OBJECTIVES: To study new biomarkers for the early diagnosis of retinopathy of prematurity (ROP) by analyzing the differences in blood metabolites based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) and metabolomics. METHODS: Dried blood spots were collected from 21 infants with ROP (ROP group) and 21 infants without ROP (non-ROP group) who were hospitalized in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2013 to December 2016. LC-MS/MS was used to measure the metabolites, and orthogonal partial least squares-discriminant analysis was used to search for differentially expressed metabolites and biomarkers. RESULTS: There was a significant difference in blood metabolic profiles between the ROP and non-ROP groups. The pattern recognition analysis, Score-plot, and weight analysis obtained 10 amino acids with a relatively large difference. Further statistical analysis showed that the ROP group had significant increases in blood levels of glutamic acid, leucine, aspartic acid, ornithine, and glycine compared with the non-ROP group (P<0.05). The receiver operating characteristic curve analysis showed that glutamic acid and ornithine had the highest value in diagnosing ROP. CONCLUSIONS Blood metabolites in preterm infants with ROP are different from those without ROP. Glutamic acid and ornithine are the metabolic markers for diagnosing ROP. LC-MS/MS combined with metabolomics analysis has a potential application value in the early identification and diagnosis of ROP.
Infant, Newborn ; Infant ; Humans ; Tandem Mass Spectrometry ; Infant, Premature ; Chromatography, Liquid ; Retinopathy of Prematurity/diagnosis* ; Glutamic Acid ; Ornithine

PURPOSE: To investigate the risk factors for retinopathy of prematurity (ROP) requiring laser treatment in preterm infants born before a gestational age (GA) of 28 weeks. METHODS: This was a single-institution retrospective case-control study of high-risk preterm infants (GA ≤28 weeks) with ROP who were, born between January 2008 and December 2016. Patients who underwent laser treatment for severe ROP were enrolled. Infants in the control group were matched to preterm infants with a similar GA and mild ROP who, did not require laser treatment. Various prenatal and postnatal risk factors were compared between the two groups. RESULTS: One hundred and twenty-two infants were included in this study (61 cases and 61 controls). The average birth weight was similar between the two groups (895.2±172.9 g vs. 938.5±168.0 g, P=0.164). There was no significant difference in the duration of invasive ventilation; however, the duration of noninvasive mechanical ventilation was significantly longer in patients (with ROP) who underwent laser treatment (P=0.036). The proportion of infants at a postnatal age of 28 days who were receiving oxygen treatment was significantly higher (60/61 [98.4%] vs. 51/61 [83.6%], P=0.004) in the severe ROP group. However, the rates of oxygen treatment for infants with a GA of 36 weeks were not significantly different (59%, for both groups). Other prematurity-associated morbidities were similar between the two groups. CONCLUSION: Altogether, a judicious reduction of oxygen therapy might reduce the incidence of laser treatment. Early diagnosis and treatment through periodic ophthalmologic examination are necessary in preterm infants receiving oxygen treatment at 28 days after birth.
Birth Weight ; Case-Control Studies ; Early Diagnosis ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Oxygen ; Parturition ; Pregnancy ; Respiration, Artificial ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors ; Ventilation

PURPOSE: To identify risk factors that affect the development of type 2 retinopathy of prematurity (ROP) and progression to type 1 or threshold ROP requiring treatment. METHODS: The medical records of premature infants born with a birth weight ≤1,500 g or a gestational age ≤32 weeks were retrospectively reviewed. Potential risk factors were divided into systemic and ophthalmic factors and analyzed by univariate and multivariate logistic regression analyses. RESULTS: Three hundred and twenty-four eyes met the screening criteria. Among them, 41 eyes (12.65%) progressed to type 2 ROP and 21 eyes (6.48%) received treatment after progression to type 1 or threshold ROP. The systemic risk factor associated with progression from type 2 ROP was periventricular leukomalacia and the ophthalmic factor was the existence of nasal ROP at the time of diagnosis of type 2 ROP. CONCLUSIONS: Careful examination was needed when type 2 ROP with periventricular leukomalacia or nasal ROP developed because there was a high probability of progression and treatment.
Birth Weight ; Diagnosis ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular ; Logistic Models ; Mass Screening ; Medical Records ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors

