Getting to know the signs of ROP
New research helps find and protect babies at highest risk of severe disease
Severe retinopathy of prematurity (ROP) is caused by multiple factors, many of which, such as gestational age and weight at birth, are beyond clinicians’ control. However, recent research suggests that an ROP “risk clock” starts at birth and runs for the first two months of life regardless of the level of prematurity, Ann Hellström MD, PhD, University of Gothenburg, Sweden, told the 2018 World Society of Paediatric Ophthalmology and Strabismus Subspecialty Day in Vienna.
Infants at high risk of severe ROP may be identified and sometimes their risk substantially reduced by modifying post-natal factors uncovered in recent research, added Dr Hellström, a leading researcher in ROP pathophysiology and treatment. In screening infants, she recommended looking closely at the following factors during the critical first two weeks of life.
O2 use: Higher levels of oxygen use in premature infants have long been associated with increased ROP risk, leading to reduced oxygen use in many centres. But recent studies linking low levels to increased mortality has reversed this practice, increasing ROP incidence, which doubled in certain regions of Sweden in recent years, Dr Hellström said. However, her research found that babies who developed ROP had lower mean oxygen levels, but higher variation in levels, which correlated with frequency of alarms for high or low oxygen. Ensuring levels remain in the target range may reduce ROP risk.
Breastfeeding: Milk from a premature infant’s mother contains unique bioactive factors that help pre-term infants adapt to life outside the uterus, Dr Hellström said. These factors are often destroyed in donor breast milk due to pasteurisation and storage and are often from mothers who have given birth to full-term babies. Premature babies don’t need to be fed their own mother’s milk exclusively, but even a little greatly reduces ROP and associated conditions such as growth, necrotising enterocolitis (NEC), late-onset sepsis and bronco-pulmonary dysplasia.
Any sign of sepsis: Sepsis and associated NEC promote ROP and should be prevented with the infant’s own mother’s milk when possible and treated aggressively.
Anaemia: Blood transfusions and administration of erythropoietin, which stimulates red blood cell production, are associated with ROP. However, Dr Hellström’s research suggests that the underlying anaemia is the culprit, and preventing and treating it in the first two weeks of life reduce ROP risk. In particular, animal studies show that infusing platelets suppresses production of factors in the retina that promote neovascularisation, e.g. VEGF.
“It is extremely important to prevent and address anaemia in the first two weeks of life,” Dr Hellström stressed.
Ann Hellström: email@example.com