Infección congénita por citomegalovirus en neonatos muy bajo peso / Congenital cytomegalovirus infection in very low birth weight neonates

Introducción: La infección congénita por el citomegalovirus en neonatos menores de 1500 gramos puede ser causa de morbilidad, mortalidad y discapacidad. Objetivo: Describir el comportamiento de la infección congénita por citomegalovirus en un servicio de neonatología. Métodos: Se realizó un estudio descriptivo y transversal con 61 neonatos. Se les realizó detección de citomegalovirus en la primera semana de vida en suero y orina, mediante reacción en cadena de la polimerasa, para determinar infección congénita. Se evaluaron variables perinatales en todos los neonatos, así como elementos clínicos y resultados de exámenes complementarios en los infectados. Resultados: La incidencia de infección congénita fue de un 10 por ciento (6/61). El 5 por ciento de los estudios fueron positivos (6/122). Ninguna muestra de orina resultó positiva (0/61) y en el 10 por ciento de las muestras de suero (6/61) se detectó el genoma del virus. Se encontró asociación entre valoración nutricional al nacer e infección por citomegalovirus (p< 0,05). El 83 por ciento de los neonatos infectados presentaron algún signo clínico y el síndrome de dificultad respiratoria fue el más frecuente (67 por ciento). En todos los neonatos con infección congénita el ultrasonido cerebral fue normal y en el 33 por ciento se detectó retinopatía de la prematuridad en el fondo de ojo. Conclusiones: La incidencia de infección congénita por citomegalovirus es alta en este grupo de riesgo. Los signos clínicos encontrados y los resultados del fondo de ojo en neonatos con infección congénita se relacionaron con la prematuridad y la valoración nutricional de hipotrófico se asoció con esta infección(AU)

Introduction: Congenital cytomegalovirus infection in neonates weighing less than 1500 grams can be a cause of morbidity, mortality, and disability. Objective: To describe the behavior of congenital cytomegalovirus infection in a neonatal service. Methods: A descriptive and cross-sectional study was conducted with 61 neonates. Cytomegalovirus was detected in the first week of life in serum and urine, by polymerase chain reaction, to determine congenital infection. Perinatal variables were evaluated in all neonates, as well as clinical elements and results of complementary examinations in infected infants. Results: The incidence of congenital infection was 10 percent (6/61). 5 percent of the studies were positive (6/122). No urine samples were positive (0/61) and the virus genome was detected in 10 percent of serum samples (6/61). An association was found between nutritional assessment at birth and cytomegalovirus infection (p < 0.05). A total of 83 percent of infected neonates had some clinical sign, with respiratory distress syndrome being the most common (67 percent). In all neonates with congenital infection, brain ultrasound was normal, and retinopathy of prematurity was detected in 33 percent of patients with fundus retinopathy. Conclusions: The incidence of congenital cytomegalovirus infection is high in this risk group. The clinical signs found and the results of the fundus in neonates with congenital infection were related to prematurity and the nutritional assessment of hypotrophic was associated with this infection(AU)

Blood metabolites in preterm infants with retinopathy of prematurity based on tandem mass spectrometry: a preliminary study / 中国当代儿科杂志

OBJECTIVES@#To study new biomarkers for the early diagnosis of retinopathy of prematurity (ROP) by analyzing the differences in blood metabolites based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) and metabolomics.@*METHODS@#Dried blood spots were collected from 21 infants with ROP (ROP group) and 21 infants without ROP (non-ROP group) who were hospitalized in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2013 to December 2016. LC-MS/MS was used to measure the metabolites, and orthogonal partial least squares-discriminant analysis was used to search for differentially expressed metabolites and biomarkers.@*RESULTS@#There was a significant difference in blood metabolic profiles between the ROP and non-ROP groups. The pattern recognition analysis, Score-plot, and weight analysis obtained 10 amino acids with a relatively large difference. Further statistical analysis showed that the ROP group had significant increases in blood levels of glutamic acid, leucine, aspartic acid, ornithine, and glycine compared with the non-ROP group (P<0.05). The receiver operating characteristic curve analysis showed that glutamic acid and ornithine had the highest value in diagnosing ROP.@*CONCLUSIONS@#Blood metabolites in preterm infants with ROP are different from those without ROP. Glutamic acid and ornithine are the metabolic markers for diagnosing ROP. LC-MS/MS combined with metabolomics analysis has a potential application value in the early identification and diagnosis of ROP.

