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Ernesto Valdes MD, Guest Contributer
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Retinopathy of Prematurity
THE INCIDENCE AND COURSE OF
RETINOPATHY OF PREMATURITY: FINDINGS FROM THE EARLY TREATMENT FOR RETINOPATHY OF
PREMATURITY STUDY. PEDIATRICS Vol.116 No.1 July 2005, pages 15-23. From
The Smith-Kettlewell Eye Research Institute, San Francisco, California
Early Treatment for Retinopathy of Prematurity Cooperative Group
Objective: To estimate the
incidence of ROP in the Early Treatment for Retinopathy of Prematurity (ETROP)
Study and compare these results with those reported in the Cryotherapy for
Retinopathy of Prematurity (CRYO-ROP) Study.
Methods: The ETROP Study, as part of its protocol,
screened 6998 infants at 26 centers throughout the U.S.. Serial eye examinations
were conducted for infants born weighing < 1251 g., making it possible to
estimate the frequency of ROP in different birth weight and gestational age
categories. ROP was categorized according to the International Classification
for ROP.
Results: The incidence of any ROP was 68% among infants
of < 1251g. (VON’s incidence is 57.2%) The findings were compared with those
for infants born in 1986-1987 in the CRYOP-ROP Study.
The overall incidence of ROP was similar in the 2 studies, but there was more zone 1 ROP in the ETROP Study. Among infants with ROP, more severe ROP (prethreshold) occurred for 36.9% of infants in the ETROP Study and 27.1% of infants in the CRYOP-ROP Study.
The gestational age of onset of
ROP of different severities has changed very little since the CRYOP-ROP Study
was conducted.
Conclusion: ROP remains a common important problem among
infants with birth weights of <1251g. The incidence of ROP, time of onset, rate
of progression and time of onset of prethreshold disease have changed little
since the CRYOP-ROP natural history study.
Comments: It is interesting to note that despite our advances in neonatal care over the last 15-20 years, the incidence of ROP has not changed. Yet our patients keep on getting smaller! EV.
Date: 20 Mar 2006
Time: 03:42:28
D-penicillamine (DPA) was first recognized as a potential benefit for ROP by our
team of Hungarian neonatologists. Over an 7 year period(1973-1979) we had
studied the use of DPA in treating neonatal hyperbilirubinemia. During this
time, we noticed a remarcable low incidence of ROP in the prematures treated
with DPA. In the 1980's we published a series of articles in the Hungarian
literature including two randomimzed trials. A Cochrane review of the data in
1998 said that there was "clearly sufficient evidence to justify further
investigation". Now, we greatly appreciate a pilot trial conducted by
Christensen et al. which has beeen published in the Journal of Perinatology.
This work can be considered as the first international replication of our
observtion and clinical trials. They recognized no immediate intolerance of the
prepared solution of penicillamine given by nasogastric tube nor did they
observe any evidence of renal, hematologic, or hepatic toxicity in their five
patients approved by the FDA. The authors suggest that trials testing enteral
3-mercapto-D-valine (DPA) as a means of reducing ROP should go forward.
UserName: Lajos Lakatos MD, Zsuzsanna Vekerdy MD, György Balla, György
Oroszlan MD
Institution: Department of Pediatrics, Kenezy Hospital Debrecen, Hungary
telephone: 36-52-511-760
email: lakatosl@kenezykorhaz.hu
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