PURPOSE: The purpose of this study was to identify the risk factors for developmental delays in preterm infants. METHODS: We studied 151 preterm infants admitted to the neonatal intensive care unit (NICU) at the Hallym University Kangnam Sacred Heart Hospital from January 2013 to November 2016. After discharge, the infants were evaluated by a pediatric neurologist via the developmental screening test K-ASQ:SE II, which consists of five domains: communication (CC), gross motor (GM), fine motor (FM), problem solving (PS), and social-emotional (SE). The subjects were divided into a normal group and an abnormal group (abnormal results on at least one of the five domains). Several variables were compared between the two groups and risk factors for developmental delays were analyzed. RESULTS: Several factors, such as birth weight (BW), gestational age (GA), Apgar score at 1 and 5 min (AS1, AS5), hospital days (HDs), respiratory distress syndrome (RDS), chronic lung diseases, intraventricular hemorrhage (IVH), early sepsis, retinopathy of prematurity (ROP), and history of management of invasive ventilators, dexamethasone, anti-hypotensive, were significantly different between the normal and abnormal groups. BW was a risk factor for developmental delay according to the binary logistic regression analysis. On individual domain analysis, risk factors were lower GA for domains CC and FM, lower AS1 for GM domain, lower BW for PS domain, and longer HDs for SE domain. CONCLUSION: In preterm infants, regular developmental screening especially follow-up observation, is important for early detection of developmental delay, considering the risk factors, such as GA (≤30 weeks), BW (≤1,500 g), low AS1, and long HDs, which may be helpful in the early diagnosis of developmental delay.
Apgar Score ; Birth Weight ; Dexamethasone ; Early Diagnosis ; Follow-Up Studies ; Gestational Age ; Heart ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Logistic Models ; Lung Diseases ; Mass Screening* ; Problem Solving ; Retinopathy of Prematurity ; Risk Factors* ; Sepsis ; Ventilators, Mechanical

PURPOSE: To design software with a novel algorithm, which analyzes the tortuosity and vascular dilatation in fundal images of retinopathy of prematurity (ROP) patients with an acceptable accuracy for detecting plus disease. METHODS: Eighty-seven well-focused fundal images taken with RetCam were classified to three groups of plus, non-plus, and pre-plus by agreement between three ROP experts. Automated algorithms in this study were designed based on two methods: the curvature measure and distance transform for assessment of tortuosity and vascular dilatation, respectively as two major parameters of plus disease detection. RESULTS: Thirty-eight plus, 12 pre-plus, and 37 non-plus images, which were classified by three experts, were tested by an automated algorithm and software evaluated the correct grouping of images in comparison to expert voting with three different classifiers, k-nearest neighbor, support vector machine and multilayer perceptron network. The plus, pre-plus, and non-plus images were analyzed with 72.3%, 83.7%, and 84.4% accuracy, respectively. CONCLUSIONS: The new automated algorithm used in this pilot scheme for diagnosis and screening of patients with plus ROP has acceptable accuracy. With more improvements, it may become particularly useful, especially in centers without a skilled person in the ROP field.
Diagnosis ; Dilatation ; Humans ; Mass Screening ; Neural Networks (Computer) ; Politics ; Retinopathy of Prematurity ; Support Vector Machine ; Telemedicine

Humans ; Infant, Newborn ; Neonatal Abstinence Syndrome ; complications ; diagnosis ; Retinopathy of Prematurity ; complications ; diagnosis

OBJECTIVETo analyze the clinical features and prognosis of extremely low birth weight infants (ELBWI).

METHODData of totally 165 hospitalized ELBWI between August 1st, 2008 and November 30th, 2013 in Hunan Children's Hospital were analyzed. The information of general data and births, prenatal care, delivery room stabilization, transfer information, complications, treatment, outcome and follow up were summarized.

RESULT(1) One hundred and sixty-five ELBWI were involved, their mean gestational age was (28.4±2.4) weeks, mean birth weight(910.9±93.1) g. (2) Rate of delivery in tertiary hospital was 46.7% (77/165) and prenatal steroids exposure was found in 52.1% (86/165). None of the cases were treated with continuous positive airway pressure (CPAP) in delivery room. (3) Rate of infants who were transfered to the class III b neonatal ward within 12 hours after birth was 58.8% (97/165). (4) The main complications of them included neonatal respiratory distress syndrome(NRDS, 77.0%, 127/165), bronchopulmonary dysplasia (BPD, 70.1%, 75/107), patent ductus arteriosus (PDA, 50.0%, 40/80), preterm retinopathy (ROP, 43.0%, 46/107), sepsis 39.4% (65/165), intraventricular hemorrhage (IVH, 34.8%, 49/141), necrotizing enterocolitis (NEC, 8.0%, 7/88). (5) TREATMENT: 97.6% (161/165) received oxygen therapy and 66.1% (109/165) received mechanical ventilation, 55.2% (91/165) used CPAP. 89.8% (114/127) of the NRDS used PS; 44.0% (33/75) of the BPD used low dose dexamethasone, 32.0% (24/75) used low dose nitric oxide; 60.0% (24/40) of the PDA used medication. 32.6% (15/46) of the ROP received laser photocoagulation. The average time of beginning enteral feeding was 2.0 d, the mean time to achieve full gastrointestinal feeding was 43.4 d. (6) OUTCOME: rate of survival in 165 cases with ELBWI was 51.5% (85/165), treatment was abandoned in 37.6% (62/165), total mortality was 48.5% (80/165). There were significant difference in survival rate between different birth weight group, gestational age group and admission age group (χ2=11.498, 8.789, 13.157, all P<0.05); There was significant difference in rate of giving up treatment between different birth weight and admission age groups (χ2=10.448, 8.259, all P<0.05). The primary cause of death was economic factor and worrying about prognosis. (7) Follow up: rate of neurodevelopmental impairment (NDI) in part of follow up cases was 27.9% (12/43).