Retinopatía del prematuro con presentación atípica / Retinopathy of prematurity with atypical presentation

La retinopatía de la prematuridad es una enfermedad dinámica vasoproliferativa de la retina inmadura postnatal que afecta a los bebés prematuros. Cuando aparecen signos de atipicidad en su diagnóstico o evolución deben descartarse otras entidades vasculares de la retina, que generalmente tienen un trasfondo genético y semejan o coexisten con dicha entidad. Se presenta un caso con características de Retinopatía del prematuro y algunos signos de atipicidad. Se describe su manejo y evolución, así como una breve descripción de las entidades que conforman el diagnóstico diferencial(AU)

Retinopathy of prematurity is a dynamic vasoproliferative disease of the immature postnatal retina that affects premature babies. When signs of atypicality appear in its diagnosis or evolution, other vascular entities of the retina must be ruled out, which generally have a genetic background and resemble or coexist with said entity. We present a case with characteristics of Retinopathy of prematurity and some signs of atypicality. Its management and evolution are described, as well as a brief description of the entities that make up the differential diagnosis(AU)

Programa de pesquisaje de retinopatía de la prematuridad en Villa Clara / Screening Program for Retinopathy of Prematurity in Villa Clara

RESUMEN La retinopatía de la prematuridad es la parte de la Oftalmología pediátrica que más interés suscita en la actualidad. En las últimas dos décadas, se realizaron rigurosos trabajos de investigación clínica sobre esta temática pues es la causa más frecuente de ceguera infantil en países desarrollados. Dicha afección fue descrita por primera vez por Terry en 1940 como fibroplasia retrolental, forma cicatricial de la enfermedad. En la década de los 50 se relacionó con el aporte elevado e incontrolado de oxígeno, lo que llevó a un control estricto de este y a restringir su uso en las Unidades de Neonatología. La Clasificación Internacional de la Retinopatía de la Prematuridad describió sus grados de gravedad basándose en cuatro parámetros: localización, estadio, extensión y presencia de enfermedad plus. El personal médico y paramédico de las salas de terapias intensivas neonatales se ha preparado para disminuir la incidencia de esta enfermedad.

ABSTRACT Retinopathy of prematurity is the part of Pediatric Ophthalmology that arouses the most interest today. In the last two decades, rigorous clinical research has been carried out on this subject, as it is the most common cause of childhood blindness in developed countries. This condition was first described by Terry in 1940 as retrolental fibroplasia, a scar form of the disease. In the 1950s, it was related to a high and uncontrolled oxygen supply, which led to its strict control, as well as to restrict its use in the Neonatology units. The International Classification of Retinopathy of Prematurity described its degrees of severity based on four parameters: location, stage, extension and presence of plus disease. Medical and paramedical personnel of the neonatal intensive care units have been prepared to reduce the incidence of this disease.

Guía de práctica clínica para la prevención, diagnóstico y manejo de la retinopatía de la prematuridad / Clinical practice guideline for the prevention, diagnosis and management of retinopathy of prematurity

La Retinopatía de la Prematuridad (ROP por sus siglas en inglés) es un trastorno retiniano vasoproliferativo y una de las causas principales de ceguera prevenible en niños (1). La ROP afecta a recién nacidos prematuros (RNP) y está asociada a la administración inadecuada de oxígeno (2). El Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) con la finalidad de establecer lineamientos basados en evidencia para gestionar de la mejor manera los procesos y procedimientos asistenciales de las presentes condiciones clínicas. Esta GPC fue realizada por la Dirección de Guías de Práctica Clínica, Farmacovigilancia y Tecnovigilancia del Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) de EsSalud.

Retinopatía del prematuro: actualización en detección y tratamiento / Retinopathy of the premature: update in screening and treatment

Resumen: La Retinopatía del Prematuro (RDP) es una alteración proliferativa de los vasos sanguíneos de la retina inmadura, que afecta principalmente a los recién nacidos de muy bajo peso (RNMBP) y de menor edad gestacional. El objetivo de esta revisión es describir a qué niño se debe efectuar la detección de esta enfermedad y analizar los recientes avances en su tratamiento. La detección de RDP está dirigida principalmente a los RNMBP y a < de 32 semanas de edad gestacional, pero también se ha propuesto un criterio según edad postmenstrual. Además de la fotocoagulación con láser, tratamiento estándar en la actualidad, se han desarrollado nuevas terapias, como los agentes anti factor de crecimiento vas cular endotelial (VEGF), que se han utilizado exitosamente en la retinopatía umbral, especialmente localizada en zona I, con menos efectos adversos y mejores resultados oculares a futuro. que la fo tocoagulación con láser. En los últimos años, se han realizado ensayos clínicos con propranolol oral como tratamiento de la RDP, principalmente en la etapa pre-umbral (etapa 2 o 3 en zona II ó III). Este bloqueador beta-adrenérgico puede prevenir la progresión de la retinopatía en RNMBP de etapa pre- umbral a umbral y/o evitar la necesidad de terapias invasivas, como la fotocoagulación con láser o la administración intravítrea de agentes anti-VEGF. La fotocoagulación con láser continúa siendo el tra tamiento de elección en la RDP. Los agentes anti-VEGF y el propranolol oral, evitarían la progresión de esta patología de etapa pre-umbral a umbral, y podrían complementar el tratamiento de la RDP.

