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Modifiable Risk Factors and Preventative Strategies for Severe Retinopathy of Prematurity
Minali Prasad1, Ellen C Ingolfsland2, Stephen P Christiansen3
1Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA.
Insights
Severe retinopathy of prematurity (ROP) is linked to modifiable factors like oxygen levels, infections, blood transfusions, and poor weight gain. Early intervention and preventative strategies are crucial for reducing ROP risks in preterm infants.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Perinatal Health
Background:
- Severe retinopathy of prematurity (ROP) involves retinal fibrovascular proliferation and potential detachment.
- Identifying modifiable risk factors is crucial for preventing severe ROP.
Purpose of the Study:
- To review five common, well-studied perinatal and neonatal modifiable risk factors for severe ROP.
- To discuss potential preventative strategies for severe ROP.
Main Methods:
- Literature review of established and emerging risk factors for severe ROP.
- Analysis of associations between perinatal/neonatal conditions and ROP severity.
Main Results:
- Hyperoxemia, hypoxia, prolonged respiratory support, maternal chorioamnionitis, neonatal sepsis, red blood cell transfusions, and poor postnatal weight gain are linked to severe ROP.
- Limited evidence supports caffeine, human milk, and vitamins A/E for ROP prevention.
Conclusions:
- Several perinatal and neonatal factors significantly increase the risk of severe ROP.
- Further research is needed to establish effective preventative strategies for ROP.
Abstract:
Severe ROP is characterized by the development of retinal fibrovascular proliferation that may progress to retinal detachment. The purpose of this report is to review five of the most common and well-studied perinatal and neonatal modifiable risk factors for the development of severe ROP. Hyperoxemia, hypoxia, and associated prolonged respiratory support are linked to the development of severe ROP. While there is a well-established association between clinical maternal chorioamnionitis and severe ROP, there is greater variability between histologic chorioamnionitis and severe ROP. Neonatal sepsis, including both bacterial and fungal subtypes, are independent predictors of severe ROP in preterm infants. Although there is limited evidence related to platelet transfusions, the risk of severe ROP increases with the number and volume of red blood cell transfusions. Poor postnatal weight gain within the first six weeks of life is also strongly tied to the development of severe ROP. We also discuss preventative strategies that may reduce the risk of severe ROP. Limited evidence-based studies exist regarding the protective effects of caffeine, human milk, and vitamins A and E.
