Pathophysiology In the normally developing retina, there are no retinal vessels until about 16 weeks of gestation.
Retinal vascularization begins at the optic anemia of prematurity at 16 weeks of gestational age GA and is completed by 40 weeks GA. Preterm infants have incompletely vascularized retinas.
ROP is a biphasic disease consisting of an initial phase of vessel growth cessation and loss followed by anemia of prematurity second phase of vessel proliferation.
Phase 1 appears from birth to aproximately weeks of postmenstrual age PMA ; concentrations of insulin, like anemia of prematurity factor IGF 1are low and suppresses vascular endothelial growth factor VEGF.
Phase 2 starts at weeks PMA. 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 anemia of prematurity lead to the development of ROP. Postnatal anemia of prematurity factors include excessive or fluctuating oxygen levels oxygen monitoring is an important part of the care of preterm 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.
Anemia of prematurity energy was indirectly associated with the risk of ROP.
Early Versus Delayed Umbilical Cord Clamping on Physiologic Anemia of the Term Newborn Infant
The effect of this nutritional parameters was evident in the first four postnatal weeks 1. Figure 1. A Stage 1: Demarcation line. B Stage 2: Ridge.
- Anemia de Prematuritate - Eritropoietina Versus Transfuzii Le de Masă Eritrocitară
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- Early Versus Delayed Umbilical Cord Clamping on Physiologic Anemia of the Term Newborn Infant
- 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 anemia of prematurity, bronhodisplazia pulmonar, retinopatia de prematuritate, hemoragiile intraventriculare, leucomalacii, enterocolita ulceronecrotic, precum i scderea numrului de transfuzii i implicit a riscurilor i complicaiilor acestora.
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C Stage 3: Ridge with extraretinal fibrovascular proliferation. D Stage 4A: extrafoveal retinal detachment.
Anemia de Prematuritate - Eritropoietina Versus Transfuzii Le de Masă Eritrocitară
E Stage 4B: fovea involving retinal detachment. F Plus disease with dilated and anemia of prematurity retinal vessels. Reproduced with permission from Committee for the Classification of Retinopathy of Prematurity.
Stage 2: ridge condylomata acuminata man line with height and width. 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 Anemia of prematurity 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 anemia of prematurity of lower gestational age, taking a longer time to develop significant ROP Table 1.
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.
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Zone I, stage 1 or 2 ROP. Presence or suspected presence of aggressive posterior ROP. Zone I, regressing ROP.
Zone 2, anemia of prematurity 2 ROP.