Abstract: Retinopathy of Prematurity (ROP) is a proliferative disorder of the blood vessels of the immature retina, which affects mainly very-low-birth-weight infants (VLBW). The objective of this review is to describe to which infant the screening examination of this disease should be performed and to analy ze the recent advances in the treatment of this disease, which have emerged in the last decade. The detection of this disease is mainly focused on VLBW infants and newborns < 32 weeks of gestational age. In addition to laser photocoagulation, standard treatment today, new therapies have appeared, such as the anti-VEGF agents, which have been successfully used in the threshold ROP, especially located in zone I. This therapy is less harmful than laser photocoagulation and with better ocular results in the future. In recent years, oral propranolol has been used as a treatment for ROP in clinical trials, mainly in the pre-threshold stage (stage 2 or 3 in zone II or III). This drug is a beta-adrenergic blocker that can prevent the progression of retinopathy in pre-threshold to threshold stage and/or avoid the need for invasive therapies, such as laser photocoagulation or intravitreal administration of anti-VEGF agents. Laser photocoagulation continues to be the standard treatment for ROP. New treatments have emerged for ROP, such as anti-VEGF agents and oral propranolol, which could pre vent the progression of this disease from the pre-threshold to the threshold stage.

Validation of ROPScore to predict retinopathy of prematurity among very low birth weight preterm infants in a southern Brazilian population / Validação de um escore (ROPScore) capaz de prever a ocorrência da retinopatia da prematuridade em prematuros de baixo peso no sul do Brasil

ABSTRACT Purposes: To evaluate the sensitivity, specificity, and cutoff points for the ROPScore, which is based on cumulative risk factors for the prediction of retinopathy of prematurity (ROP), in a population of very low birth weight (BW) preterm infants in southern Brazil. Methods: The medical records of all preterm infants with a very low birth weight ≤1,500 g and/or gestational age ≤32 weeks screened for retinopathy of prematurity in two Brazilian institutions between August 2009 and December 2015 were retrospectively reviewed. ROPScores were calculated using birth weight and gestational age, the use of oxygen therapy with mechanical ventilation, and weight gain proportional to birth weight, as measured at postpartum week six and the need for blood transfusions. Results: The study cohort included 322 infants with a mean birth weight of 1181.8 ± 292.5 g and mean gestational age of 29.5 ± 2.3 weeks. The incidences of any stage of retinopathy of prematurity and severe retinopathy of prematurity were 68.3% and 17%, respectively. ROPScore values ranged from 8.7 to 19.9. The best cutoff point for sensitivity and specificity was 11 for any stage of retinopathy of prematurity and 14.5 for severe retinopathy of prematurity. For any stage of retinopathy of prematurity, the sensitivity and specificity of the ROPScores were 98.6% (95% confidence interval = 97.9%-99.3%) and 35.3% (95% confidence interval= 32.3%-38.3%), with a positive predictive value of 76.6% (95% confidence interval= 74.0%-79.2%) and a negative predictive value of 92.3% (95% confidence interval= 90.6%-94.0%). For severe retinopathy of prematurity, the sensitivity was 100% and specificity was 57.3% (95% confidence interval= 54.2%-60.4%), with positive predictive value of 22% (95% confidence interval= 19.4%-24.6%) and negative predictive value of 100%. The cutoff points correctly identified all infants that developed severe retinopathy of prematurity in this cohort. Conclusions: The ROPScore was useful to identify preterm babies at risk for retinopathy of prematurity. In this population, the ROPScore detected all patients at risk for any stage retinopathy of prematurity and severe retinopathy of prematurity. The ROPScore values in this study were similar to those previously described, thereby successfully validating the ROPScore for early detection of retinopathy of prematurity in very low birth weight preterm infants.

RESUMO Objetivos: Avaliar a sensibilidade, especificidade e os valores de pontos de corte do ROPScore, um escore baseado em fatores de risco cumulativos capaz de prever a ocorrência da retinopatia da prematuridade em prematuros de baixo peso no sul do Brasil. Métodos: Estudo retrospectivo por meio de análise de prontuários de todos os prematuros com peso ao nascer ≤1500g e/ou idade gestacional ≤32 semanas selecionados para retinopatia da prematuridade em duas instituições brasileiras entre agosto de 2009 e dezembro de 2015. Resultados: O estudo incluiu 322 pacientes. A média do peso ao nascer foi de 1181,8 ± 292,5 gr e a idade gestacional média foi de 29,5 ± 2,3 semanas. A incidência de retinopatia da prematuridade em qualquer estágio e retinopatia da prematuridade grave foi de 68,3% e 17%, respectivamente. Os valores do ROPScore variaram de 8,7 a 19,9. O melhor ponto de corte para sensibilidade e especificidade foi estabelecido em 11 para retinopatia da prematuridade em qualquer estágio e 14,5 para retinopatia da prematuridade grave. Para retinopatia da prematuridade em qualquer estadiamento, o ROPScore apresentou sensibilidade de 98,6% (95%IC 97,9-99,3) e especificidade de 35,3% (95%IC 32,3-38,3), valor preditivo positivo (VPP) de 76,6% (95%IC 74,0-79,2) e valor preditivo negativo de 92,3% (IC95% 90,6-94,0). Para retinopatia da prematuridade grave, foi registrada sensibilidade de 100%, especificidade de 57,3% (95%IC 54,2-60,4), valor preditivo positivo de 22% (95%IC 19,4-24,6) e valor preditivo negativo de 100%. Os pontos de corte identificaram corretamente todos os pacientes que desenvolveram qualquer estágio ou retinopatia da prematuridade grave no estudo. Conclusão: O ROPScore foi importante para detectar pacientes prematuros com risco de retinopatia da prematuridade. Nesta população, o ROPScore detectou todos os pacientes em risco para qualquer retinopatia da prematuridade em estágio e retinopatia da prematuridade grave. Este estudo mostrou valores semelhantes aos descritos anteriormente, validando com sucesso a ROPScore para detecção precoce de retinopatia da prematuridade em prematuros de muito baixo peso.

