Search Results (133)

Objectives: Myopia of prematurity (MOP) is a refractive error occurring in individuals born prematurely and is considered a distinct entity from pathologic and school-age myopia. Children affected by MOP are at risk of developing high myopia, with an increased lifelong cumulative risk of related complications. The aim of this study was to evaluate the progression of MOP in children previously affected by retinopathy of prematurity (ROP) who wore spectacles with Highly Aspherical Lenslet Target (HALT) technology compared to conventional single-vision lenses during childhood. Methods: Enrolled subjects were divided into two groups: subjects who used HALT lenses for at least 12 months and children who used standard single-vision lenses for the same period. The temporal evolution of spherical equivalent (SE) and axial length (AL) was evaluated in both groups. Results: Of the 252 preterm children screened, 58 were included in the study: 38 subjects (66%) in the standard lenses group and 20 subjects (34%) in the HALT lenses group. At 12 months SE progression and AL elongation in the HALT group (−0.32 ± 0.20 D and 0.12 ± 0.05 mm) were lower compared to the standard group (−0.93 ± 0.34 D and 0.46 ± 0.09 mm, p < 0.0001). Conclusions: The progression of MOP appears to be reduced in subjects corrected with HALT lenses compared to those wearing conventional lenses. These results suggest further investigation of HALT technology in selected subgroups of patients at high-risk of severe myopia to reduce its progression and the related lifelong cumulative risk of visual impairment. Full article

Background and Objectives: Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness, with its severity influenced by a complex interaction between nutritional status, metabolic maturation, and systemic vulnerability. This study aimed to evaluate whether early nutritional patterns and serum metabolic parameters, including hepatic and renal biomarkers, are associated with ROP severity and whether they may serve as potential predictors of disease progression. Materials and Methods: We conducted a retrospective study on 140 preterm infants, totaling 280 eyes, admitted between 2021 and 2024 in two neonatal intensive care units (NICU). Each eye was analyzed independently according to International Classification of Retinopathy of Prematurity (ICROP) criteria. Data on the timing of enteral feeding, duration and type of nutrition, and serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, blood glucose, urea and creatinine were collected throughout the first 28 days of life. Statistical analysis included Kruskal–Wallis and Chi-square tests, with a significance threshold of p < 0.05. Results: ROP was identified in 53.57% of cases. Enteral feeding began earlier in infants without ROP, whereas delayed initiation and prolonged parenteral nutrition were associated with more advanced stages. Natural feeding decreased with increasing severity and was absent in aggressive retinopathy of prematurity (A-ROP). Severe disease stages showed higher AST, ALT, urea and creatinine levels, along with lower early total protein values. Glycemic instability was observed more frequently in stage 2 and stage 3. Conclusions: Early nutritional support, especially early enteral feeding and natural feeding, appears protective against ROP progression. Hepatic, renal and glycemic metabolic changes are closely correlated with disease severity, indicating that metabolic balance reflects overall vulnerability in preterm infants. Incorporating nutritional and metabolic assessment into routine screening may enhance early risk identification and optimize clinical monitoring. Full article

