Medical risk factors and ways to reduce frequency and severity of retinopathy of prematurity in perinatal center modern conditions. Experience of the V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthcare of the Russian Federation
AbstractAim of the study was to determine the frequency of retinopathy of prematurity and to assess the effect of ROP certain risk factors in conditions of level III B perinatal center.
Material and methods. 1003 premature infants data from the ROP risk group with gestational age (GA) of 2434 weeks (mean GA - 31.27±0.06 weeks) and 450-2240 g body weight (mean birth weight - 1603.08±13.65 g) were included in the study. For greater certainty of the most significant risk factors effect two groups of children were examined: with and without ROP. 1 group consisted of 146 children with ROP, average GA at birth 28.35±0.16 weeks and mean birth weight 1058±24.7 g. Group 2 included 233 children without ROP (average GA at birth 30.3±0.08 weeks, mean birth weight 1363±23.9 g). Exclusion criteria was GA 32 weeks or more and/or birth weight 2000 g or more.
All the children were born in V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthсаre of the Russian Federation and from the first minutes of life they required to conduct initial resuscitation procedures. After delivery room stabilization children were transferred to V.I. Kulakov Obstetrics, Gynecology and Perinatology Research Center of Ministry of Healthсаre of the Russian Federation neonatal resuscitation and intensive care unit (NICU), where they carried out a standard intensive treatment. The governing principle of respiratory therapy was maintenance of threshold of transition from one type of respiratory therapy to a higher level. Threshold is excess of oxygen non-toxic concentrations (30-40%). Target saturation level corridor was 90-95%. Examination of the eye carried out by ophthalmologists has been made according to the Order of the Ministry of Health of the Russian Federation dd. 25.10.2012 N 442n.
Results. ROP was diagnosed in 150 (15%) children. laser photocoagulation was performed in 12 (8%) children, induced regression was 99%, retinal detachment after laser treatment was observed in 2 children in 3 eyes (1%). Aggressive posterior ROP did not developed. When comparing two groups of children (with and without ROP) the authors obtained following results: children from the 1 group had AlV in 76% of cases, children from the 1 group had AlV in 42.5% of cases (p<0.01). AlV mean duration was 238.1±54.8 hours in group 1, and 31.24±12.6 hours in group 2 (p<0.01). Average duration of CPAP in group 1 was 176±12.4 h, and 81.3±2.5 hours in group 2 (p<0.01). Total duration of respiratory support was 1326.5±11.3 hours in group 1, 105.89±44.1 hours in group 2 (p<0.01). Apnea was in 78.8% cases in group 1, and in 12% in group 2 (p<0.01), the frequency of oxygen saturation drop was 72.6% in group 1 and 32.2% in group 2 (p<0.01). Blood transfusions in group 1 was made on 71% cases and in 15.4% cases in group 2. Retransfusions in group 1 was made in 65% of cases, and were not carried out in group 2 (p<0.01). The average length of stay in the NICU was 38.6±6.2 days of life for group 1, and 15.7±3.2 days of life for group 2 (p<0.01).
Conclusions. ROP frequency was 15%, laser photocoagulation frequency - 8% (for all children with ROP), retinal detachment frequency was 1%. ROP and its severe forms relatively low frequency is associated with child's location in perinatal center at all stages of nursing, and lack of transportation to other hospitals, as well as strictly systematic approach to respiratory therapy implementation in NICU. Blood oxygen saturation drop (desaturation episodes) and repeated apneas, severe congenital infection, which leads to long-term ventilator support, repeated packed red cell transfusions contribute to the ROP development.
Keywords:abruptio placentae, cause of death, early neonatal mortality