ROP Prevention Strategy

[JACK]

I assume like other big NICUs out there with decreasing mortality of preterms (especially the extreme preterms), the incidence of ROP continues to increase...with some cases progressing to threshold disease requiring laser photocoagulation.

Though ROP seems to be more prevalent in our extreme preterms with CLD (Chronic Lung Disease) - (anecdotal opinion), we also have plenty of preterms who had a short ventilation with quick weaning and a relatively smooth course who also ended up developing threshold ROP.

Our main ROP prevention strategy aims at oxygen therapy - avoidance of exposure to high SpO2.

I wanted to know how my colleagues in other NICUs around the world are minimizing ROP incidence in their NICU graduates. What strategy other than evidence based oxygen therapy are they trying in their NICUs ?

[sudershan.kumari]

we have a marked reduction in rop in preterm nicu graduates over last 10 years Earlier it was noted that rop was associated with oxygen use, blood transfusions,and sepsis specially fungal. With policy of keeping oxygen use to a minimum , reduction of blood transfusions and infection control measure the incidence wea significantly reduced.

[JACK]

I agree with you sudershan.kumari regarding the effect of good infection control and decrease in ROP. Even we have noticed that when fungal sepsis incidence decreases, ROP prevalence also decreases. Is it a direct effect or secondary to sepsis prolonging ventilation and oxygen exposure, I am not sure. (There are some published studies Ref05 Ref06 Ref07 Ref08 Ref09 Ref10

Regarding minimizing blood transfusion and its effect on reducing ROP incidence, I thank you for raising this point. I think so long as no harm is proven from restrictive blood transfusion policy, this could be another addition to ROP minimizing strategy.

( Ref01 Ref2 Ref03 Ref04 Ref05 )

[m.jahanshahifard]

Hi, if we use ferrous sulfate since 15 days old +vit E , then we do not need use erythropoietin in preterm baby. Erythropoietin increase possibility of ROP.

[JACK]

Relevant here:

http://www.ncbi.nlm.nih.gov/pubmed/21303729

http://content.karger.com/produktedb/produkte.asp?DOI=000322848&typ=pdf