Resultados del Programa Nacional de Prevención de la Ceguera en la Infancia por Retinopatía del Prematuro en Argentina (2004-2016) / Results of the National Program for the Prevention of Blindness in Childhood by Retinopathy of Prematurity in Argentina (2004-2016)

Introducción. El Grupo ROP Argentina,a cargo del "Programa Nacional para la Prevención de la Ceguera en la Infancia por Retinopatía del Prematuro" (ROP), se creó en 2003. Objetivos. Describir la implementación y resultados alcanzados por el programa en la efectividad, acceso y calidad en la atención de la ROP (2004-2016). Población y métodos. Estudio descriptivo, retrospectivo, de una cohorte dinámica, en instituciones adheridas al registro. Población elegible: la totalidad de recién nacidos prematuros con factores de riesgo para desarrollar ROP. Resultados. Los servicios incorporados aumentaron de 14 a 98; cubrieron 24 provincias. Los niños < 1500 g registrados en 2004fueron 956, y 2739 en 2016. El 22,7 % de estos presentó algún grado de ROP y el 7,8 % requirió tratamiento (ROP grave). La pesquisa superó el 90 % y aumentaron los tratamientos en el lugar de origen (57 %-92 %). La incidencia de casos inusuales sigue siendo elevada (17,3 % de los tratados) y aún se registran oportunidades perdidas. El uso de drogas antiangiogénicas se triplicó desde su inicio en 2011. Conclusiones. Se observan logros significativos en términos de representatividad, alcance y adherencia al programa, también en el acceso a la pesquisa y tratamiento en el lugar de origen; sin embargo, la incidencia de ROP es aún elevada. La subraya la necesidad de fortalecer aún más las acciones del programa en cuanto a servicios.

Introduction. The ROP Argentina Group was created in 2003 and is responsible for the National Program for the Prevention of Blindness in Childhood by Retinopathy of Prematurity (ROP) in Argentina. Objectives. To describe the program implementation and results achieved in relation to ROP care in terms of effectiveness, access, and quality (2004-2016). Population and methods. Descriptive, retrospective study with a dynamic cohort carried out in facilities that are part of the registry. Eligible population: All preterm newborn infants with risk factors for ROP. Results. Participating health care services increased from 14 to 98 and covered the 23 provinces and the Autonomous City of Buenos Aires. A total of 956 infants were born with < 1500 g in 2004 and 2739, in 2016. Of these, 22.7 % had some degree of ROP and 7.8 % required treatment (severe ROP). Vision screening exceeded 90 %, and treatments at the place of origin increased (57 %-92 %). The incidence of unusual cases is still high (17.3 % of treated cases), and missed opportunities are still recorded. The use of anti-angiogenic drugs trebled since 2011, when they started to be used. Conclusions. Significant achievements were observed in terms of program representativeness, scope, and adherence, and also in relation to screening access and treatment at the place of origin; however, the incidence of ROP is still high. The persistence of unusual cases and missed opportunities evidences deficiencies in the quality of health care and outpatient followup and underlines the need to strengthen the program actions in relation to services.

The Ropscore as a screening algorithm for predicting retinopathy of prematurity in a brazilian population

OBJECTIVES: To evaluate the accuracy of the ROPScore algorithm as a predictor of retinopathy of prematurity (ROP). METHODS: A prospective cohort of 220 preterm infants with a birth weight ≤1500 g and/or gestational age ≤32 weeks was included. The ROPScore was determined in the sixth week of life in 181 infants who then survived until a corrected gestational age of 45 weeks. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the algorithm were analyzed. RESULTS: ROP was found in 17.6% of the preterm infants. The sensitivity of this test for any stage of ROP was 87.5%, while that for severe ROP was 95.4% (21/22 cases). The PPV and NPV were 59.6% and 97%, respectively, for any stage of ROP and 44.7% and 99.25%, respectively, for severe ROP. The ROPScore could therefore hypothetically reduce the number of ophthalmologic examinations required to detect ROP by 71.8%. CONCLUSION: The ROPScore is a useful screening tool for ROP and may optimize examinations and especially the identification of severe ROP.

