Marlene Coelho da Costa

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.

Results of a program for the prevention of blindness caused by retinopathy of prematurity in southern Brazil.

OBJECTIVE To describe the results of a program for the prevention of blindness caused by retinopathy of prematurity implemented in 2002 at a tertiary-care hospital, according to screening criteria adopted in Brazil, and to compare some aspects with the criteria adopted by other countries. METHODS Descriptive observational study including all preterm infants born at this hospital weighing <or= 1,500 g at birth and/or gestational age <or= 32 weeks who survived up to the sixth week after birth, between October 2002 and June 2006. Ophthalmic examinations were performed from the sixth week of life and repeated as necessary until remission of the disease. RESULTS A total of 300 newborns were included and there were 18 cases of treatable threshold disease (18/300, 6%) according to the Brazilian criteria. One patient was not treated because s/he developed the disease after hospital discharge and did not turn up for examination in order to initiate treatment. According to the criteria suggested by industrialized countries, the total number of exams would be reduced under the same circumstances, but 11.76% of the cases of threshold disease would not be detected. CONCLUSIONS The Brazilian criteria for neonatal screening were efficient in detecting treatable cases. Blindness was averted in 17 preterm infants in the study period. The universal use of such program at teaching hospitals or in the public and private health networks could help prevent one of the main causes of preventable and treatable blindness among infants in developing countries. Currently, a change in these criteria in Brazil may compromise the diagnosis of some treatable patients.

Is being small for gestational age a risk factor for retinopathy of prematurity? A study with 345 very low birth weight preterm infants

OBJECTIVE To analyze prevalence and risk factors for retinopathy of prematurity (ROP) among preterm infants born small for gestational age (SGA) and appropriate for gestational age (AGA). METHODS A prospective cohort study included preterm infants with birth weight (BW) < or = 1,500 grams and gestational age (GA) < or = 32 weeks, divided into two groups: AGA or SGA. Prevalences and risk factors for ROP were determined in both groups. Logistic regression was used for the significant variables after univariate analysis. RESULTS A total of 345 patients were examined: 199 included in the AGA group and 146 in the SGA. Mean BW and GA in the whole cohort (345 patients) were 1,128.12 grams (+/-239.9) and 29.7 weeks (+/-1.9), respectively. The prevalence of any stage ROP and severe ROP (needing treatment) was 29.6 and 7.0%, respectively. ROP in any evolutive stage developed in 66 AGA (33.2%) and in 36 SGA (24.7%) (p = 0.111). Severe ROP occurred in 15 AGA (7.5%) and in nine SGA (6.2%) (p = 0.779). After adjusted logistic regression, weight gain from birth to sixth week of life and need for blood transfusions were found to be significant risk factors for ROP in both groups. CONCLUSIONS This study has shown that being SGA was not a significant risk factor for any stage ROP or for severe ROP in this cohort and, also, that the risk factors for ROP were similar among SGA and AGA very-low-birth-weight preterm babies.

Resultados de um programa de prevenção da cegueira pela retinopatia da prematuridade na Região Sul do Brasil

OBJECTIVE: To describe the results of a program for the prevention of blindness caused by retinopathy of prematurity implemented in 2002 at a tertiary-care hospital, according to screening criteria adopted in Brazil, and to compare some aspects with the criteria adopted by other countries. METHODS: Descriptive observational study including all preterm infants born at this hospital weighing < 1,500 g at birth and/or gestational age < 32 weeks who survived up to the sixth week after birth, between October 2002 and June 2006. Ophthalmic examinations were performed from the sixth week of life and repeated as necessary until remission of the disease. RESULTS: A total of 300 newborns were included and there were 18 cases of treatable threshold disease (18/300, 6%) according to the Brazilian criteria. One patient was not treated because s/he developed the disease after hospital discharge and did not turn up for examination in order to initiate treatment. According to the criteria suggested by industrialized countries, the total number of exams would be reduced under the same circumstances, but 11.76% of the cases of threshold disease would not be detected. CONCLUSIONS: The Brazilian criteria for neonatal screening were efficient in detecting treatable cases. Blindness was averted in 17 preterm infants in the study period. The universal use of such program at teaching hospitals or in the public and private health networks could help prevent one of the main causes of preventable and treatable blindness among infants in developing countries. Currently, a change in these criteria in Brazil may compromise the diagnosis of some treatable patients.

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.

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.

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).

Ser pequeno para a idade gestacional é um fator de risco para a retinopatia da prematuridade? Estudo com 345 pré-termos de muito baixo peso

OBJETIVO: Comparar a prevalencia e os fatores de risco para a retinopatia da prematuridade entre pre-termos pequenos para a idade gestacional e pre-termos apropriados para a idade gestacional. METODOS: Estudo de coorte, prospectivo, incluindo pre-termos com peso de nascimento ≤ 1.500 g e idade gestacional ≤ 32 semanas divididos em dois grupos: apropriados para a idade gestacional ou pequenos para a idade gestacional. As prevalencias da retinopatia da prematuridade e os fatores de risco foram estudados nos dois grupos. Regressao logistica foi utilizada apos analise univariada. RESULTADOS: Foram examinados um total de 345 pacientes: 199 no grupo apropriados para a idade gestacional e 146 no grupo pequenos para a idade gestacional. As medias do peso de nascimento e da idade gestacional na coorte de 345 pacientes foram 1.128,12 g (±239,9) e 29,7 semanas (±1,9), respectivamente. A prevalencia da retinopatia da prematuridade em qualquer estadiamento e da retinopatia da prematuridade severa (necessitando tratamento) foi 29,6 e 7%, respectivamente. A retinopatia da prematuridade em qualquer estadiamento ocorreu em 66 apropriados para a idade gestacional (33,2%) e em 36 pequenos para a idade gestacional (24,7%) (p = 0,111). A retinopatia da prematuridade severa ocorreu em 15 apropriados para a idade gestacional (7,5%) e em nove pequenos para a idade gestacional (6,2%) (p = 0,779). Apos regressao logistica ajustada, o ganho ponderal do nascimento ate a sexta semana de vida e a necessidade de transfusoes sanguineas foram fatores de risco significativos para a retinopatia da prematuridade nos dois grupos. CONCLUSOES: Este estudo mostrou que ser pequenos para a idade gestacional nao foi um fator de risco significativo para o surgimento da retinopatia da prematuridade e que os fatores de risco para a retinopatia da prematuridade sao semelhantes em pre-termos pequenos para a idade gestacional e apropriados para a idade gestacional.

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.