The Risk Factors for Retinopathy of Prematurity and Need of Laser Photocoagulation: A Single Center Experience

  • Emrah Utku Kabataş
  • Serdar Beken
  • Banu Aydın
  • Dilek Dilli
  • Ayşegül Zenciroğlu
  • Nurullah Okumuş
Keywords: Retinopathy of prematurity, risk factors, transfusion, caffeine

Abstract

Objective: It was aimed to determine the risk factors for the development of retinopathy of prematurity (ROP) in premature infants. The factors affecting the need of laser photocoagulation (LP) were also investigated.Methods: The study was prospectively conducted at a tertiary neonatal intensive care unit (NICU) between March 2011 and August 2012. A total of 113 premature infants born at <37 weeks of gestational age were evaluated. The patients were divided into two groups according to ROP development; Group 1: with ROP and Group 2: without ROP.Results: In Group 1 (n=53), 15 patients (38.3%) had stage >2 ROP. LP was performed on 18 (33.9%) patients. While the mean birth weight and gestational age were lower, the rates of associated disorders, use of prophylactic or therapeutic caffeine for apnea, and need of red blood cell transfusion were higher in Group 1 compared to Group 2 (p<0.05). Multivariate analysis showed that the need of transfusion in the first 10 days of life has increased the risk for ROP (OR: 1.9, 95% CI: 1.1-3.3, p=0.01). In another model, it was determined that the higher gestational age and the absence of apnea or prophylactic caffeine use were associated with reduced need of LP [OR: 0.5, 95% CI: 0.2-0.9), p=0.02, and (OR: 0.1, 95% CI: 0.03-0.9), p=0.02), respectively].Conclusion: Red blood cell transfusion in early neonatal period may contribute to the development of ROP. The use of prophylactic or therapeutic caffeine for apnea could negatively affect the progression of ROP with need of LP.

References

Terry TL. Extreme prematurity and fibroblastic overgrowth of persistent vasculer sheat behind each crystalline lens. Am J Ophthalmol 1942; 25: 203-4.

Araz-Ersan B, Kir N, Akarcay K, et al. Epidemiological analysis of retinopathy of prematurity in a referral centre in Turkey. Br J Ophthalmol 2013; 97: 15-7.

Section on Ophthalmology American Academy of Pediatrics; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2006; 117: 572-6.

Palmer EA, Schaffer DB, Plotsky DF. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Prognostic factors in the natural course of retinopathy of prematurity. Ophthalmology 1993; 100: 230–7.

Altunbaş HH, Kır N, Ovalı T, Dağoğlu T. Prematüre Retinopatisi Klinik Seyir ve Risk Faktörleri. Turk J Ophthalmol 2002; 32: 286-98.

Ilıkkan DY, Vural M, Karaçorlu M, Ilıkkan B, Perk Y, İlker Ö. Prematüre bebeklerde retinopati taraması. Cerrahpaşa Tıp Fakültesi Verileri. Çocuk Sağlığı ve Hastalıkları Dergisi 2000; 44: 122-7

Ciechan J, Gerkowicz M, Wróblewska E. The prognostic significance of shape of demarcation line and ridge in clinical course of active phase of retinopathy of prematurity. Klin Oczna 2003; 105: 392-4.

Talu S, Cormos D, Zaharia G, Stefanut C, Popa M, Lucaci DI. Prognostic factors for laser treatment in retinopathy of prematurity. Oftalmologia 2011; 55: 84-9.

International Committee for the Classification of Retinopathy of Prematurity. The International classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123: 991–9.

Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol 2003; 121: 1684–94.

Shah VA, Yeo CL, Ling YL, Ho LY. Incidence, risk factors of retinopathy of prematurity among very low birth weight infants in Singapore. Ann Acad Med Singapore 2005; 34: 169-78.

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.

Fielder AR., Shaw DE., Robinson J, Ng YK. Natural history of retinopathy of prematurity: a prospective study. Eye 1992; 6: 233-242

Termote JU, Schalij-Delfos NE, Wittebol-Post D, Brouwers HA, Hoogervorst BR, Cats BP. Surfactant replacement therapy: a new risk factor in developing retinopathy of prematurity? Eur J Pediatr 1994; 153: 113-6.

Ved GP, Upreet D, Rohit S, Piyush G, Jolly R. Retinopathy of prematurity-Risk factors. Indian J Pediatr 2004; 71: 887-92.

Tlucek PS, Grace SF, Anderson MP, Siatkowski RM. Effect of the oxygen saturation target on clinical characteristics of early- versus late-onset retinopathy of prematurity. Journal of AAPOS 2012; 16: 70-4.

Gellen B, McIntosh N, McColm JR, Fleck BW. Is the partial pressure of carbon dioxide in the blood related to the development of retinopathy of prematurity? Br J Ophthalmol 2001; 85: 1044-5.

Greenough A, Ahmed N. Perinatal prevention of bronchopulmonary dysplasia. J Perinat Med 2013; 41: 119–26

Mueni E, Opiyo N, English M. Caffeine for the management of apnea in preterm infants. Int Health 2009; 1: 190–5.

Allegaert K, Coen K, Devlieger H. On behalf of the Epibel Study Group Threshold retinopathy at threshold of viability. The Epibel Extended Report. Br J Ophtalmol 2004; 88: 239-42.

Dani C, Reali MF, Bertini G, Martelli E, Pezzati M, Rubaltelli FF. The role of blood transfusions and iron intake on retinopathy of prematurity. Early Hum Dev 2001; 62: 57-63.

Inder TE, Clemett RS, Austin NC, Graham P, Darlow BA. High iron status in very low birth weight infants is associated with an increased risk of retinopathy of prematurity. J Pediatr 1997; 131: 541-4.

Thomas WJ, Rauser M, Dovich JA, Dustin L, Flaxel CJ. Oxygen saturation in premature infants at risk for threshold retinopathy of prematurity. Eur J Ophthalmol 2011; 21: 189-93.

Ikeda H, Kuriyama S. Risk factors for retinopathy of prematurity requiring photocoagulation. Jpn J Ophthalmol 2004; 48: 68-71

Thomas WJ, Rauser M, Dovich JA, Dustin L, Flaxel CJ. Oxygen saturation in premature infants at risk for threshold retinopathy of prematurity. Eur J Ophthalmol 2011; 21: 189-93.

Published
2013-12-29
Section
Original Research