Introduction: Primary Cytomegalovirus (CMV) infection occurs in 0.7–4.1% of all pregnancies. Our study aims to analyze the incidence rate of ultrasound anomalies, as well as CMV PCR analysis of the amniotic fluid sample obtained from amniocentesis in CMV-infected pregnancies, as well as the outcome of the pregnancies and neonatal follow-up. Methods: We analyzed cases of recent maternal CMV infections confirmed by serological testing at the Department of Obstetrics and Gynecology, Semmelweis University, between 2001 and 2023. In cases of primary CMV infection confirmed by serological testing during pregnancy, we offered amniocentesis at the genetic counseling, which was performed at the 20–21 weeks stage of the pregnancy. Results: In 130 cases of recent maternal CMV infection confirmed by serological testing, amniocentesis was performed, and a total of 11 cases (8.46%) were found to have CMV DNA in the amniotic fluid. Based on the neonatological follow-up examinations in 116 deliveries, 18 newborns had complications (15.52%); however, some cases were associated with multiple complications, resulting in a total of 33 types of complications being identified (28.45%). Among the 11 neurological complications (9.48%), we found 1 case each (0.86%) of severe inoperable intracranial space occupation, hydrocephalus, balance disorder, sleep disorder–sleep apnea, and speech development disorder. Two cases (1.72%) were found to have rigid muscles, epilepsy, and hypotonic muscles. Ophthalmological complications occurred in five cases (4.31%), such as enophthalmos, cataract, and retinopathy of prematurity (ROP), one case each, and two cases of strabism. Other complications were detected in 17 cases (14.66%). Conclusions: Because of the high incidence rate of recent CMV infection, serological testing is recommended following fetal abnormality detected by ultrasound. If a serologically confirmed new infection is diagnosed, the affected couple should be offered amniocentesis. Full article

Dysregulation of angiogenesis can cause a disruption in oxygen and nutrient delivery, resulting in impaired neural retinal function. Understanding the underlying components involved in its pathophysiology is essential to develop new treatments for preserving and restoring vision. The aim of this review is to describe the role of angiogenesis in different retinal and choroidal pathologies and evaluate current and emerging anti-angiogenic therapies for retinopathies. Current research articles, focusing on the latest clinical trials from the last two decades, were used to write this review. We discuss normal angiogenesis, in contrast to pathological angiogenesis, in four diseases: retinal vein occlusion (RVO), age-related macular degeneration (AMD), diabetic retinopathy (DR), and retinopathy of prematurity (ROP). Alongside these diseases, this review discusses relevant anti-angiogenic therapies that have been approved for use and are under active investigation through clinical trials for their safety and efficacy. Full article

Objectives: The aim of this study was to determine which color imaging facilitated easier detection of the persistent avascular retina (PAR) in ultra-widefield (UWF) fundus imaging in children undergoing retinopathy of prematurity (ROP). Methods: A total of 20 eyes of 10 children aged between 6 and 9 who underwent diagnostic and therapeutic procedures for ROP were included. Fundus images were obtained using Optos confocal scanning laser ophthalmoscopy (cSLO; Optos PLC, Daytona, Dunfermline, UK). The images were divided and recorded into three groups as original imaging (composite), red reflectance imaging, and green reflectance imaging. These images were prepared as a slideshow for 10 ophthalmology specialists and they were surveyed to determine in which color imaging the peripheral avascular area was more easily detected. The results were evaluated. Results: The rate of detecting the PAR in green reflectance imaging by the participants included in the study was found to be statistically higher compared to other colors of imaging (composite 0.63 ± 0.09 (0.5–0.8), red 0.12 ± 0.05 (0.05–0.2), and green 0.94 ± 0.06 (0.85–1), p < 0.0001). All respondents reported that the boundaries of the peripheral avascular area were more clearly defined in the UWF (Optos PLC, Daytona, Dunfermline, UK) green reflectance imaging. Conclusions: Each color imaging used in UWF fundus imaging helps to visualize different layers of the retina. Our study showed that retinal vascular endings appear more distinct due to the lower penetration of the green laser into the choroidal vessels. Based on these findings, we believe that UWF fundus green reflectance imaging is more useful for detecting and monitoring PAR. Full article

