral sem contraste. RESULTADOS: fizeram parte do estudo 22 pacientes (44 olhos). Treze olhos apresentavam lesoes oculares maculares (29,5%), oito lesoes perifericas (18,2%), e 22 olhos tinham lesoes perifericas e maculares concomitantes (50%). Dezessete pacientes (77,3%) apresentaram alteracoes radiologicas. Dentre estes, 16 pacientes (94,1%) apresentaram calcificacoes encefalicas, dois pacientes (11,7%) apresentaram dilatacao ventricular, dois hidrocefalia (11,7%), um (5,9%) hidroanencefalia, um (5,9%) cisto porencefalico (hemiatrofia cerebral), um (5,9%) cisto de aracnoide, e um (5,9%) aumento discreto dos ventriculos e das cisternas subaracnoideas. CONCLUSAO: em pacientes com diagnostico de toxoplasmose congenita e lesoes oculares, deve-se suspeitar e investigar alteracoes neurorradiologicas concomitantes, devido a importância desses achados na maioria dos pacientes.

Prevalence of retinopathy of prematurity: an institutional cross-sectional study of preterm infants in Brazil

OBJECTIVE Retinopathy of prematurity (ROP) is the leading cause of childhood blindness in most developed countries. This study aimed to verify ROP prevalence among all very low birth weight (VLBW) preterm infants admitted to a level-3 teaching hospital in Porto Alegre, Rio Grande do Sul, Brazil. METHODS Institutional cross-sectional study of 407 premature infants with birth weight < or = 1,500 g or gestational age (GA) < or =32 weeks between 2002 and 2007. All infants screened for ROP were examined after the fourth week of life and followed up until the 45th week of adjusted GA. ROP prevalence was estimated at a 95% confidence level. RESULTS Some degree of ROP in one or both eyes occurred in 25.5% (104) of all screened infants, and severe ROP (threshold stage 3 or higher, requiring treatment to prevent vision loss, as per the criteria of the U.S.-based Multicenter Trial of Cryotherapy for Retinopathy of Prematurity, CRYO-ROP) occurred in 5.8% (24). Based on the criteria of The International Classification for Retinopathy of Prematurity (ICROP, 1984/1987), the disease reached stages 1, 2, and 3 in 11.3% (46), 8.4% (34), and 5.4% (22), respectively. One infant developed the disease up to stage 4 (partial retinal detachment), and one progressed to stage 5 (complete retinal detachment, resulting in 0.2% overall prevalence for ROP-induced blindness). CONCLUSIONS Overall incidence of ROP in this institutional study (25.5%) was comparable to international results from developed countries. A comprehensive countrywide survey on ROP in Brazil is recommended to determine any regional differences in disease prevalence.

Prevention of retinopathy of prematurity

Retinopathy of prematurity (ROP) is related to oxygen-regulated vascular endothelial growth factor and to insulin-like growth factor-I. After premature birth, supplemental oxygen induces a retinal hyperoxic condition with vasoconstriction and to a definitive interruption of retinal vasculogenesis. Peripheral ischemia may stimulate retinal neovascularization and the onset of additional ROP-related complications. The natural course of the disease may result in irreversible blindness if not promptly diagnosed and attended. Recently, a significant increase in the prevalence of ROP has been observed in survival rates of preterm infants, especially in emerging-economy countries in Latin America, Asia, and Eastern Europe. This article addresses the main preventive measures in ROP.

Postconceptional age at the treatment of retinopathy of prematurity in inborn and referred preterm infants from the same institution

PURPOSE The outcomes of the treatment of retinopathy of prematurity (ROP) seem to be better in inborn patients than in those patients who were referred for ROP treatment. This study aims to investigate the timing of treatment and the outcomes in inborn patients and in patients referred for treatment to the Hospital de Clínicas de Porto Alegre, Brazil. METHODS An institutional prospective cohort study was conducted from 2002 to 2010 and included in group 1 all inborn preterm neonates treated for retinopathy of prematurity and in group 2 all babies referred for treatment to the same institution. All of the included patients presented birth weight (BW) ≤1,500 g and/or gestational age (GA) ≤32 weeks. Main outcomes were postconceptional age at the treatment and one year follow-up outcomes in both groups. The considered variables were: BW, GA, stage and location of retinopathy of prematurity at treatment. RESULTS Group 1 comprised 24 inborn patients. Mean BW and GA at birth were 918 ± 232 g and 28.2 ± 2.1 weeks, respectively, and median post-conceptional postconceptional age at treatment was 37 weeks. Group 2 comprised 14 infants transferred for treatment. Mean BW and GA at birth were 885 ± 188 g and 28.2 ± 2.4 weeks, respectively, and median postconceptional age at treatment was 39 weeks. Mean BW and GA were similar in both groups (P=0.654 and P=0.949, respectively), but the difference among the postconceptional age was significant (P=0.029). CONCLUSIONS Inborn patients were treated for retinopathy of prematurity during the 37(th) week of postconceptional age while transferred patients were treated, usually, after the 39(th) week postconceptional age. The worst outcomes observed among referred patients could be partially explained by the delayed time for treatment.

