cardiovascular-agents and Retinopathy-of-Prematurity

Retinopathy of Prematurity (ROP) is a preventable neovascular retinal disease with a lifetime impact on vision and ocular morbidities. Retinal vessel immaturity and oxygen therapy, influenced or modulated by several risk factors including oxidative stress, intermittent hypoxia and desaturations, inflammation, infection, malnutrition, retinal growth factor deficiencies or excesses, and others are determinant factors of pathologic retinal angiogenesis and ROP. These factors are pharmacologic targets for prevention and/or rescue therapy. These drugs, include intravitreal anti-vascular endothelial growth factor drugs, erythropoietin, ocular propranolol, caffeine, antioxidants, insulin-like growth factor-I, and omega 3 poly-unsaturated fatty acids, and are promising therapies to prevent ROP, but require further studies. Topical ocular non-steroidal anti-inflammatory drugs (NSAIDs) target inflammatory cascade but the best, safest, and most effective ocular NSAID and formulation remain to be developed. Timing of drug intervention appears critical. Moreover, the complex interactions of the various pathophysiologic mechanisms resulting in aberrant angiogenesis thence ROP strongly suggest that drug combinations and synergisms may be required for effective prevention of ROP and a lifetime of blindness.

Topics: Anti-Inflammatory Agents; Antioxidants; Cardiovascular Agents; Drug Administration Schedule; Humans; Infant, Newborn; Infant, Premature; Intercellular Signaling Peptides and Proteins; Purinergic P1 Receptor Antagonists; Retinopathy of Prematurity; Risk Factors

Extremely preterm infants are peculiar in regard to their risk of retinopathy of prematurity (ROP). In this study, we aim to study insults that may affect extremely preterm infants, including prenatal, at birth, and postnatal insults and their effect on the development of ROP.. This study used the data from Prematurity and Respiratory Outcomes Program (PROP). All included infants with a gestational age of 23 0/7 to 28 6/7 weeks using best obstetrical estimate. We included stressful events and/or modifiable variables that may affect the normal development. We used multiple regression analysis in our statistical analysis.. We included a total of 751 infants in our study. The mean birth weight for the included sample was 915.1 (±232.94) grams. 391 (52.1%) Infants were diagnosed with ROP. We found a significant negative correlation between ROP development and birth weight (p < 0.001), with a correlation coefficient of - 0.374. We found that the need for prophylactic indomethacin (OR 1.67), the occurrence of air leaks (OR: 2.35), ventilator-associated pneumonia (OR: 2.01), isolated bowel perforations (OR: 3.7), blood culture-proven sepsis (OR: 1.5), other infections (OR: 1.44), and receiving ventricular shunt (OR: 2.9) are significantly associated with the development of ROP.. We believe this study included the largest number of factors studied in the largest sample of extremely premature infants. We recommend a screening program for extremely preterm infants that takes into account a scoring system with higher scores for complicated condition.

Topics: Birth Weight; Cardiovascular Agents; Cellulitis; Cerebrospinal Fluid Shunts; Continuous Positive Airway Pressure; Ductus Arteriosus, Patent; Embolism, Air; Female; Humans; Indomethacin; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Intestinal Perforation; Male; Mediastinal Emphysema; Meningitis; Neonatal Sepsis; Pneumonia, Ventilator-Associated; Pneumopericardium; Pneumoperitoneum; Pneumothorax; Protective Factors; Retinopathy of Prematurity; Subcutaneous Emphysema; Urinary Tract Infections