Objective: The aim of this study was to assess the efficacy of laser photocoagulation (LPC) combined with anti-vascular endothelial growth factor (VEGF), in comparison with routine LPC monotherapy, in the treatment of retinopathy of prematurity (ROP). Methods: This retrospective study included data from 142 eyes treated according to the standard criteria of the Early Treatment for Retinopathy of Prematurity (ETROP). Group A patients had received LPC alone, and Group B had received anti-VEGF therapy followed by routine LPC. Group B was further categorized into two subgroups: Groups B1 and B2 had received bevacizumab and ranibizumab, respectively. Data collected included ROP stage, gestational week, postmenstrual week, birth weight, number of laser spots and sessions. Results: Group B required significantly fewer laser spots than was the case with Group A (Group A: 583.0 ± 350.72, Group B: 274.9 ± 124.77, p < 0.0001). The number of LPC sessions differed significantly between the groups (Group A: 1.8 ± 1.28, Group B: 1.2 ± 0.45, p = 0.0003). Conclusions: Combining anti-VEGF therapy with routine LPC reduced the number of laser spots required. This approach offers an effective treatment strategy for managing severe ROP, potentially reducing long-term complications associated with extensive laser use. Full article

Objective: We aimed to determine the incidence and screening outcomes of retinopathy of prematurity (ROP) in preterm infants managed at a tertiary neonatal intensive care unit (NICU) and to identify associated risk factors. Material and Methods: Medical records of 454 premature infants who underwent ROP screening between April 2016 and August 2021 were retrospectively analyzed. Infants with birth weight (BW) ≤ 1500 g or ≤32 weeks of gestational age and those with BW > 1500 g or GA > 32 weeks who had an unstable clinical course were included. All of them were born in the same center. Demographic characteristics, potential risk factors for ROP, ocular examination findings, and treatment requirement were recorded. Results: During the five-year study period, ROP was observed in 75 (16.6%) of a total of 454 premature infants with a mean gestational age (GA) of 30.19 ± 2.49 weeks and a mean BW of 2025.15 ± 614.46 g in the NICU. Of these patients, 67 (14.8%) had stage I disease and 8 (1.8%) had stage II disease. Advanced-stage ROP was not detected in any of the cases. The median GA of patients diagnosed with ROP was 29 weeks (22–35) and the median BW was 2100 g (500–3750), which were significantly lower than those without ROP (p < 0.001). When multivariate logistic regression analysis was evaluated with the Wald method, the accuracy rate of the model examining the combined effect of GA, intraventricular hemorrhage (IVH), respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and surfactant treatment was 85.9%. In this model, gestational age (OR: 0.712, p < 0.001), IVH (OR: 2.915, p = 0.010), RDS (OR: 2.129, p = 0.004), NEC (OR: 3.679, p < 0.001), PDA (OR: 2.434, p = 0.021), and surfactant treatment (OR: 2.271, p = 0.002) were found to be independent risk factors for ROP development. Conclusions: Small GA and low BW are the main risk factors for the development of ROP. The incidence of ROP was found to be lower than similar studies conducted in our country. While severe ROP cases have been reported in more mature infants in Turkey, our study found no treatment-requiring ROP cases, likely reflecting the higher mean GA and BW characteristics of our cohort. Full article

Introduction: Fetal Inflammatory Response Syndrome (FIRS) is widely acknowledged for its contribution to neonatal morbidity in premature infants. Being a systemic inflammatory process triggered by intrauterine infections or other stimuli, FIRS has gained significant attention due to its complex implications for neonatal adverse outcomes: preterm birth, early onset neonatal sepsis, death or long-term neurodevelopmental impairments. Fetal plasma Interleukin-6 (IL-6) levels above 11 pg/mL define FIRS and serve as an essential biomarker, providing insights into the complex mechanisms underlying this response. This study aims to evaluate the clinical, laboratory, and therapeutic differences between preterm neonates with and without FIRS. Methods: A prospective cohort study was conducted, involving 125 preterm neonates with gestational ages between 23 and 37 weeks, who were admitted to the Neonatal Intensive Care Unit (NICU) at the Emergency University Hospital Bucharest between April 2023 and April 2025. Infants were stratified into FIRS and non-FIRS groups based on the measurement of cord blood IL-6 levels greater than 11 pg/mL. Demographic, biochemical, and therapeutic parameters were compared across the two groups. Results: Preterm neonates with FIRS had significantly lower birth weight, length, and head circumference, and lower Apgar scores at 1 and 5 min (p = 0.001). FIRS was associated with a higher incidence of vaginal delivery, meconium-stained amniotic fluid, and neonatal metabolic imbalances, requiring more respiratory support, longer antibiotic treatment periods, and more blood transfusions (p < 0.05). Neonatal complications such as early-onset sepsis (EOS) and late-onset sepsis (LOS), respiratory distress, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP) were significantly more frequent in the FIRS group (p ≤ 0.01). Among maternal cervical screening, Chlamydia trachomatis was the only pathogen significantly associated with FIRS. Conclusions: FIRS in preterm neonates is linked to important perinatal inflammation, adverse short and long-term outcomes, and extensive medical intervention. These findings highlight the value of early identification of intrauterine inflammation and targeted neonatal monitoring strategies. Further studies are needed to explore long-term outcomes and improve diagnostic and therapeutic protocols. Full article