Association between human breast milk and retinopathy of prematurity

PURPOSE To evaluate the possible protective effect of breast milk against retinopathy of prematurity by comparing the amount of breast milk received by patients who developed retinopathy of prematurity and those who did not and to determine both the required minimum amount of breast milk and the time of life during which neonates need to receive breast milk for this effect to be significant. METHODS Cohort study of newborns with a birth weight of <1500 g or gestational age of <32 weeks, or both, born between January 2011 and October 2014 and hospitalized within the first 24 h of life in the Hospital Criança Conceição Neonatal Intensive Care Unit in Porto Alegre, RS, Brazil. RESULTS The prevalence of retinopathy of prematurity of any degree was 31% (100 of 323 patients) and that of severe retinopathy of prematurity was of 9% (29 of 323 patients). The median amounts of breast milk received daily by patients with and without retinopathy of prematurity were 4.9 mL/kg (interquartile range, 0.3-15.4) and 10.2 mL/kg (1.5-25.5), respectively. The amount of breast milk received in the first 6 weeks of life was inversely associated with the incidence of both retinopathy of prematurity of any degree and severe retinopathy of prematurity in the univariate analyses. However, the statistical significance was maintained only during the sixth week of life in a per-period multivariate analysis controlling for confounding factors. CONCLUSIONS Small amounts of breast milk are inadequate to prevent retinopathy of prematurity in premature newborns at risk for the disease.

1297 A Randomized Clinical Trial of the Use of Oral Glucose for Pain Relief During Retinopathy of Prematurity Examination (ROP)

Background Ophthalmologic examination for ROP is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed in order to reduce pain during eye examination. Purpose To evaluate the use of oral 25% glucose solution to relief pain during ophthalmologic examinations for ROP. Methods A masked randomized clinical trial with the use of 1 ml of oral 25% glucose solution once 2 minutes before the first ophthalmologic examination was carried out from March 2008 to April 2010 comparing with a control group that did not receive oral glucose solution. Pain was evaluated by Neonatal Infant Pain Scale (NIPS) immediately before and immediately after the ophthalmologic examination in both groups. Results 124 patients who were examined for the first time for ROP were included (70 in intervention and 54 in control groups). Prior to examination, mean NIPS scores were 0.8±0.8 and 1.2±1.2 (P=0.100) in newborns of intervention and control groups respectively, and after examination mean NIPS scores were 2.6±1.1 and 4.5±1.3 (P<0.001) in intervention and control groups respectively. The number of patients with pain prior the eye examination was one (1.4%) and 2 (3.7%) in intervention and control groups (P=0.580) respectively. After eye examination 11 patients with pain (NIPS≥4) in intervention group (15.7%) and 37 patients with pain (68.5%) in control group (P<0.001). Conclusions One ml of oral 25% glucose solution given 2 minutes before the ophthalmologic examination for ROP is an effective measure for pain relief. (clinicaltrials.gov. NCT00648687).

Incidence of retinopathy and neonatal nurse practioner’s role in prevention of blindness due to retinopathy of prematurity at Hospital de Clínicas de Porto Alegre, Brazil – prospective observational descriptive study

Introduction: Retinopathy of prematurity is a leading cause of blindness in children in middle-income countries. Recent improvements in the intensive neonatal cares allied with better personal qualification for assistance to the pre-term neonate increased survival rates among very low birth weight infants. This study aims to evaluate the incidence of the disease in premature children born at Hospital de Clinicas de Porto Alegre - Brazil, and also to describe the neonatal nurse practioner’s in prevention of blindness at this institution. Methods: A prospective observational descriptive study was conducted on 329 premature children born with birth weight ≤ 1.500 grams and/or ≤ 32 weeks of gestational age between October of 2002 and October of 2006. All of the children were examined by indirect binocular ophthalmoscopy after pupil dilation with association of Tropicamide 0.5% and Phenylephrine 2.5%, eye drops. The ophthalmological examination was first conducted between the 4th and the 6th weeks of life and repeated according the findings based in the international classification. Results: Retinopathy was diagnosed in 84 of the neonates with an incidence rate of 25.5% (84/329). Eighteen of the 329 screened children (5.5%) reached threshold disease and 17 of them needed diode laser treatment to prevent the disease progression. One patient missed the treatment. Conclusions: The incidence of retinopathy was similar to other international results as well as the occurrence of 5.2% of treatable disease. Only one of the infants developed the disease up to the most serious stage (ROP 5), resulting in a 0.3% of blindness due to the retinopathy at the institution since 2002.