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Volume 5
Journal of Pediatric Care
ISSN: 2471-805X
Page 14
April 23-24, 2019 London, UK
&
JOINT EVENT
23
rd
Edition of International Conference on
Neonatology and Perinatology
4
th
International Conference on
Pediatrics and Pediatric Surgery
Neonatology 2019
Pediatrics Surgery 2019
April 23-24, 2019
Clare Gilbert, J Pediatr Care 2019, Volume 5
DOI: 10.21767/2471-805X-C1-020
Clare Gilbert
London School of Hygiene & Tropical Medicine, UK
Update on retinopathy of prematurity
Risk factors, classification and natural history of ROP
:
ROP starts within a fewweeks of birth and can progress rapidly over the following fewweeks or regress spontaneously.The
international classification describes 5 stages, 3 zones and plus disease tortuosity and dilation of retinal blood vessels. Risk
factors for ROP include increasing prematurity, intrauterine fetal growth restriction and a range of postnatal risk factors
including hyperoxia and fluctuating hypo-/hyperoxia, sepsis, failure to gain weight, thrombocytopenia and transfusion
with blood products. Infants who are unstable and who develop necrotising enterocolitis and bronchopulmonary dyplasia
are particularly at risk. Control of these risk factors requires high quality neonatal care from immediately after birth.
Screening for ROP: Which babies, when, where, how and by whom?:
The purpose of screening for ROP is to detect infants who develop the constellation of signs where there is a significant
risk of progression to blinding retinal detachment (i.e., 15% risk, described as Type 1 ROP). Criteria for screening need to
vary depending on the population of babies developing Type 1 ROP: In low and middle income countries wider criteria
are needed than in high income settings. The standard approach to screening entails examination by an ophthalmologist
using an indirect ophthalmoscope; Alternatives include digital imaging with cot-side or remote interpretation of the
images. The first screening episode should start by 4 weeks after birth and subsequent screening is determined by the
findings. At each screening episode a management decision is needed: Discontinue screening; Screen again and when,
or urgent treatment is needed. Screening of inpatients must take place in the neonatal unit; Discharged infants can be
examined in the unit or eye department. Findings and themanagement decisionmust be documented and communicated.
Treatment of ROP: Indications, current uncertainties and follow up
:
Type 1 ROP is the current indication for treatment. Treatment must be delivered within 48-72 hours as the condition can
progress rapidly to retinal detachment. Standard treatment is laser photocoagulation to the avascular peripheral retina,
which gives good resolution in around 90% of cases. Laser treatment can be repeated if necessary. AntiVEGF agents are
being assessed for the treatment of ROP and although they can be effective in the short term, ROP can reoccur many
months later. In addition, there are concerns about the ocular and systemic longer term complications of these agents,
which are currently only recommended as “rescue” treatment when laser is not possible.