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[Retrolental fibroplasia--a preventable disease? (author's transl)]
Insights
Retrolental fibroplasia affects premature infants due to oxygen therapy. Managing oxygen levels and considering Vitamin E can help prevent this serious eye condition in newborns.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Pediatric critical care
Context:
- Retrolental fibroplasia (RLF) is a significant cause of blindness in premature infants.
- The highest risk period is between 28 and 40 weeks of gestation due to immature retinal vascularization.
- Oxygen administration is a primary cause, linked to concentration and duration.
Purpose:
- To identify risk factors for Retrolental Fibroplasia in premature infants.
- To discuss optimal oxygen management strategies and preventative measures.
- To highlight the importance of ophthalmoscopic screening for at-risk neonates.
Summary:
- High incidence of RLF in premature infants is associated with oxygen therapy, severe apnea, and blood transfusions.
- Recommended oxygen levels (Preductal PaO2 60-70 mm Hg) require careful monitoring.
- Vitamin E (25 mg) is suggested for prevention, alongside vigilant ophthalmoscopy schedules.
Impact:
- Informing neonatal intensive care protocols to reduce RLF incidence.
- Guiding clinical practice for safer oxygen administration in premature neonates.
- Emphasizing the role of early detection and intervention in preventing infant blindness.
Abstract:
Retrolental Fibroplasia has a high incidence in premature infants of low gestational age. The most susceptible period for developing retrolental fibroplasia is the immature vascularisation of the retina during the 28th to 40th gestational week. The disease is caused by the direct effect of oxygen administration. Retrolental fibroplasia is associated with the concentration of oxygen administered and the length of time in supplemental oxygen. There is also a significant association between its development and severe apnea requiring bag and mask resuscitation maintaining ambient oxygen concentration during the procedure. Furthermore there is an association between retrolental fibroplasia and the amount of adult blood transfused. Infants with these factors are at high risk to develop retrolental fibroplasia. Preductal PaO2-level should be kept between 60 and 70 mm Hg and supervised by continuous transcutaneous readings. There is some concern about intermittent arterial sampling. Problems of interpreting PaO2-analyses are discussed. 25 mg Vitamin E are recommended for prevention. There are many management protocols and techniques during neonatal intensive care of premature infants for prevention of the disease. Premature infants at risk should have a close time schedule for ophthalmoscopy.