Background and Objectives: Retinopathy of prematurity (ROP) persists as a major global cause of preventable childhood blindness. While early diagnosis and timely intervention can significantly mitigate visual loss, research is increasingly focused on identifying novel prognostic factors, with hematological markers emerging as a promising avenue for refining ROP risk prediction. This study aimed to assess the association of hemoglobin levels, red blood cell count, platelet count, and blood transfusions with the risk of developing ROP. Materials and Methods: We conducted a retrospective study involving 140 preterm infants (gestational age ≤ 34 weeks) admitted to a neonatal intensive care unit between 2021 and 2024. Hematological parameters were monitored sequentially during the first 28 days of life, and ROP screening was performed in accordance with international guidelines. Statistical analyses evaluated associations between hematological markers and the risk of developing ROP. Results: Anemia prevalence was significantly higher in infants who developed ROP (83.1%) compared with those who did not (60.3%), conferring an increased risk of ROP (OR = 3.239; p = 0.001). Red blood cell transfusions were linked to a higher likelihood of developing ROP (OR = 3.088; p = 0.001), while platelet transfusions showed a similar association (OR = 2.807; p = 0.027). Platelet counts were significantly lower on days 7, 14, and 21 in the ROP group, and thrombocytopenia was associated with an elevated risk of disease (OR = 3.542; p = 0.001). Conclusions: Early hematological imbalances (anemia, thrombocytopenia) and the requirement for blood product transfusions are significantly associated with an increased risk of ROP. Integrating the monitoring of these specific parameters into existing ROP screening protocols could enhance early identification of vulnerable preterm infants, enabling more targeted surveillance and potential preventative strategies. Full article

Aim: We aimed to investigate the incidence, treatment patterns, and associated risk factors of type 1 retinopathy of prematurity (ROP) in the only tertiary-level Neonatal Intensive Care Unit (NICU) in Cyprus. Methods: This retrospective study included all infants screened for ROP between January and December 2023. Data were collected from standardized NICU discharge summaries and included gestational age (GA), birth weight (BW), multiple birth, systemic infection, blood transfusion, oxygen therapy, surgical interventions, and ROP outcomes. Infants were categorized into non-ROP, non-type 1 ROP, and type 1 ROP groups. Statistical analysis was performed to identify differences in risk factor distribution. Results: Among 183 infants, 33 (18.0%) developed ROP, with 11 (6.0%) requiring treatment for type 1 ROP. All infants with type 1 ROP were born at ≤28 weeks GA and weighed <1501 g. Type 1 ROP was significantly associated with lower GA, lower BW, systemic infection, surgery, and prolonged oxygen support (p < 0.05). Six infants were treated with laser and three with intravitreal bevacizumab. No recurrence was observed in the anti-VEGF group during 18 months of follow-up. Two infants with aggressive ROP died before treatment. Conclusions: Type 1 ROP in Cyprus occurred exclusively in extremely preterm infants, associated with the cumulative effect of multiple risk factors. Laser remained the primary treatment, while anti-VEGF was used selectively with favorable outcomes. This study emphasizes the importance of tailoring ROP screening and treatment strategies based on individual neonatal risk profiles, supporting a personalized approach to neonatal ophthalmic care. Full article

