Anemia of prematurity. Retinopathy of prematurity - an update on screening and management

anemia of prematurity

Pathophysiology In the normally developing retina, there are no retinal vessels until about 16 weeks of gestation.

Retinal vascularization begins at the optic nerve at 16 weeks of gestational age GA and is completed by 40 weeks GA.

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Preterm infants have incompletely vascularized retinas. ROP is a biphasic disease consisting anemia of prematurity an initial phase of vessel growth cessation and loss followed by a second phase of vessel proliferation. Phase 1 appears from birth to aproximately weeks of postmenstrual age Ovarian cancer obstruction bowel ; concentrations of insulin, like growth factor IGF 1are low and suppresses vascular endothelial growth factor VEGF.

Phase 2 starts at weeks PMA.

Anemia de Prematuritate - Eritropoietina Versus Transfuzii Le de Masă Eritrocitară

Insult and high oxygen exposure released by the hypoxic retina, VEGH are increase and appears retinal neovascularization. Risk factors The most significant risk factor of ROP is extreme prematurity.

Birth characteristics and postnatal risk factors may also lead to the development of ROP. Postnatal risk factors include excessive or fluctuating oxygen levels oxygen monitoring is an important part of the care of anemia of prematurity infantsrespiratory distress, hypercapnia and hypocapnia, exchange transfusion and anemia, sepsis and intrauterine infections, hyperglicemia, prolonged parenteral nutrition, lactic acidosis, low IGF 1 levels, low omega-3 fatty acids, and low energy delivery.

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Total energy was indirectly associated with the risk of ROP. The effect of this nutritional parameters was evident in the anemia of prematurity four postnatal weeks anemia of prematurity.

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  • Anemia de Prematuritate - Eritropoietina Versus Transfuzii Le de Masă Eritrocitară
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Figure 1. A Stage 1: Demarcation line.

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B Stage 2: Ridge. C Stage 3: Ridge with extraretinal fibrovascular proliferation.

Diagnosticul anemiei În prezent, criteriile de diagnostic al anemiei la nou-nascut nu sunt foarte bine stabilite si fundamentate stiintific. Detectarea anemiei semnificative clinic este, în prezent, un domeniu de cercetari active.

D Stage 4A: extrafoveal retinal detachment. E Stage 4B: fovea involving retinal detachment. F Plus disease with dilated and tortuous retinal vessels.

Teza de doctorat prin cercetarea efectuat i propune s analizeze aspecte legate de tratamentul anemiei de prematuritate cu rHuEPO comparativ cu transfuziile de mas eritrocitar, evoluia comparativ a patologiei asociate prematuritii: sindromul de detres respiratorie, bronhodisplazia pulmonar, retinopatia de prematuritate, hemoragiile intraventriculare, leucomalacii, enterocolita ulceronecrotic, precum i scderea numrului de transfuzii i implicit a riscurilor i complicaiilor acestora.

Reproduced with permission from Committee for the Classification of Retinopathy of Prematurity. Stage 2: ridge demarcation line with height and width.

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Stage 3: ridge with extraretinal neurovascularization that extends into the vitreous. Stage 4: substage 4A - extrafoveal retinal detachment.

Stage 5: complete retinal detachement. Diagnosis ROP screening The time of the first examination should be based on menstrual age rather than postnatal age.

The moment for the initial ophtalmologic examina­tion to screen for ROP is based on postmenstrual age for preterm infants of lower gestational age, taking a anemia of prematurity time to develop significant ROP Table 1.

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Guidelines on timing for ROP screening In infants with specific retinal findings, with significant disease, after this initial screening examinations, it is required a careful follow-up 3.

Zone I, stage 1 or 2 ROP. Presence or suspected presence of aggressive posterior ROP.

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Zone I, regressing ROP. Zone 2, stage 2 ROP.

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