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Screening for retinopathy of prematurity after surfactant treatment
D Brunner-Di Pietro1, E Bossi, F Koerner
1Universitäts-Kinderklinik, Inselspital, Bern, Switzerland.
Insights
Surfactant treatment for premature infants does not increase the risk of severe retinopathy of prematurity (ROP). The safety index (SI) helps identify infants at low risk, reducing the need for intensive ophthalmological follow-up.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Pediatric Respiratory Care
Background:
- Surfactant administration in premature infants can alter tissue oxygenation, potentially influencing retinopathy of prematurity (ROP) risk.
- Two surfactant preparations, natural (Curosurf) and synthetic (Exosurf), were compared in this study.
- The safety index (SI) was utilized to assess ROP risk post-surfactant administration.
Purpose of the Study:
- To evaluate the impact of surfactant administration on the risk of developing severe retinopathy of prematurity (ROP) in premature infants.
- To assess the utility of the safety index (SI) in predicting ROP risk and guiding ophthalmological follow-up.
- To compare the effects of natural versus synthetic surfactant on ROP development.
Main Methods:
- A retrospective study of 255 premature infants (< or = 2000 g birth weight) treated with surfactant for respiratory distress syndrome between 1991 and 1993 in Switzerland.
- Infants received either natural surfactant (Curosurf, n=29) or synthetic surfactant (Exosurf, n=226).
- The safety index (SI) was calculated for each infant to determine ROP risk (SI >= 1 indicating low risk).
Main Results:
- A significant reduction in fraction inspired oxygen (FiO2) was observed within 3-6 hours post-surfactant, more pronounced with natural surfactant.
- Among infants treated with Exosurf, 47% had an SI >= 1, with only one developing ROP stage 3. Conversely, 12 infants with ROP stages 3-4 had an SI < 1.
- In the natural surfactant group, 7 infants had an SI >= 1, and none developed ROP beyond stage 2. The SI was useful in reducing the number of infants requiring intensive ophthalmological follow-up.
Conclusions:
- Surfactant therapy in premature infants does not appear to increase the risk of severe retinopathy of prematurity (ROP).
- The safety index (SI) is a valuable tool for identifying premature infants at low risk for severe ROP, aiding in the reduction of unnecessary ophthalmological surveillance.
- Both natural and synthetic surfactants led to significant oxygenation improvements, with natural surfactant showing a more pronounced effect.
Abstract:
Surfactant administration in premature infants is supposed to induce rapid changes in tissue oxygenation. It might therefore modify the risk of developing retinopathy of prematurity (ROP). We have been using the so-called safety index [equation see text] to calculate the number of infants at low risk to develop ROP stage 3 or higher (SI > or = 1) after administration of two preparations of a surfactant. The study population consisted of 255 prematures of < or = 2000 g birth weight treated with surfactant for respiratory distress syndrome in Switzerland between 1991 and 1993. Of these infants, 29 received a natural surfactant (Curosurf), and 226 infants were treated with the synthetic surfactant Exosurf. Reduction of fraction inspired oxygen (FiO2) was significant within 3 and 6 h and was more pronounced in infants having received natural surfactant. An SI > or = 1 was calculated in 106 of the 226 infants (47%) treated with Exosurf. Only one of these infants developed ROP stage 3 in one eye (no ROP in the fellow eye) whereas 12 infants with ROP stages 3 or 4 had an SI < 1. Seven of the 29 infants treated with natural surfactant had an SI > or = 1; none of these infants developed ROP > stage 2. According to this survey, the risk of developing severe stages of ROP does not increase in low birth weight infants who have been treated with surfactant. Irrespective of a surfactant therapy, the calculation of the SI is useful for substantially reducing the number of prematures who need intensive ophthalmological follow up.