CONCLUSIONELBWI have many severe complications and sequelae, which need complex treatment and long hospital stay with a low survival rate. In order to improve the level of treatment, we need to improve the rate of prenatal steroids, carry out intrauterine and postnatal, transport of ELBWI to III b neonatal ward as early and rationally as possible, give professional, sophisticated and integrated treatment technologies as far as possible.

Birth Weight ; Bronchopulmonary Dysplasia ; diagnosis ; therapy ; Cerebral Hemorrhage ; diagnosis ; therapy ; China ; epidemiology ; Dexamethasone ; therapeutic use ; Ductus Arteriosus, Patent ; diagnosis ; therapy ; Enterocolitis, Necrotizing ; diagnosis ; therapy ; Gestational Age ; Humans ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; therapy ; Prognosis ; Respiratory Distress Syndrome, Newborn ; diagnosis ; therapy ; Retinopathy of Prematurity ; diagnosis ; therapy ; Sepsis ; diagnosis ; therapy ; Survival Rate ; Treatment Outcome

OBJECTIVETo determine the prevalence and risk factors of retinal diseases of preterm infants and full term for newborns small gestational age born (SGA) by using wide-angle digital retinal imaging system (RetCam3).

METHODSClinical data of 779 preterm and SGA infants whose eyes were detected by RetCam3 between January and December 2013 before discharge were studied retrospectively.

RESULTSAmong the 779 infants, there were 69 cases of retinal hemorrhage (8.9%), 10 cases (1.3%) of retinopathy of prematurity (ROP), 9 cases of retinal exudative changes, 4 cases of retinal myelinated nerve fibers, 2 cases of congenita cataract, 3 cases of retinal chromatosis, 2 cases of retinal crystalline changes and 1 case of retinoblastoma. Logistic regression analysis indicated that low birth weight and gestational age and the history of oxygen inhalation were risk factors for the development of ROP and that vaginal delivery and mechanical ventilation increased the risk of retinal hemorrhage.

CONCLUSIONSNeonatal fundus diseases may be so various and harmful that early fundus screening should be carried out on high-risk infants, such as preterm and SAG infants. Preventive measures should be taken against the risk factors for fundus diseases.

Birth Weight ; Female ; Fundus Oculi ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Neonatal Screening ; Retinal Hemorrhage ; diagnosis ; etiology ; Retinopathy of Prematurity ; diagnosis ; etiology ; Risk Factors

A 6-year-old boy was referred to our hospital with symblepharon and lateral canthal deformity in both eyes, which developed 6 years ago. The patient was born at 27 weeks gestation. He had received cryotherapy for retinopathy of prematurity. One month after cryotherapy, he developed a conjunctival scar with symblepharon in both eyes and underwent symblepharon lysis at another hospital 5 years prior. Ocular examination revealed an extensive conjunctival hypertrophic scar with symblepharon and limitation of extraocular movements. An excisional biopsy, lateral canthoplasty, and symblepharon lysis with conjunctival autograft from the contralateral eye were performed in the left eye. Histopathologic examination revealed diffuse proliferation and infiltration of collagenous tissue.
Biopsy ; Child ; Cicatrix, Hypertrophic/diagnosis/*etiology ; Conjunctiva/pathology ; Conjunctival Diseases/diagnosis/*etiology ; Cryotherapy/*adverse effects ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Male ; Retinopathy of Prematurity/*therapy

Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Male ; Retinal Telangiectasis ; diagnosis ; therapy ; Retinopathy of Prematurity ; diagnosis