Referentes teóricos sobre la retinopatía de la prematuridad y sus criterios de pesquisa / Theoretical framework on retinopathy of prematurity and research criteria

Fundamento: La retinopatía de la prematuridad es una microangiopatía vasoproliferativa que se desencadena en los niños pretérminos y con factores de riesgo para su desarrollo. Puede avanzar, de no ser detectada y tratada, hacia la discapacidad visual e incluso la ceguera, de ahí la importancia de su pesquisaje. Se realizó una revisión sistemática sobre este tema relativamente joven en la oftalmología, en la base de datos Medline, que involucrara la última década, por ser esta la etapa en que Cuba ha desarrollado el trabajo de pesquisaje y tratamiento de la enfermedad. Objetivo: Actualizar los conocimientos acerca de la retinopatía de la prematuridad y sus criterios de pesquisa. Desarrollo: En el mundo se han realizado estudios multicéntricos para su mejor comprensión y manejo; y se han unificado criterios para su clasificación, siendo los principales factores de riesgo a los que se asocia la baja edad gestacional al nacimiento, el bajo peso extremo, el empleo de ventilación y oxígeno, entre otros. Existen varios tratamientos para evitar la ceguera por retinopatía de la prematuridad, siendo el láser el más utilizado actualmente, combinándose en muchos casos con terapéuticas novedosas como la vitrectomía y los antiangiogénicos. En cuanto a los criterios de pesquisa no existe uniformidad en el mundo, pero Cuba cuenta con un Protocolo Nacional para su manejo, que garantiza su diagnóstico oportuno y un tratamiento inmediato. Conclusiones: La retinopatía de la prematuridad es una enfermedad oftalmológica que constituye prioridad en Cuba, existiendo en el país un protocolo nacional para su manejo y así evitar el daño visual que puede ocasionar.

Background: The retinopathy of the prematurity is a vasoproliferative microangiopathy that is unchained in preterm children and with factors of risk for its development. It can advance, of not being detected and treated, toward the visual handicap and even the blindness, of there the importance of their inquire criteria. It was carried out a systematic revision on this relatively young topic in ophthalmology, in the database Medline that involved the last decade, to be this the stage in that Cuba has developed the inquire criteria work and treatment of the illness. Objective: To upgrade the knowledge about the retinopathy of the prematurity and its investigation approaches. Development: In the world there have been carried out multicentre studies for its best understanding and handling; and it have become unified approaches for its classification, being the main factors of risk to those that associates the low gestational age at birth, the extreme low weight, the ventilation and oxygen employment, among others. Several treatments exist to avoid the blindness for retinopathy of the prematurity, being the laser the more used at the moment, combining in many cases with therapeutic novel as the vitrectomy and the angiogenic. As for the investigation approaches uniformity doesn't exist in the world, but Cuba has a National Protocol for its handling that guarantees its opportune diagnosis and an immediate treatment. Conclusions: The retinopathy of the prematurity is an ophthalmologic illness that constitutes priority in Cuba, existing in the country a national protocol for its handling and this way to avoid the visual damage that can cause.

Perfil epidemiológico dos recém-nascidos prematuros com retinopatia da prematuridade no Hospital Regional de São José Dr. Homero de Miranda Gomes / Epidemiologic profile of preterm infants with retinopathy of prematurity in the Dr. Homero de Miranda Gomes Regional Hospital in São José

RESUMO Objetivo: Avaliar a prevalência da retinopatia da prematuridade (ROP) em recém-nascidos (RN) prematuros (Idade Gestacional (IG) < 37 semanas) e/ou peso ao nascimento (PN) £ 1500g e os que possuem fatores de risco, nascidos no HRSJ entre janeiro de 2007 e janeiro de 2011. Método: Estudo transversal, retrospectivo, analítico e observacional. Os dados foram obtidos a partir de prontuários no Hospital Regional de São José Dr. Homero de Miranda Gomes. Resultados: Observou-se a presença de retinopatia em 37,81% dos RNs, sendo o estágio 1 o mais prevalente. Verificou-se que não houve diferença estatística entre os sexos (p=0,993). A presença da ROP foi maior no grupo com PN < 1000 gramas (83,33%), avaliados com mais de 6 semanas de vida e com IG menor que 32 semanas (49,48%). Os fatores de risco com significado estatístico foram: oxigenioterapia, ventilação mecânica, persistência do canal arterial, asfixia perinatal, síndrome do desconforto respiratório, transfusão sanguínea, hemorragia intraventricular, sepsis, infecção neonatal e doença da membrana hialina. Conclusão: Conclui-se que o fator sexo e gestação múltipla não tiveram significância estatística. Os RNs com menor PN e IG tem um maior risco de desenvolver ROP. Em relação à oxigenioterapia, a prevalência nos expostos é maior e proporcional ao tempo de utilização de oxigênio.

