Study on the correlation between maternal iron deficiency anemia and ROP in premature or low birth weight infants / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To explore the correlation between maternal iron deficiency anemia and retinopathy of prematurity(ROP)in premature infants or low birth weight infants so that to provide possible scientific basis for the prevention and control of ROP.<p>METHODS: This study was a case-control study. The clinical data of 317 premature or low birth weight infants who were diagnosed with ROP and their mothers in our hospital during January 2019 to July 2021 due to ROP screening for the first time(about 30d after birth)were analyzed. The relationship between maternal iron deficiency anemia and ROP and its stages were observed. And the relationship between Hb, blood value characteristics, mean gestational age, gestational weeks, infant birth weight of maternal iron deficiency anemia and ROP stage.<p>RESULTS: There were 235 mothers(74.1%)with iron deficiency anemia, 82 mothers(25.9%)without iron deficiency. Among them, there were 194 mothers(82.6%)with mild anemia according to anemia classification, 119 cases with stage Ⅰ ROP and 75 cases with stage Ⅱ ROP. There were 39 mothers(16.6%)with moderate anemia, 8 cases with stage Ⅱ ROP, 22 cases with stage Ⅲ ROP and 9 cases with stage Ⅳ ROP. There were 2 mothers(0.9%)of severe anemia, all of whom had stage Ⅳ ROP. No children with stage Ⅴ or threshold ROP and mothers with very severe anemia were found in this study. Compared with mothers with iron deficiency anemia, premature infants or low birth weight infants with normal iron levels were more likely to have stage Ⅰ ROP, but stage Ⅱ ROP was more pronounced in mothers with iron deficiency anemia, and the differences were statistically significant(all <i>P</i><0.05). Stage Ⅲ and stage Ⅳ ROP was not observed in the mothers with normal serum iron, but was 9.4% and 4.7% in the mothers with iron deficiency anemia, respectively. The differences were statistically significant(<i>P</i><0.05). Stage Ⅴ and threshold lesions ROP was not observed in preterm or low birth weight infants in mothers with normal serum iron values or iron deficiency anemia. Compared with mothers with normal iron levels, mothers with iron deficiency anemia had significantly lower hemoglobin, hematocrit, mean erythrocyte volume, serum iron and ferritin levels. At the same time, the higher mean gestational age, mean shorter gestational week and mean lower birth weight in the mothers with iron deficiency anemia, and the differences were statistically significant(all <i>P</i><0.05).<p>CONCLUSION:Pregnant iron-deficiency anemia is associated with the occurrence and development of ROP in premature or low birth weight infants. The more severe maternal anemia, the higher maybe stage of ROP. Therefore, monitoring and supplementation of iron during pregnancy can effectively prevent and reduce the risk of ROP.

Comparison of Related Factors between Twins in Which Premature of Retinopathy Developed on One Twin

PURPOSE: To analyze related factors of retinopathy of prematurity by comparing between premature twins in which retinopathy developed on one twin. METHODS: A retrospective survey consisting of 13 premature twins in which retinopathy of prematurity (stage 1 or more) developed on one twin was performed. All twins were born in Kosin University Gospel Hospital. The twins were separated into two groups according to whether they had retinopathy of prematurity: the retinopathy of prematurity (ROP) group and non-ROP group. The twins' gestational age, weight, sex, Apgar score, treatments, blood tests, and neonatal complications were investigated. RESULTS: There were no significant differences between the twins except platelet count and aspartate aminotransferase. Platelet count was 191 (±46) ×10³/µL in the ROP group and 240 (±77) ×10³/µL in the non-ROP group, a significant difference (p = 0.046). Aspartate aminotransferase was 36 (±26.6) IU/L in the ROP group and 22 (±5.9) IU/L in the non-ROP group, a significant difference (p = 0.019). CONCLUSIONS: In conclusion, we found platelet count and aspartate aminotransferase to be significant factors related to development of retinopathy of prematurity. It is thought that these factors should be considered when screening for ROP, although a larger prospective study is be needed before the results can be applied in clinical practice.

The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting.

Aim: To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously developed tele-ROP model. Materials and Methods: KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained to use a portable Retcam Shutt le (Clarity, USA) and validated against ROP experts performing indirect ophthalmoscopy. An indigenously developed 20-point score (STAT score) graded their ability (Level I to III) to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone, Apple). Results: 6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with 94.3% of all expert decisions. The sensitivity, specifi city, positive predictive value and negative predictive value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to decide discharge of babies was 0.94 (P < 0.001). Only 0.4% of infants needing treatment were missed.The kappa agreement of experts reporting on the iPhone vs Retcam for treatment requiring and mild ROP were 0.96 and 0.94 (P < 0.001) respectively. Conclusions: This is the fi rst and largest real-world program to employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other middle-income countries with similar demographics.

Refractive States of 3~4 Year Olds that Underwent Cryotherapy in ROP

The previous researches proved that the incidence of myopia in cryotreated retinopathy of prematurity[ROP]eyes is higher than that of non-treated ROP eyes. The authors compared refractive states, anterior-posterior axial length and other contributing factors of treated eyes with those of nontreated eyes at the same age group between 3~4 years old. In the cases of cryotreated group, the mean refractive error was -3.48 +/-4.02D. Among 42 treated eyes, 30 eyes became myopic[71.4%]. The mean axial length was 22.46 +/-1.43mm. The mean length of posterior segment was 15.53 +/-1.33mm. In contrast, the mean refractive error was 1.09 +/-1.04D in non-cryotreated group. Three eyes among 42 untreated eyes developed myopia [7.1%]. The mean axial length was 21.02 +/-1.17 mm. The mean length of posterior segment is 14.09 +/-0.97mm. We concluded that myopia could be developed in cryotreated ROP eyes by the elongation of eyeball, specifically of posterior segment.

Myopia in Premature Infants

The authors performed cycloplegic refraction in premature infants at the 6 months and 3 years of age to evaluate the incidence and degree of myopia and the changes of refractive errors according to the development, disease course and cryotherapy of retinopathy of prematurity (ROP). In 180 eyes of 99 infants at the 6 months of age, the incidences of myopia were not different between eyes with no ROP and eyes with spontaneously regressed ROP (36.3%, 25.5%), and the degrees of myopia were low in both groups (-1.76D, - 2.25D). In eyes with regressed ROP after cryotherapy, the incidence of myopia was high (75.5%) but the degree of myopia low (-3.0:3D). In eyes with cicatrical ROP, cryotreated or not, both of the incidence and the degree of myopia were high(93.9%, -5.50D). It is suggested that the incidence of myopia is increased after cryotherapy but the degree of myopia occurring after cryotherapy is low. In eyes with spontaneously regressed ROP, the degrees of refractive errors did not change from 6 months to 3 years of age, whereas in eyes cryotreated or with cicatrical ROP, the degrees of refractive errors were progressively changed to myopic side.