الفهرس 
Retinopathy Of PrematurityOnly 14 pages are availabe for public view
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Abstract
Retinopathy of prematurity (ROP) remains a major cause of childhood blindness in developing countries. As childhood and neonatal mortality in Egypt has shown tremendous improvement over the past two decades, it is expected to encounter an increasing number of cases of blindness from ROP in surviving infants unless strict guidelines and cooperation between different involved departments are explicitly set.
The study aimed to spot on the occurrence of R.O.P among our preterm newborns in addition to studying the beneficial effect of vitamin A and beta-blockers supplementation on ROP if it exists. The study was carried out on 186 preterm newborns of both sexes whom were admitted to NICU, Pediatric department at Menoufia university hospitals fulfilling the inclusion and exclusion criteria. They were divided into 3 groups. The first group included 62 preterm newborns who received vitamin A supplementation -in addition to oxygen therapy- as a daily dose 1500 IU/day in a DROP form added to their enteral feeds as soon as minimal trophic feeding was introduced for 28 days. The second group included 62 preterm newborns who received oral propranolol -in addition to oxygen therapy- in 0.5-1 mg/kg/day in 3 divided doses as soon as minimal trophic feeding was introduced for 28 days followed by gradual withdrawal with serial dose reduction for 5 to 7 days. The third group included 62 preterm newborns on oxygen therapy only.
For all neonates studied, investigations were done at admission [CBC, CRP, Chest x-ray, Arterial blood gases, Liver function test, Kidney function tests and Random blood glucose] in addition to thorough clinical examination.
Also for all neonates studied, fundus examination was implemented twice. The first time was at 2 weeks old age then at 28 days old age according to the recommendations of the examining ophthalmologist.
The prevalence of ROP in this study was 23.6% (44/186). The largest share of the cases with ROP was represented by the ―O2 group‖ (20/44 cases) while the lowest share was for the ―Vitamin A‖ group (10/44 cases). Beta blockers group had the largest share of the most advanced ROP grades among the three studied groups represented by 13 cases as ROP grade 2.
Data of this study suggest that low gestational age, oxygen therapy, blood transfusions and low birth weight are independent risk factors in the development of ROP. Also, the timely retinal screening of high-risk preterm infants is important to prevent the development of advanced ROP.
We also could observe that maintaining infants within the targeted oxygen range is challenging as adhering to that range is difficult. As a result, guidelines for oxygen target ranges need to consider the ability to adhere to goals and need to provide as best as possible a safe range of oxygen target levels that can be reliably used in the practice setting.
In the neonates supplied by 1500 IU/day vitamin A orally, there was a significant decrease in ROP progression through the weeks in comparison to the other studied groups.
Limited evidences of low-to-moderate quality suggest that prophylactic administration of oral beta blockers might reduce progression of ROP and decrease the need of anti-VGEF agents or laser therapy. The results of our study showed that prophylactic oral propranolol (0.5 mg/kg/day) appeared not to be that effective in preventing ROP in premature infants. Propranolol administered too early appears to favor a more aggressive ROP, suggesting that a βadrenoreceptor blockade may be only useful during certain phase of the disease.