ABSTRACT Objectives: To evaluate the prevalence of retinopathy of prematurity (ROP) in premature newborns (gestational age < 37 weeks) and / or birth weight £ 1,500g and those with risk factors, born at the Dr. Homero de Miranda Gomes Regional Hospital in São José (HRSJ) between January 2007 and January 2011. Methods: Cross-sectional, retrospective, observational and analytical study. Data were obtained from medical records at the HRSJ. Results: The presence of 37.81% of retinopathy in newborns was observed, with stage 1 being the most prevalent. No statistical difference was found between the sexes (p = 0.993). The presence of ROP was higher in the group with PN < 1,000 grams (83.33%), evaluated over 6sixweeks of age and with gestational ages less than 32 weeks (49.48%). Risk factors with statistical significance were: oxygen therapy, mechanical ventilation, patent ductus arteriosus, perinatal asphyxia, respiratory distress syndrome, blood transfusions, intraventricular hemorrhage, sepsis, neonatal infection and hyaline membrane disease. Conclusion: It is concluded that: the gender factor and multiple pregnancy were not statistically significant. The newborns with lower birth weight and gestational age have an increased risk for developing ROP. Regarding oxygentherapy, the prevalence is higher in the exposed and proportional to the period of oxygen.

Screening for Retinopathy of Prematurity in a Provincial Hospital in Port Elizabeth; South Africa

Background. Retinopathy of prematurity (ROP) is an emerging public health problem in many middle-income countries where improved neonatal survival rates coupled with inadequate health resources have created a new epidemic. There are limited available data on the magnitude of the problem; and screening in South African (SA) hospitals has not been uniformly practised.OBJECTIVE:To describe the results of various interventions implemented over a 6-year period while developing a new ROP screening service in a provincial hospital in Port Elizabeth; SA.METHOD: A retrospective case folder review of ROP screening at Dora Nginza Hospital; Port Elizabeth; SA; over the 6-year period 2009 - 2014 was conducted.RESULTS:A total of 919 new cases were seen. Fifteen patients received treatment for type 1 ROP (T1ROP); 223 had type 2 (T2) or earlier ROP; 1 had stage 4 ROP and 6 had stage 5 ROP. The combination of healthcare worker education; improved equipment and human resources and the introduction of dual responsibility for case referrals resulted in an increase in the number of new infants screened from 33 in year 1 to 292 in year 6. The number of infants who were screened late decreased from 33/33 (100%) in year 1; prior to the interventions; to 23/292 in the final year (7.9%). Improved oxygen delivery and adequate oxygen saturation monitoring contributed to a decrease in the incidence of T1ROP from 1.5% to 1% over 1 year and in the incidence of T2 or earlier ROP from 30.3% to 24%.CONCLUSIONS:Better management of ROP can be achieved through adequate provision of healthcare professionals and material resources coupled with education and a well-supported referral system. A close working relationship between paediatricians and ophthalmologists results in a more efficient screening programme

Features of retinopathy of prematurity in a tertiary care hospital in Lahore

To study the demographic and clinical features of Retinopathy of Prematurity in urban Punjab. The cross-sectional study was performed at Hameed Latif Hospital, Lahore, from April 2010 to October 2013 and comprised neonates born with birth weight less than 2000g, gestational age less than 37 weeks, or those who were considered high risk for Retinopathy of Prematurity. Variables recorded included history, birth weight, gestational age, oxygen supplementation, development of Retinopathy of Prematurity, and laser treatment. Data was analysed using SPSS 17. There were 285 neonates in the study with a mean birth weight of 1280.34 +/- 350.43g and mean gestational age being 29.38 +/- 3.14 weeks. Overall, 167[58.6%] received supplemental oxygen, 86[30.2%] were anaemic and 44[15.4%] received blood transfusion. Besides, 47[16.5%] premature babies were product of multiple gestation, 34[11.9%] were having respiratory distress, 25[8.8%] had sepsis and received intravenous antibiotics, 70[24.6%] developed Retinopathy of Prematurity, and 22[7.7%] developed threshold disease and received laser treatment at mean gestational age of 32.11 +/- 2.53 weeks. Screening is key to preventing childhood blindness caused by Retinopathy of Prematurity. Prematurity, low birth weight and supplemental oxygen therapy are significant risk factors for the condition

Retinopathy of prematurity screening and treatment cost in Brazil / Costo de la detección y el tratamiento de la retinopatía de la prematuridad en el Brasil

OBJECTIVE: To assess the additional cost of incorporating the detection and treatment of retinopathy of prematurity (ROP) into neonatal care services of Brazil's Unified Health System (SUS). METHODS: A deterministic decision-tree simulation model was built to estimate the direct costs of screening for and treating ROP in neonatal intensive-care units (NICUs), based on data for 869 preterm infants with birth weight less than 1 500 g examined in six governmental NICUs in the capital city of Rio de Janeiro, where coverage was 52% and 8% of infants were treated. All of the parameters from this study were extrapolated to Brazilian newborn estimates in 2010. Costs of screening and treatment were estimated considering staff, equipment and maintenance, and training based on published data and expert opinion. A budget impact analysis was performed considering the population of preterm newborns, screening coverage, and the incidence of treatable ROP. One- and two-way sensitivity analyses were performed. RESULTS: In Rio de Janeiro, unit costs per newborn were US$ 18 for each examination, US$ 398 per treatment, and US$ 29 for training. The estimated cost of ROP diagnosis and treatment for all at-risk infants NICUs was US$ 80 per infant. The additional cost to the SUS for one year would be US$ 556 640 for a ROP program with 52% coverage, increasing to US$ 856 320 for 80% coverage, and US$ 1.07 million or 100% coverage. CONCLUSIONS: The results of this study indicate that providing ROP care is affordable within the framework of the SUS in Brazil, and might be feasible elsewhere in Latin America, considering the evidence of the effectiveness of ROP treatment and the social benefits achieved.

