Influence of the blood glucose level on the development of retinopathy of prematurity in extremely premature children / Influência do nível de glicose sanguínea no desenvolvimento de retinopatia da prematuridade em crianças extremamente prematuras

ABSTRACTPurpose:To investigate the influence of the blood glucose level on the development of retinopathy of prematurity (ROP) in extremely premature infants.Methods:Sixty-four premature infants with a gestational age of less than 30 weeks and a birth weight of less than 1500 g were included in the study. Children without ROP were allocated to Group 1 (n=14, gestational age 28.6 ± 1.4 weeks, birth weight 1162 ± 322 g), and children with spontaneous regression of ROP were allocated to Group 2 (n=32, gestational age 26.5 ± 1.2 weeks, birth weight 905 ± 224 g). Children with progressive ROP who underwent laser treatment were included in Group 3 (n=18, gestational age 25.4 ± 0.7 weeks, birth weight 763 ± 138 g). The glucose level in the capillary blood of the premature infants was monitored daily during the first 3 weeks of life. A complete ophthalmological screening was performed from the age of 1 month. The nonparametric signed-rank Wilcoxon-Mann-Whitney test was used for statistical analysis.Results:The mean blood glucose level was 7.43 ± 2.6 mmol/L in Group 1, 7.8 ± 2.7 mmol/L in Group 2, and 6.7 ± 2.6 mmol/L in Group 3. There were no significant differences in the blood glucose levels between children with and without ROP, and also between children with spontaneously regressing ROP and progressive ROP (p>0.05). Additionally, there were no significant differences in the blood glucose levels measured at the first, second, and third weeks of life (p>0.05).Conclusion:The blood glucose level is not related to the development of ROP nor with its progression or regression. The glycemic level cannot be considered as a risk factor for ROP, but reflects the severity of newborns’ somatic condition and morphofunctional immaturity.

RESUMOObjetivo:Investigar a influência do nível de glicose sanguínea sobre o desenvolvimento da retinopatia da prematuridade (ROP) em prematuros extremos.Método:Sessenta e quatro prematuros com idade gestacional inferior a 30 semanas e um peso de nascimento abaixo de 1.500 g foram incluídos no estudo. As crianças sem ROP foram atribuídos ao Grupo 1 (n=14, idade gestacional 28,6 ± 1,4 semanas, peso ao nascer 1.162 ± 322 g). As crianças com regressão espontânea da ROP foram atribuídos ao Grupo 2 (n=32, idade gestacional 26,5 ± 1,2 semanas, peso ao nascimento 905 ± 224 g). Crianças com ROP progressiva que se submeteram a tratamento com laser foram incluídos no Grupo 3 (n=18, idade gestacional 25,4 ± 0,7 semanas, o peso ao nascer de 763 ± 138 g). O nível de glicose de sangue capilar de prematuros foi monitorado diariamente durante as três primeiras semanas de vida. A triagem oftalmológica completa foi realizada a partir da idade de 1 mês. O teste não paramétrico de Wilcoxon-Mann-Whitney foi utilizado para análise estatística.Resultados:O nível médio de glicose no sangue em crianças do Grupo 1 foi de 7,43 ± 2,6 mmol/L, o grupo 2 foi de 7,8 ± 2,7 mmol/L, e o Grupo 3 foi de 6,7 ± 2,6 mmol/L. Não houve diferenças significativas nos níveis de glicose no sangue entre crianças com e sem ROP, e também entre crianças com regressão espontânea ROP e ROP progressiva (p>0,05). Também não houve diferenças significativas nos níveis de glicose no sangue medidos na primeira, segunda e terceira semana de vida (p>0,05).Conclusões:O nível de glicose no sangue não tem relação com o desenvolvimento de ROP, bem como sobre a sua progressão ou regressão. O nível glicêmico não pode ser considerado como um fator de risco para ROP, mas reflete a gravidade do estado somático de recém-nascidos e imaturidade morfofuncional.

Insulin-like growth factor binding protein-3 in preterm infants with retinopathy of prematurity.

Background: Retinopathy of prematurity (ROP) is the main cause of visual impairment in preterm newborn infants. Objective: This study was conducted to determine whether insulin-like growth factor binding protein -3 (IGFBP-3) is associated with proliferative ROP and has a role in pathogenesis of the disease in premature infants. Materials and Methods: A total of 71 preterm infants born at or before 32 weeks of gestation participated in this study. Studied patients consisted of 41 neonates without vaso-proliferative findings of ROP as the control group and 30 preterm infants with evidence of severe ROP in follow up eye examination as the case group. Blood samples obtained from these infants 6-8 weeks after birth and blood levels of IGFBP-3 were measured using enzyme-linked immunosorbent assay (ELISA). Results: The mean gestation age and birth weight of the studied patients were 28.2±1.6 weeks and 1120.7±197 gram in the case group and 28.4±1.6 weeks and 1189.4±454 gram in the control group (P=0.25 and P=0.44 respectively). The infants in the case group had significantly lower Apgar score at first and 5 min after birth. Insulin-like growth factor binding protein -3 (IGFBP-3) was significantly lower in the patients with proliferative ROP than the patients without ROP [592.5±472.9 vs. 995.5±422.2 ng/ml (P=0.009)]. Using a cut-off point 770.45 ng/ml for the plasma IGFBP-3, we obtained a sensitivity of 65.9% and a specificity of 66.7% in the preterm infants with vasoproliferative ROP. Conclusion: Our data demonstrated that the blood levels IGFBP-3 was significantly lower in the patients with ROP and it is suspected that IGFBP-3 deficiency in the premature infants may have a pathogenetic role in proliferative ROP.

Effect of trace elements on retinopathy of prematurity / 华中科技大学学报（医学）（英德文版）

The effect of the trace elements on retinopathy of prematurity (ROP) were studied. Thirty preterm infants who had potential high risk factors of ROP were selected as observation group and 18 normal infants as control groups. By using atom spectrophotometer, the contents of serum trace elements (Mg, Cu, Zn, Mn, Se) were measured and analyzed statistically. The contents of serum Zn, Cu and Se in observation group were 0.75+/-0.22, 0.41+/-0.20 and (134.07+/-71.57)x10(-3) mg/L respectively, and 0.55+/-0.12, 0.65+/-0.194 and (202.92+/-44.71)x10(-3) mg/L in control group respectively (P0.05). It was concluded that the contents of serum Cu and Se in preterm infants who had high risk factors of ROP were obviously lower than in the controls. The contents of serum Cu and Se in the ROP infants were also much lower while contents of Zn much higher. Attention should be paid to the detection of the trace elements in preterm infants in order to prevent the deficiencies of Cu and Se. Only in this way can we prevent the deficiencies of Cu and Se, so as to decrease the ROP risk factors and prevent the disease.