School of Medicine and Health Sciences Poster Presentations
Neonatal Intensive Care Unit (NICU) Management during Treatment for Type 1 Retinopathy of Prematurity and Eye Outcomes
Poster Number
182
Document Type
Poster
Publication Date
3-2016
Abstract
Introduction: Retinopathy of prematurity (ROP) is caused by abnormal retinal blood vessel development in premature infants and requires treatment of severe Type 1 disease to prevent ophthalmic complications such as scarring, retinal detachment, and blindness. However, even with treatment, many become blind or are affected by myopia, strabismus, or visual impairment. Currently, there are no published guidelines for NICU medical management during laser treatment for Type 1 ROP. The purpose of this study was to evaluate NICU care during ROP laser treatment and determine eye outcomes associated with treatment circumstances in order to better prevent medical and ophthalmic complications.
Methods: We historically reviewed neonates with Type 1 ROP treated between January 2009 and June 2015 at Children’s National Medical Center (CNMC) which is a Level IV NICU.1 For infants receiving their first laser treatment at CNMC, we assessed demographics, intubation requirements, treatment duration, median time to return to respiratory and feeding baselines, and eye outcomes at ≥6 months of follow-up. Incidence of grade 3 or 4 intraventricular hemorrhage (IVH), hydrocephalus, sepsis anytime prior to treatment, necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD) were noted as indicators of medical disease burden.
Results: Of the 51 infants reviewed, 2 were excluded due to first treatments at other hospitals. Six others were excluded because they received anti-VEGF injection as ROP treatment. For the 43 infants treated with laser, mean age at treatment was 37.0±2.7 weeks (range 32.0-42.4), gestational age was 24.1±1.6 weeks, and birth weight was 684.5±284.7g. Incidence of sepsis anytime prior to the procedure was high at 88% (38), with BPD at 86% (37), NEC at 42% (18), and grade 3 or 4 IVH at 23% (10). Nine infants (21%) were intubated at baseline (base-ETI), 10 (23%) were electively intubated before laser (elect-ETI), 3 (7%) required urgent intubation during treatment due to respiratory distress (urg-ETI), and 21 (49%) received no intubation (no-ETI). Treatment duration for no-ETI was shorter (0.8 hours) than all intubated groups (base-ET 1.0, pre-ET 1.4, urg-ETI 2.0). Return to respiratory and feeding baselines were markedly prolonged for elect-ETI at median 90.0 hours and 75.0 hours, respectively, compared to base-ETI (16.8, 3.0), urg-ETI (51.7, 30.0), and no-ETI (11.0, 5.9) (Figures 1 and 2). Eye outcomes included macular scar (14%), retinal detachment (8%), legal blindness (17%), and strabismus (28%) with elect-ETI having poorest outcomes (20%, 30%, 40%, 40%, respectively).
Discussion: For extremely low-birth-weight infants with Type 1 ROP, elect-ETI prolonged return to respiratory and feeding baselines, and eye outcomes were poorest for this group. In contrast, urg-ETI was associated with shorter return to baselines despite increased procedure duration. Given these surprising findings, there may be cause to avoid elective intubation for laser treatment when neonates are stable as longer ventilation can lead to respiratory morbidity and delayed feeding in this population of infants with an already high disease burden.
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Open Access
1
Neonatal Intensive Care Unit (NICU) Management during Treatment for Type 1 Retinopathy of Prematurity and Eye Outcomes
Introduction: Retinopathy of prematurity (ROP) is caused by abnormal retinal blood vessel development in premature infants and requires treatment of severe Type 1 disease to prevent ophthalmic complications such as scarring, retinal detachment, and blindness. However, even with treatment, many become blind or are affected by myopia, strabismus, or visual impairment. Currently, there are no published guidelines for NICU medical management during laser treatment for Type 1 ROP. The purpose of this study was to evaluate NICU care during ROP laser treatment and determine eye outcomes associated with treatment circumstances in order to better prevent medical and ophthalmic complications.
Methods: We historically reviewed neonates with Type 1 ROP treated between January 2009 and June 2015 at Children’s National Medical Center (CNMC) which is a Level IV NICU.1 For infants receiving their first laser treatment at CNMC, we assessed demographics, intubation requirements, treatment duration, median time to return to respiratory and feeding baselines, and eye outcomes at ≥6 months of follow-up. Incidence of grade 3 or 4 intraventricular hemorrhage (IVH), hydrocephalus, sepsis anytime prior to treatment, necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD) were noted as indicators of medical disease burden.
Results: Of the 51 infants reviewed, 2 were excluded due to first treatments at other hospitals. Six others were excluded because they received anti-VEGF injection as ROP treatment. For the 43 infants treated with laser, mean age at treatment was 37.0±2.7 weeks (range 32.0-42.4), gestational age was 24.1±1.6 weeks, and birth weight was 684.5±284.7g. Incidence of sepsis anytime prior to the procedure was high at 88% (38), with BPD at 86% (37), NEC at 42% (18), and grade 3 or 4 IVH at 23% (10). Nine infants (21%) were intubated at baseline (base-ETI), 10 (23%) were electively intubated before laser (elect-ETI), 3 (7%) required urgent intubation during treatment due to respiratory distress (urg-ETI), and 21 (49%) received no intubation (no-ETI). Treatment duration for no-ETI was shorter (0.8 hours) than all intubated groups (base-ET 1.0, pre-ET 1.4, urg-ETI 2.0). Return to respiratory and feeding baselines were markedly prolonged for elect-ETI at median 90.0 hours and 75.0 hours, respectively, compared to base-ETI (16.8, 3.0), urg-ETI (51.7, 30.0), and no-ETI (11.0, 5.9) (Figures 1 and 2). Eye outcomes included macular scar (14%), retinal detachment (8%), legal blindness (17%), and strabismus (28%) with elect-ETI having poorest outcomes (20%, 30%, 40%, 40%, respectively).
Discussion: For extremely low-birth-weight infants with Type 1 ROP, elect-ETI prolonged return to respiratory and feeding baselines, and eye outcomes were poorest for this group. In contrast, urg-ETI was associated with shorter return to baselines despite increased procedure duration. Given these surprising findings, there may be cause to avoid elective intubation for laser treatment when neonates are stable as longer ventilation can lead to respiratory morbidity and delayed feeding in this population of infants with an already high disease burden.
Comments
Presented at: GW Research Days 2016