Analysis of the effect of intensive therapy of premature infants on the development of neonatal retinopathy

Retinopathy of prematurity is one of the most severe diseases that lead to permanent blindness from early childhood. The frequency of retinopathy of prematurity in neonatology closely correlates with the degree of maturity of the child’s body.

Goal. To conduct a analysis of the correlation of the degree of oxygenation, the number of blood transfusions with the severity of progressive retinopathy in newborns. The study included 40 premature infants diagnosed with retinopathy of newborns who were being treated in the neonatal intensive care unit. Conducted: clinical and diagnostic examination of patients; analysis of the dependence of the degree of oxygenation, the number of blood transfusions, gestational age, inotropic support and the severity of retinopathy.

Materials and methods. Out of 40 patients diagnosed with neonatal retinopathy, 6 children were operated on.

Results and discussion. The study showed that all the operated children were born at a gestation period of less than 29 weeks, were treated with antibacterial and inotropic drugs. There was no direct relationship between the number of blood transfusions and the risk of developing a severe form of the disease with further surgical treatment. In 40% of cases, children who developed retinopathy of stages 1 and 2 did not receive transfusion of erythrocyte suspension at all. At the treatment stage, all operated patients received a gas-air mixture with an oxygen content above 45%, as well as inotropic and vasopressor support with epinephrine and norepinephrine. Statistical analysis has shown that the number of blood transfusions is not the leading factor in the decision to refer a child for surgery. Among children with a gestation period of less than 29 weeks, retinopathy of varying severity was found in all infants; in the group of children aged 30–35 weeks, the disease developed only in 45% of patients.

Conclusion. The conducted studies have shown that the parameter number of hours spent using IVL (the parameter artificial lung ventilation) is informative, and parameters such as weight and gestational age are significant.

It is necessary to note the importance of additional parameters. Among the operated children, the condition of severe asphyxia was suffered by 45.5% of children in group A, in Weight groups severe asphyxia was in 28% of cases. Statistical analysis showed that children who required surgical treatment received catecholamine therapy at the initial stages. The most unfavorable percentage of oxygen supplied with the air mixture starts from 40–45%. The children who required surgical treatment received catecholamine therapy at the initial stages.

1. Neonatologiya: Uchebn. posobie: V 2 t. / N.P. Shabalov. T. I. 3-e izd., ispr. i dop. M.: MED-press-inform, 2004. 608 s.: il. [In Russ.].

2. Simahodskij A.S., Gorelik YU.V., Gorelik K.D., Ivanov S.L., Lukashova YU.V. Smertnost’ detej, rodivshihsya na rannih srokah gestacii,– nepreodolimyj bar’er ili rezerv snizheniya mladencheskoj smertnosti? Voprosy sovremennoj pediatrii. 2020; (19): 340–345. [In Russ.]. https://doi.org/10.15690/vsp.v19i5.2209

3. Dem’yanova T.G., Grigor’yanc L.YA., Avdeeva T. G., Rumyancev A. G. Nablyudenie za gluboko nedonoshennymi det’mi na pervom godu zhizni. Minzdravsocrazvitiya RF. M.: Medpraktika-M, 2006. 148 s. [In Russ.].

4. Polin I., Yoder R.A. Practical Neonatology. 2007; 500.

5. Hughes S., Yang H., Chan-Ling T. Vascularization of the human fetal retina: roles of vasculogenesis and angiogenesis. Invest. Ophthalmol. Vis. Sci. 2000; (41): 1217–28.

6. Penn J.S., Madan A., Caldwell R.B., Bartoli M., Caldwell R.W., Hartnett M.E. Vascular Endothelial Growth Factor in Eye Disease. Progress in retinal and eye research. 2008; (27): 331–371. https://doi.org/10.1016/j.preteyeres.2008.05.001

7. Ponomareva M.N., Pochinok E.M., Fomina E.V., Ashihmina E.P., Alekina V.N., Golubeva A.M., Bedash K.I., Luntovskaya P.A. Osobennosti oftal’mologicheskogo statusa i faktory riska u pacientov s retinopatiej nedonoshennyh. Medicinskaya nauka i obrazovanie Urala. 2021; (22): 67–70. [In Russ.]. https://doi.org/1036361/1814-8999-2021-22-3-67-70

8. Volodin N. N., Avetisov S. E., Sidorenko E. I. Aksenova I. I., Astasheva I. B., Ahmadeeva E. N., Bajbarina E.N. Principy rannej diagnostiki, profilaktiki i lecheniya retinopatii u nedonoshennyh detej. Metodicheskie rekomendacii. Voprosy prakticheskoj pediatrii. 2006; (1): 20–26 [In Russian].

9. Tereshchenko A.V., Chuhrayov A.M. Sovremennye aspekty diagnostiki, lecheniya i organizacii vysokotekhnologichnoj oftal’mologicheskoj pomoshchi detyam s aktivnymi stadiyami retinopatii nedonoshennyh. OOO «Izdatel’stvo «Oftal’mologiya», FGAU «MNTK «Mikrohirurgiya glaza» im. akad. S.N. Fedorova» Minzdrava Rossii, 2016. 234 c. [In Russ.].

10. Gariano R.F., Hu D., Helms J. Expression of angiogenesis-related genes during retinal development. Gene Expr Patterns. 2006; (6): 187–92. https://doi.org/10.1016/j.modgep.2005.06.008

11. West H., Richardson W.D., Fruttiger M. Stabilization of the retinal vascular network by reciprocal feedback between blood vessels and astrocytes Development. 2005; (132): 1855–62. https://doi.org/10.1242/dev.01732

12. Loskutova V.E., Sidorenko E.E., Nazarenko A.O i dr. Preimushchestva anti-VEGF terapii pri retinopatii nedonoshennyh. Quantum Satis. 2021; (4): 15–18. [In Russ.].