OBJETIVO: Evaluar el costo adicional de incorporar la detección y el tratamiento de la retinopatía de la prematuridad (RP) en los servicios de atención neonatal del Sistema Único de Salud (SUS) del Brasil. MÉTODOS: Se estableció un modelo de simulación determinístico en forma de árbol de decisión para calcular los costos directos del tamizaje y el tratamiento de la RP en las unidades de cuidados intensivos neonatales (UCIN), con base en los datos correspondientes a 869 lactantes prematuros con un peso al nacer inferior a 1 500 g examinados en seis UCIN gubernamentales de Rio de Janeiro, capital del estado del mismo nombre, donde la cobertura fue de 52% y se trató a un 7% de los lactantes. Todos los parámetros de este estudio se extrapolaron a los cálculos de recién nacidos brasileños correspondientes al año 2010. Se calcularon los costos de la detección y el tratamiento, teniendo en cuenta el personal, el equipo y la capacitación, con base en los datos publicados y la opinión de los expertos. Se llevó a cabo un análisis de la repercusión presupuestaria considerando la población de recién nacidos prematuros, la cobertura del tamizaje y la incidencia de RP susceptible de tratamiento. Se realizaron análisis de sensibilidad en uno y dos sentidos. RESULTADOS: En Rio de Janeiro, los costos unitarios por recién nacido fueron de US$ 18 por cada examen, US$ 398 por tratamiento y US$ 29 por capacitación. El costo calculado del diagnóstico y el tratamiento de la RP en todos los lactantes en situación de riesgo de las UCIN fue de US$ 80 por lactante. El costo anual adicional para el SUS de un programa de RP con una cobertura de 52% sería de US$ 556 640, y ascendería a US$ 856 320 para una cobertura de 80%, y a US$ 1,07 millones si la cobertura fuera de 100%. CONCLUSIONES: Los resultados de este estudio indican que, teniendo en cuenta los datos probatorios de la eficacia del tratamiento de la RP y los beneficios sociales obtenidos, la prestación de asistencia a la RP es asequible en Brasil en el marco del SUS y podría ser factible en otros lugares de América Latina.

Prevalencia y características de la retinopatia del prematuro / Prevalence and characteristics of retinopathy of prematurity

Antecedentes y Objetivos: La retinopatía del prematuro (ROP) se caracteriza por un desa- rrollo anormal de los vasos sanguíneos en la retina de los prematuros; Las formas graves traen como consecuencia el desprendimiento de retina y la ceguera. En el Hospital Nacional Mario Catarino Rivas (HNMCR) nacen al año más de 7000 recién nacidos, de los cuales el 21% son prematuros, y muchos de estos prematuros desarrollan ROP. Por esto se quiso conocer la prevalencia y caracterización de la retinopatía en estos pacientes. Pacientes y Métodos: Se realizó un estudio descriptivo-re- trospectivo en el HNMCR, en la unidad de neo- natología y su Programa Madre Canguro. Los datos se obtuvieron del expediente médico y a cada uno de los prematuros se les realizó oftal- moscopia indirecta para detectar la presencia de ROP o no, y clasificar el tipo de ROP según la clasificación internacional de ROP (ICROP). Se enrolaron 130 prematuros. Resultados: 37% (n=48) tenían Retinopatía del prematuro; el 7% desarrolló retinopatía con enfermedad umbral y necesitaron tratamiento, y el 30% restante tenían enfermedad pre umbral. La ROP es más frecuente en menores de 1250 gramos y menores de 32 semanas (OR: 14 [3.9522-52.7650] y OR:7 [2.9365-16.9684]) respectivamente). Conclusiones: Cuanto menor es el peso y la edad gestacional, mayor es la incidencia de ROP...(AU)

Comportamiento de la retinopatía de la prematuridad en la provincia La Habana / Behavior of retinopathy of prematurity in La Habana province

Objetivo: evaluar el comportamiento de la retinopatía de la prematuridad en los nacidos con menos de 1 750 g o menos de 35 semanas de gestación. Métodos: se realizó un estudio retrospectivo, observacional, descriptivo en el período comprendido de enero de 2005 a septiembre de 2010, en los servicios de neonatología de la provincia La Habana. Se estudió el total de recién nacidos vivos (207) con menos de 35 semanas de edad gestacional y un peso inferior a 1 750 g al nacer ingresados en las unidades de cuidados intensivos neonatales de este territorio. Resultados: el 42,8 por ciento correspondió con los nacidos entre las semanas 33 y 34,6, y un 42,8 por ciento con un peso entre 1 250 y 1 499 g. El 89,8 por ciento de los recién nacidos presentaron una retina inmadura y un 10,1 por ciento desarrolló retinopatía de la prematuridad. El 88,8 por ciento de los tratados con láser evolucionaron favorablemente. Conclusiones: la retinopatía de la prematuridad ha disminuido en los últimos años a pesar de que existe un incremento en el bajo peso al nacer y prematurez. La edad gestacional menor de 34,6 semanas, el peso al nacer menor de 1 500 g y el síndrome de dificultad respiratoria fueron los factores más importante en la aparición de la retinopatía. Con el diagnóstico precoz de la enfermedad se trató oportunamente, logrando disminuir las secuelas y mejoría de la calidad de vida