Background and Objectives: Neonatal respiratory distress syndrome (NRDS), resulting from a deficiency of pulmonary surfactant (PS), can cause alveoli to collapse. Glucocorticoids reduce inflammation and are effective in reducing pulmonary swelling. This study aims to assess the effectiveness of the combination of PS and budesonide in the management of NRDS. Materials and Methods: Publications between 21 May and 24 November were screened through PubMed, Cochrane and Embase. Data analysis was performed on RevMan 5.3 software. Subgroup analysis was performed to evaluate the routes of administrations. Results: The use of budesonide along with pulmonary surfactant for treating NRDS revealed the following results: (1) a reduced duration of invasive mechanical ventilation (standardized mean difference (SMD) = −1.06, 95% confidence interval (CI) = −1.55 to −0.56, p < 0.0001); (2) reduced rate of bronchopulmonary dysplasia (BPD) occurrence (relative risk (RR) = 0.72, 95% CI = 0.60 to 0.86, p = 0.0003); (3) reduced duration for hospital admittance (SMD = −0.38, 95% CI = −0.64 to −0.11, p = 0.005). The occurrence of complications, i.e., sepsis, pneumothorax, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), rate of mortality, hyperglycemia and intraventricular hemorrhage (IVH), was not significantly different among the intervention and comparison group except for patent ductus arteriosus (PDA) and pulmonary hemorrhage, with their incidence being higher in the control group (p = 0.002 and p = 0.05, respectively). Conclusions: The combination of pulmonary surfactant and budesonide decreases the occurrence of BPD, duration of mechanical ventilation, length of hospital stay and risk of pulmonary hemorrhage and PDA. It does not increase the risk of complications and death and is clinically safe. Full article

Background/Objective: We sought to address ongoing gaps in understanding the relationship between first-week percent maximal weight loss (MWL) and average first-week total fluid intake (TFI), enteral intake, and parenteral intake among premature newborns with adverse in-hospital outcomes born in low- and middle-income countries (LMICs). Methods: We evaluated newborns born <34 weeks gestation or <1500 g who survived at least 7 days at the St. Paul’s Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit in Ethiopia. We performed univariate and multivariate regression models analyzing the first-week MWL, average TFI, parenteral, and enteral intake and their relationships with adverse in-hospital outcomes. Results: Among N = 490 moderately and very preterm newborns, multivariate regression models demonstrated that >13% MWL was associated with significantly increased odds of suspected necrotizing enterocolitis (NEC), culture-positive sepsis, retinopathy of prematurity (ROP), and a longer length of stay (LOS). An average enteral intake of >60 mL/kg/day was significantly associated with reduced odds of all-cause mortality, suspected NEC, culture-positive sepsis, ROP, and a shorter LOS, whereas an average parenteral intake of >60 mL/kg/day was associated with increased odds of in-hospital mortality, culture-positive sepsis, ROP, and a longer LOS. Conclusions: In moderately and very preterm neonates in an LMIC setting, >13% MWL is associated with adverse health outcomes. Increasing the average parenteral intake over the first week after birth among moderately and very preterm neonates is significantly associated with adverse in-hospital outcomes whereas increasing the average enteral intake is associated with improved outcomes. Full article

Purpose: To review the current literature on the combined use of cataract surgery (or lensectomy) and vitrectomy in pediatric patients, with a focus on clinical indications, surgical techniques, outcomes, and complications across various pediatric ocular pathologies. Methods: A narrative review of published studies addressing the use of combined lensectomy and vitrectomy (LV) in pediatric patients was conducted. Conditions discussed include congenital cataracts, ectopia lentis, retinopathy of prematurity (ROP), retinal detachment (RD), and persistent fetal vasculature (PFV). Key surgical considerations, visual and anatomical outcomes, and postoperative complications were examined. Results: The literature search yielded a total of 160 articles, of which 43 met the inclusion criteria and were included in this review. Although lens-sparing vitrectomy (LSV) is preferred in many pediatric cases to preserve accommodation and reduce complications, combined LV is often necessary in advanced or complex diseases. Studies have shown that combined LV can achieve favorable anatomical outcomes, but functional visual recovery remains variable and is affected by factors such as patient age, baseline ocular anatomy, and disease severity. Postoperative complications such as glaucoma, visual axis opacification (VAO), and intraocular lens (IOL) dislocation are more frequent with combined procedures and require long-term follow-up and rehabilitation. Conclusions: Combined cataract surgery (or lensectomy) and vitrectomy may represent a valuable strategy in the management of complex pediatric ocular conditions, particularly when individualized to the clinical context. Tailored surgical approaches are essential to optimize anatomic and functional outcomes. Further prospective studies and harmonized multicenter registries are needed to develop evidence-based principles that can guide individualized surgical decision-making in this unique patient population. Full article

Background/Objectives: Retinopathy of prematurity (ROP) is a significant cause of childhood blindness, particularly among preterm infants. Patent ductus arteriosus (PDA) is commonly observed in neonates and may contribute to the development of ROP through increased oxygen delivery to the retina. However, the association between PDA and the severity of ROP remains unclear. This study aims to evaluate the relationship between PDA and the development of treatment-requiring ROP in preterm infants. Methods: A retrospective cohort study was conducted on preterm infants born between 2014 and 2020 at Izmir Private Medical Park Hospital. Infants with a birth weight of less than 2000 g and a gestational age of ≤36 + 6 weeks were included. Data on demographics, prematurity-related complications, PDA status, ROP severity, and treatment requirements were collected. Statistical analysis was performed using univariate and multivariate logistic regression models to identify predictors of ROP. Results: Of 516 infants, 328 did not have PDA, 117 had spontaneous PDA closure, and 71 required PDA treatment. Neonates requiring PDA treatment had significantly lower gestational age and birth weight, as well as longer respiratory support duration. PDA presence was associated with increased ROP incidence in univariate analysis (p < 0.001); however, it was not an independent predictor of treatment-requiring ROP in multivariate models. Significant predictors for treatment-requiring ROP included longer non-invasive ventilation duration (OR = 1.029) and total respiratory support (OR = 1.009). Conclusions: The findings of this study highlight the central role of respiratory morbidity in ROP pathogenesis and suggest that optimal respiratory management may be more critical for ROP prevention than PDA treatment alone. Full article

The complications observed in preterm infants are largely attributable to underdeveloped organ systems and inadequate nutritional stores at birth. Insufficient nutritional support can further exacerbate persistent sequelae, such as bronchopulmonary dysplasia (BPD), metabolic bone disease of prematurity (MBDP), and retinopathy of prematurity (ROP). As a result, clinicians have collaborated to develop optimal nutrition strategies for preterm neonates. However, these clinical nutrition plans may be hindered by several factors, including fluid restrictions due to patent ductus arteriosus (PDA) and delayed enteral nutrition following necrotizing enterocolitis (NEC). Modified strategies for specific conditions can help prevent further deterioration, but inadequate nutritional support may limit organ growth and contribute to additional complications. Achieving an optimal balance between nutritional support and managing specific medical conditions varies across institutions. In addition to fluid balance and energy intake, supplementary nutrition—such as vitamins and probiotics—plays a crucial role in disease prevention. Drawing on recent evidence and our clinical experiences with neonatal nutritional strategies, this review article summarizes the specialized nutritional management required for preterm neonates with conditions such as BPD, NEC, MBDP, PDA, and ROP. Full article