Objective: to evaluate the behavior of retinopathy of prematurity in newborns weighing less than 1750 grams or with less than 35 weeks of gestation. Methods: a retrospective, observational and descriptive study was conducted in the neonatology service of La Habana province in the period of January 2005 to September 2010. A total number of 207 livebirths with less than 35 weeks of gestational age and weight under 1750 grams, who had been admitted to the neonatal intensive units of the territory, were studied. Results: in this group, 42.6 percent were newborns aging 33 to 34.6 weeks, and 42.8 percent weighing from 1250 to 1499 g. Immature retina was observed in 89.6 percent of newborns and 10.1 percent developed retinopathy of prematurity. Of these cases, 88.8 percent treated with laser had favorable recovery. Conclusions: retinopathy of prematurity has decreased in the last few years despite an increase of low birth weight and prematurity. The gestational age under 34.6 weeks, the weight less than 1500g and the respiratory distress syndrome were the most important factors in the occurrence of retinopathy. The early diagnosis of the disease allows prompt treatment and reduction of sequelae as well as improvement of their quality of life

Oral glucose for pain relief during examination for retinopathy of prematurity: a masked randomized clinical trial

OBJECTIVE: Ophthalmologic examination for retinopathy of prematurity is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed to reduce pain during eye examinations. This study aims to evaluate the analgesic effect of 25% glucose using a validated pain scale during the first eye examination for retinopathy of prematurity in preterm infants with birth weight <1,500 g and/or gestational age <32 weeks. METHODS: A masked, randomized clinical trial for one dose of 1 ml of oral 25% glucose solution 2 minutes before the first ophthalmologic examination for retinopathy of prematurity was conducted between March 2008 and April 2010. The results were compared to those of a control group that did not receive oral glucose solution. Pain was evaluated using a Neonatal Infant Pain Scale immediately before and immediately after the ophthalmologic examination in both groups. Clinicaltrials.gov: NCT00648687 RESULTS: One hundred and twenty-four patients who were examined for the first time for retinopathy of prematurity were included. Seventy were included in the intervention group and 54 in the control group. The number of patients with pain immediately before the procedure was similar in both groups. The number of patients with pain after ophthalmologic examination was 15.7% in the intervention group and 68.5% in the control group (p<0.001). CONCLUSIONS: One ml of oral 25% glucose solution given 2 minutes before an ophthalmologic examination for retinopathy of prematurity was an effective measure for pain relief.

Retinopatía del prematuro en el Hospital Nacional Doctor Mario Catarino Rivas de Honduras / Retinopathy of prematurity in the National Hospital Doctor Mario Catarino Rivas de Honduras

Antecedentes: la retinopatía del prematuro es el desarrollo anormal de los vasos de la retina y principal causa de ceguera infantil. El diagnóstico precoz y tratamiento oportuno mejoran el pronóstico visual. En Latinoamérica viven unos 25,000 ciegos por esta causa. Los principales factores de riesgo son: prematurez, bajo peso al nacer y oxígenoterapia; cuando esta última es necesaria, se debe mantener la saturación de oxígeno por debajo del 93% hasta llegar a la semana 34, para disminuir el riesgo de retinopatía. Objetivo: determinar la frecuencia de retinopatía del prematuro para despertar el interés de las autoridades de salud pública en la prevención de ceguera por esta causa. Pacientes y Métodos: Estudio descriptivo transversal realizado en el Hospital Nacional Doctor Mario Catarino Rivas en la ciudad deSan Pedro Sula, al norte de Honduras, en donde la natalidad anual supera los 7,000 nacidos vivos, y de estos, 21% nacen con algún grado de prematurez. Resultados: se valoraron 561 lactantes con factores de riesgo para desarrollar retinopatía del prematuro: peso al nacer≤ 1,800 g, edad gestacional ≤ 35 semanas, oxígenoterapia mayor a 8 horas, peso menor a 2,000 g y uno de los siguientes criterios: apoyo ventilatorio, exsanguíneo transfusión, fototerapia, transfusión de hemoderivados, maniobras de reanimación, apgar inferior al normal, embarazos múltiples menores de 2,000 g. Encontrándose 242 (43%) afectados y 24 prematuros con ceguera. Conclusión: La mayor sobrevida de niñosprematuros ha aumentado la morbilidad, entre ellas está la retinopatía del prematuro, que obliga a establecer protocolos para la prevención, diagnóstico y manejo precoz, y así, evitar la ceguera por esta causa...